As a breast cancer surgeon who has seen more male breast cancer patients the last several years than most surgeons see in their entire career, I hear it far too often: "I didn't do anything because I just didn't think it could be anything."
For women, the possibility of a lump in the breast is very real, and very scary. We hear the drumbeat calling attention to the issue for women on the news, in the papers, on the internet, and during the entirety of Breast Cancer Awareness month throughout October every year. Women are appropriately aware of the fact that a new finding in the breast needs to be evaluated by their doctor. But for men, all too many are unaware of the fact that male breast cancer is not only possible, but now affects about 2,600 men in the United States alone.
Although, a man's likelihood of surviving a breast cancer is as good as a woman's odds of beating the disease, men are typically diagnosed at a later stage. This means that they are diagnosed when the disease is more severe. Too many men don't realize that the lump they have many not just be "man boobs" (or as we say in medicine: gynecomastia) after all.
We are starting to learn a little bit more about breast cancer in men, but because the disease occurs far less frequently in men than in women, it is much harder for researchers to do studies, and our knowledge remains lacking.
Although we are still trying to determine what puts a man at risk for the disease, we know two things. The first is that about 15% of the men diagnosed with breast cancer have a genetic mutation in their BRCA gene – a gene that we all have. Certain mutations in that gene put both men and women at higher risk of developing breast cancer. The second is that the risk of a man developing breast cancer is not related to his testosterone, DHT, androstenedione, and other hormone levels, but is related to his estradiol level. High estradiol levels in men seem to correlate with a higher risk of developing the disease, as they do in women. The risk of men having breast cancer is so rare overall, however, we don't screen everyone for these genes or routinely evaluate hormone levels.
So what should men be aware of, and what should they do if they find a lump?
- It is critical to know that any lump that is new in the breast or in the armpit and that remains present for more than a few weeks can be a cancer.
- If you have a family history of breast and/or ovarian cancer, see your doctor for a discussion about your potential risk. Specific patterns of family history might suggest you are at risk to have a gene mutation that predisposes you to developing breast cancer.
- Don't be complacent and don't wait. Any new finding that persists more than a few weeks should be brought to a doctor's attention.
- If you do need to be evaluated, find a breast cancer specialist who is very familiar with the disease and treats a lot of it.
- If you are seen for evaluation, and are either unhappy with your evaluation, find that your questions are not satisfactorily answered, or concerns dismissed with little explanation, seek a second opinion.
And always remember: we usually regret the things we don't do more than the things we decide to do. Knowledge is power, so seek evaluation. The worst that can happen is that you find out there is nothing to worry about.
Richard J. Bleicher, is a breast surgeon and associate professor in the Department of Surgical Oncology at the Fox Chase Cancer Center.