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Male Breast Cancer and the Dilemma of Delayed Diagnosis
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Why are men more likely to discover their breast cancer later than women?
In preparation for writing this piece I posted an informal survey on a male breast cancer Facebook page and on my Twitter account. I asked men how they first discovered that they had breast cancer. Did they find it and seek help on their own, or was it a friend, family member, spouse or partner who urged them to seek help? A number of my fellow survivors and some others who assisted them in the process of identifying their cancer responded, and I'll share that information later in this writing.
I consider myself to be one of the "lucky ones" with breast cancer. Although the cancer in my left breast was an aggressive form of the disease with a grade 3 designation, my official diagnosis after sentinel lymph node surgery was stage 1.
But it was a series of fortunate, random occurrences — none of which I was aware of at the time – that ultimately got me a favorable diagnosis. Had these circumstances not aligned perfectly to wave the red flag that alerted my doctors, I most certainly would have waited to have that tiny bump below my breast checked out. I would have rationalized it as a meaningless inflammation that active, healthy men get as part of aging. For the year preceding the discovery of my cancer, I was living in Hawaii, following a strict vegetarian diet, exercising daily, spending long hours in the outdoors and living what I thought of as a stress-free life. I certainly did not consider myself to be a candidate for cancer.
But cancer is a cunning adversary.
My first wife died of ovarian cancer 22 years ago. She was a certified aerobics instructor and personal fitness trainer who never smoked or drank. I never knew her to take an aspirin in her life. If I had to choose someone I knew who I thought was least likely to have cancer, it would have been her.
It is well documented that guys are slower to get checked for breast cancer symptoms than women. As a result, men are frequently diagnosed with more advanced cases of the disease once they seek professional help.
In my case, it was my spouse (now married for 15 years) whom I credit with getting me the urgent help that I needed. I had just been assigned to my new primary care doctor after living for six months as a resident of Hawaii. I had no real reason to see him other than to say hello and introduce myself. But on a whim, I decided to make an appointment. After visiting with him for half an hour, I shook his hand and headed out the door, intent on walking the beach at Waikiki.
"Is there anything else you want to discuss?" my new doctor asked. My wife chimed in, "Honey, why don't you show him that little bump you found on your breast?" The rest is history. I was in Queen's Hospital a few days later for a mammogram, ultra-sound and needle biopsy. I had my surgery two weeks after my cancer was identified.
So the question I've had since my own diagnosis five years ago is, "How many of us were prompted to get checked out by someone else and how many of us took the initiative to get ourselves into the doctor's office to find out what was going on in that malevolent breast?"
I promised the guys that my little survey would be anonymous, so here are the condensed results and their own comments:
CANCER FOUND BY SOMEONE ELSE
1. "It was totally my wife. Otherwise I probably would have waited several months longer."
2. "I noticed my nipple had inverted. Showed it to my wife and she told me to go."
3. (From the mother of a male breast cancer survivor) "Son found lump at age 17 and every doctor told him he was becoming a man and going through puberty. Prompted by me to get it checked. Doctor did not think it was anything. Diagnosed with stage one.
4. (From the wife of a male breast cancer survivor) "I noticed his nipple was becoming inverted. I said go now. He did."
5. (Another wife of a male breast cancer survivor) "I told a co-teacher about my husband complaining about a lump he had. Thought it was from working out so much. She gave me the name of the oncology surgeon that did her mastectomy and said to call him immediately. He was seen within days. That started our long journey with stage 2c HER2 positive male breast cancer."
6. "My male GP and a male specialist did not physically examine me but suggested a change of diet. It was my wife who took me to her GP (a woman) who diagnosed breast cancer and referred me to a specialist surgeon."
7. "My wife noticed my lump in my left breast. I thought it was just cystic acne, so I let it go a bit but then it got larger. She was the one who called the doctor and set up the appointment and made me go."
8. My wife noticed my inverted nipple. After a routine physical I was scheduled for a mammogram.
9. My wife found a lump on me and exclaimed "what the hell is THIS?" She directed my fingers to what felt like a pea adjacent to the nipple. I had no clue, never having done a self-breast exam. I was tempted to ignore it but she was having none of that. We made an appointment with my GP who thought it was just a cyst and no cause for alarm. Turns out my 'cyst' was an estrogen receptive ductal infiltrating tumor.
CANCER FOUND BY ME
1. "All on my own. I'd called for an exam before my wife woke up on the morning I discovered a bloody discharge from my nipple.”
2. “I didn't need a prompt to visit my PCP. The problem for me was getting the doctor to even examine the affected breast.”
3. “I saw my nipple retracting. Thought I may have banged it on a door or something and hurt it. I thought it was healing. Looked it up online and went for a mammogram and biopsy. Stage 1a total mastectomy.”
4. “I found the lump myself.”
5. “Found mine myself. Went straight to the doctor the next week. Found it on the weekend. After all the probing and sonograms, finally a mammogram and there it was: stage 2 breast cancer.”
6. “I also found mine myself. Was insistent with the first doctor when he was dismissive.”
7. “I found my pea sized lump above my left nipple. I called my doctors attention to it. He said we'd keep an eye on it. It was a couple years before I was back in to see him and just happened to remember to ask him about the lump. It was stage 3a, Er/pr pos, HER2 neg, grade 2-3.”
8. “I was in the best shape of my life lying on a yoga mat doing a class. Felt a rock-hard object under my nipple. Got on to Web and found that my nipple was also inverted. Found a doctor who saw me immediately.”
It's impossible to draw any firm conclusions from such a small survey, but I was surprised to see both groups represented nearly equally. What this tells me is that regardless of the avenue through which we discover our male breast cancer, around half of those who responded did not discover the cancer on their own. If nothing else, this is a good reminder that men need to know that this disease exists, and most importantly, guys need to be wise and check the pecs. It's 60 seconds that can add years to your life.
