Men: Don't Ignore Lump In Your Breast


Andrea Torres The Miami Herald 

March 19--Herb Wagner was convinced men could not get breast cancer, so he was surprised when his doctor said he needed to get a mammogram. 
That was eight years ago. Wagner, 69, is now a breast cancer survivor. Wagner is a retired synthetic organic chemist, who said he spent decades of his career developing methods for the analysis of potential carcinogens in drinking water. He knows his ignorance could have killed him, so he spends as much time as he can talking about his experience. 

"I was very fortunate the cancer had not spread when they found it,'' Wagner said. "I have made it my mission to increase awareness. I'm not shy about it. If I can save one life then it's worth it.'' 

He is a regular at Making Strides Against Breast Cancer walks, was in a documentary and likes to wear his "Tough Enough To Wear Pink" T-shirt and his blue and pink ribbon. Male breast cancer is not common, so when men have symptoms -- such as lumps behind the nipple, nipple discharge or an inverted nipple like Wagner did -- they tend to ignore it. Early detection is breast cancer's worst enemy. 

Dr. Robert Derhagopian, breast medical director at Baptist Health, said there aren't any guidelines for men to get regular mammograms and several professional organizations have contradictory opinions. 

"Some women want to go public, but a lot of men are very private,'' Derhagopian said. "I think they are very reluctant to talk about it because they look upon it as a women's disease.'' 

Male cases make up about 1 percent of patients in the United States. According to the National Cancer Institute, this year about 2,240 men will be diagnosed and about 410 men will die of breast cancer. 

Dr. Charles Vogel, a University of Miami professor of medicine and director of the women's center in Deerfield Beach, said the incidence of breast cancer in males is not as high, because women's breast are far more active than men's in terms of cell turnover and hormonal fluxes. 
"Most of the male patients can't believe it,'' Vogel said. "Many are under the misconception that they can't get breast cancer.'' 

The disease most commonly strikes between the ages of 60 and 70 when testosterone levels are lower. A Cancer Prevention Institute of California study published in January estimated that about 80 percent of male breast cancer tumors were sensitive to the hormones estrogen and progesterone. 

The liver helps to metabolize estrogen, so some experts believe alcohol abuse and cirrhosis of the liver are a risk factor. Since fat cells can convert testosterone into estrogen, being obese may also be a risk. 

Derhagopian said men with a family history of breast cancer or of Ashkenazi Jewish descent are likely to have a higher incidence. 

"Male breast cancer is so rare that the first thing we do is check to see if he carries a genetic mutation,'' Derhagopian said. "We have identified two mutations, BRCA1 and BRCA2, that also increase the risk for prostate cancer and even pancreatic cancer.'' 

Some men with breast cancer are first misdiagnosed with Gynecomastia, the benign enlargement of breast tissue in males, and Klinefelter syndrome, a condition very few men are born with, which can also cause enlarged breast. 

"Benign Gynecomastia is an indirect sign that there is some hormonal imbalance in the man,'' Derhagopian said. "We see Gynecomastia in marijuana smokers, but as how marijuana does that we are not sure. It is also commonly seen in pubital boys and in men who use certain anabolic steroids to beef up.'' 

Currently the breast cancer treatment protocol is about the same for both men and women because the pathology is the same. Usually surgery to remove the breast tissue is first and then chemotherapy and hormone therapy usually follow. 

"From a standpoint of making a surgical decision, it is much different for women in terms of the psychosexual component,'' Vogel said. "The breast is associated with femininity and body image, consequently there is more of a thrust to do breast preservation in women.'' 
Eleven days after his mammogram, Wagner underwent a mastectomy, surgery to remove the breast, and a few lymph nodes dissected were clear. And since the tumor was estrogen and progesterone positive, he was prescribed a drug called Arimidex, as hormone therapy. 
"Other drugs like Tamoxifen can cause hot flashes,'' Vogel said. "One of the biggest complains is a decrease in libido and this is sometimes quite troubling for the men.'' 

Wagner said he has a good quality of life and he is grateful to be able to play golf, dance and spend time with his daughters. He has some advice for men who may happen to feel something in their breast like he once did. 

"Don't ignore it,'' he said. "And because not all breast cancers show up in mammograms. There are some men who still need to have a biopsy. Don't ignore that lump.'' 
(c)2013 The Miami Herald