- I walked into the examination room where John, who had an athletic built, sat expectantly in a hospital gown. After a light conversation to help him relax, I examined him. I asked typical questions, such as ‘when did you first notice this lump? Does it hurt when I touch it?’
John’s* medical documents made me pause. As I read over his answers from the patient questionnaire form he had filled in, I found out that this 51-year-old man had not seen a doctor since his childhood-not until last month when his new primary care physician referred him to me after finding a large breast mass.
I walked into the examination room where John, who had an athletic built, sat expectantly in a hospital gown. After a light conversation to help him relax, I examined him. I asked typical questions, such as ‘when did you first notice this lump? Does it hurt when I touch it?’
Under my fingers, I could feel enlarged lymph nodes in both of his armpits, a frequent symptom of unaddressed breast cancer that has spread beyond the breast. Based on what I knew beyond this man’s history, this didn’t surprise me. This didn’t mean cancer, not yet, we’d only know after the results came back from a breast biopsy.
Hundreds of men are diagnosed with breast cancer every year. Some reports even suggest that over the last 25 years, the frequency of new male breast cancers has gone up by about 25 per cent.
With male patients, which seem to be a growing population, we really have to consider their unique needs. Just because it’s less common for men to experience breast cancer, it doesn’t mean men don’t have particular concerns that could surprise and challenge us.
A week later when John returned, I was able to give him some news. His breast biopsy showed high concerns for cancer. I started discussing with him the treatment plan for male breast cancer, including the one I most often recommend as it offers the best outcome, a mastectomy [the removal of the whole breast].
Then, John said something I didn’t expect, “No doctor. I have always said that I would rather die than have a visible part of my body like my nipple, removed.” He blinked back at me as I swallowed my surprise. He seemed to have a strong stance about his decision.
Saving his breast was the last thing I’d expect a physically powerful man to be concerned about. But I always respect my patients’ wishes, as long as they are safe. So we agreed to remove the lump only, allowing us to be absolutely sure of a cancer diagnosis. Once we confirmed it was cancer, then, and only then, did john agree to remove the remaining cancer in his breast. John is now cancer free, after completion of his planned treatments.
A colleague of mine who is a clinical oncologist at the Ocean Road Cancer Institute, recently presented a research about male breast cancer at the medical training fellowship conference. In his research, he found that over the last five years, the percentage of male patients who showed an interest in conserving their breasts went up from 2 per cent to 28 per cent. However, each of these patients did require a mastectomy. To my knowledge, this was the first study evaluating whether to desire to preserve the breast is a concern for male breast cancer patients.
John’s story reminds me of one thing. Men are indeed the forgotten victims when it comes to breast cancer. I therefore recommend people in their societies to be given massive awareness lessons on the disease itself and it also should be known that “breast cancer for men is real.” This will help men draw more awareness, get regular breast cancer screening and abstaining themselves from risk factors.
* The name has been altered to protect the patient’s identity.