By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

FACTS CAN HELP MEN OVERCOME STIGMA OF HAVING A “FEMALE DISEASE”

Question: A male friend of mine was just diagnosed with breast cancer. I didn’t know men could get this too. Should men have regular tests, like mammograms? How common is this?

Answer: Men can get breast cancer as you have just found out, but it is far less common in men than in women. About 100 women are diagnosed with breast cancer for every man that is diagnosed. It is estimated that slightly over 2,000 men will be diagnosed with breast cancer in the U.S. and 450 will die from it this year.
Men obviously have much less breast tissue than women. This is one factor in their reduced risk; another is their lower level of estrogen production. The lack of awareness that men can get breast cancer is a risk factor in itself. Usually when a man is diagnosed with breast cancer, the disease has spread.
This was the case with former U.S. Senator Edward Brooke of Massachusetts, whose cancer had spread to nearby lymph nodes before it was diagnosed in 2003. For several months he had ignored the initial symptoms and passed off the discomfort in his right breast as simply muscle strain or the affects of aging. Then his wife felt a lump under his nipple and pressured him to see a doctor.
When Sen. Brooke was diagnosed, his first reaction was complete surprise that men could even get breast cancer. Once he had undergone the surgery, Sen. Brooke had a great deal of difficulty telling anyone -- even other members of his own family -- about his diagnosis and treatment. This is very typical of male breast cancer patients, because of the stigma associated with having what is generally considered a “female disease.” Eventually, though, Sen. Brooke was able to overcome his reticent attitude, and has become an active spokesman for raising male breast cancer awareness.
Several risk factors have been identified that increase a man’s likelihood of developing breast cancer. The biggest of these is longevity. The average age at time of diagnosis is between 60 and 70. As with women, having a family member with breast cancer, either male or female, increases a man’s risk. Other risk factors include exposure to radiation in the chest area -- especially if it occurred early in life and a rare genetic condition called Klinefelter’s syndrome.
Finally, being overweight and having a chronic liver disorder can also make a man more prone to breast cancer. That’s because both of these can raise a man’s estrogen level.
The signs of male breast cancer are similar to those in women. A lump in the chest area, changes in the nipple, dimples or puckered skin around the breast area, redness or scaling of the nipple or breast skin, and discharge from the nipple are all signs that should send a man to his doctor.
If a lump is found or malignancy is suspected, a man will undergo the same tests as a woman -- history and physical exam, mammography, and possibly a biopsy. Treatment for breast cancer is determined by the type of cancer as well as the stage of the cancer at diagnosis. Generally treatment involves surgery, chemotherapy, radiation treatment and hormone therapy.
As with any cancer, early diagnosis allows for the best outcome. Men should learn from Sen. Brooke’s experience and not ignore changes in the chest area that could signal breast cancer.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.