Men in pink

Amid October’s pink tide of breast cancer awareness, there’s one demographic that’s all too often overlooked: men with breast cancer.

Yes, guys get this disease too.

I was reminded of that fact earlier this week when the Mayo Clinic tweeted a link to a story that appeared a few years ago in the Sharing Mayo Clinic publication. It’s the story of Craig McMillan, a 59-year-old insurance agent from Florida who was diagnosed with breast cancer in 2004 and underwent a double mastectomy followed by chemotherapy and radiation.

Was it a shock? Absolutely. “Like most men, I thought it was a women’s disease, so I was in denial and didn’t think it could happen to me,” McMillan told the Mayo magazine.

His wife, Jane, said she had never even heard before of breast cancer among men. “After the diagnosis, we found out that three other men we know have also survived breast cancer,” she said. “I guess this is an issue that men just don’t like to talk about.”

Some facts about male breast cancer:

- It’s rare, which may account for why many people remain unaware of it. About 2,000 new cases are diagnosed in the United States each year, and about 400 men die of male breast cancer. To put it in perspective, men account for about 1 percent of all new breast cancers annually in the U.S.

- The cause remains unknown. Research suggests that acquired or inherited gene mutations may play a role – primarily the BRCA1 and BRCA2 genes, which are thought to be a factor in 5 to 10 percent of breast cancers among women. Men with either one of these genes face a higher lifetime risk of breast cancer but apparently less so than women with one of the BRCA genes.

- As with women, the risk of breast cancer among men tends to increase with age, family history (McMillan’s grandmother and sister both had breast cancer, and both his parents had lung cancer), heavy drinking and estrogen treatment. There also seems to be a link with environmental exposure, such as medical radiation or occupational exposure, although more research is needed on how strong this link might be for male breast cancer.

- Treatment options are the same for men as for women: surgery, radiation, chemotherapy, hormone therapy and some of the newer targeted therapies.

- Breast cancer actually is easier to diagnose in men because they have less breast tissue, making lumps easier to spot while they’re still relatively small. Lack of awareness, coupled with embarrassment, is more likely with men than with women, however, and can lead to delays in diagnosis and treatment. Also, male breast cancer unfortunately doesn’t need to grow very far to spread to nearby tissue or lymph nodes, which means their cancer may be at a more advanced stage by the time it’s diagnosed.

- Men with breast cancer seem to have better survival rates than women – but survival for male breast cancer has been increasing at a slower rate than for female breast cancer.

- Men are not well represented in the research on breast cancer. Much of what we know about male breast cancer stems from studies made up mostly of women who have the disease.

How men fare emotionally when they go through diagnosis and treatment for male breast cancer seems to be similar to anyone else who has cancer. After all, much of this terrain is universal, regardless of gender, age or diagnosis. But it surely must be more complicated, and more isolating, for many men. It’s hard to picture how comfortable they might feel as the lone guy at a mammography center. Are they marginalized by the symbolic pink ribbon – and if so, does this make their experience more difficult than it needs to be?

if ever there was a case to be made for avoiding one-size-fits-all approaches to how we talk about cancer and how we respond to those who have the disease, this would be it.

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