BREAST CANCER IN men is rare, but it does happen. Around 350 men are diagnosed with breast cancer every year in the UK (compared with over 55,000 women), and they are normally diagnosed in their sixties and over. Because male breast cancer is uncommon, less is known about it, and most of the research into treatment and survival has been carried out on women.
All men have a very small amount of breast tissue behind their nipples, which is why you can get breast cancer. Ninety per cent of male breast cancers are sensitive to oestrogen, a female sex hormone, and while you don’t have ovaries, you do produce a small amount of oestrogen in your fat. Anything that increases your exposure to oestrogen, such as some prostate cancer treatments, being overweight and liver damage due to alcohol, will increase your risk of breast cancer. Exposure to environmental chemicals, such as pollutants and petroleum solvents, previous radiotherapy for Hodgkin’s lymphoma and the genetic condition Klinefelter syndrome (in which men have an extra female chromosome) can also increase your risk. You may also have a mutation in the BRCA 1 or 2 genes (see here) that increases your lifetime risk of getting breast cancer from 0.1 per cent to 10 per cent; this kind of breast cancer is more likely if you have a strong family history of breast cancer at a young age.
Because your breasts are much smaller than a woman’s, your symptoms are slightly different. Most men normally feel a hard lump close to the nipple. You may also notice that your nipple has been pulled in, or find a rash on your nipple (which can be mistaken for ‘jogger’s nipple’). Other signs are bloody nipple discharge or a lump in your armpit. If you are concerned, see your GP for an urgent check-up. Because men don’t expect to get breast cancer, it tends to be more advanced by the time it is diagnosed, though this is not the case in all men.
If your GP is concerned, they will refer you to your local breast clinic where you will have the same set of tests that a woman would have (see Chapter 3). Please don’t feel embarrassed about being referred to the breast clinic. The doctors and nurses are used to seeing male patients, and will do their best to make you feel at ease. It may help to take someone with you for moral support.
The principles of treatment are the same – namely, surgery, followed by additional treatments, such as chemotherapy, radiotherapy and hormone therapy, if needed, to reduce the chance that your cancer will come back. These are all explained in earlier chapters, which are relevant to men as well as women. However, there are a few subtle differences that we will go through below.
Because you only have a very small amount of breast tissue, your surgeon will do a mastectomy to treat the breast cancer. This includes removing your nipple. There are options available to improve the cosmetic appearance of your chest after surgery such as lipofilling, nipple reconstruction or a nipple tattoo (see Chapter 8).
If your cancer is sensitive to oestrogen, you will be given a tablet called tamoxifen to stop any remaining breast cancer cells responding to oestrogen (see Chapter 10). Tamoxifen causes menopausal symptoms in women, and you may find that you have these symptoms as well (see Chapter 16).
If you need chemotherapy, the drugs will damage your sperm cells so sperm production slows down or stops altogether. If you think you might want to have children in the future (whether it’s your first or another child, or just keeping your options open if you don’t have a current partner), your sperm can be collected before you start chemotherapy. The sperm is then frozen until you want to use it. This is called sperm-banking and the sperm is normally kept for 10 years. Treatment should be free on the NHS because you are having cancer treatment, but this is not always the case.
You may lose your sex drive (libido) during treatment for one of two reasons. The first is psychological – dealing with the mental impact of a cancer diagnosis combined with a loss of self-esteem or depression. The second reason is due to the treatments themselves, namely chemotherapy and hormone therapy, which can lower your libido and make it difficult to get an erection. Treatment may also make you simply too tired for sex.
We talk about sex and relationships in detail in Chapter 17. It’s important to talk to your partner about how you are feeling. There are many ways of making love without having penetrative sex, and it can help to maintain some degree of intimacy during this emotionally challenging time. If you are finding it difficult to maintain an erection sufficient to achieve penetration, your GP may be able to prescribe you a drug such as Viagra (though some other medical conditions mean that Viagra is not an option for all men).
Because breast cancer in men is so rare, you may feel very alone. It may be frustrating that all the information you find online is directed at women, and that the media associate the colour pink with breast cancer, forgetting that men get breast cancer too. The UK charity Breast Cancer Care has an excellent leaflet available on their website called ‘Men With Breast Cancer’, and we encourage you to read it. Your breast care nurse and GP are a good source of support, and you may also want to try their online forum (see here) for men with breast cancer. This is where you’ll find other men who have had breast cancer and their stories may help you get your head round what’s happening to you.