Personal Story: Men get breast cancer too


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Men diagnosed with breast cancer

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Checked Men with breast cancer


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Cathy Free's piece for People, “Men Have Breasts Too: New York Man Who Survived Stage 2 Breast Cancer Spreads Message,” tells the stories of two men whose experiences with breast cancer inspired them to speak openly about breast cancer awareness for men. (11/29/16)

Contents

Men have breasts too     Questions for your doctor           
Risk for breast cancer in men               Guidelines                
Genetic testing for men with breast cancer Resources and references
Signs of breast cancer in men  

In her article, Cathy Free addresses the misconception that men don’t get breast cancer by telling the stories of two male breast cancer survivors, Michael Singer and Bret Miller.

“Men have breasts too”

Michael Singer discovered he had breast cancer after he mentioned “on a whim” to his health care provider that he had a small lump under his left nipple. Singer had been ignoring this lump for months. The biopsy the health care provider ordered came back positive for stage 2 breast cancer.

Michael was surprised, because like many people, he didn’t think men got breast cancer. “I was embarrassed to talk about my diagnosis, except for telling my wife, Patty…I told everyone else that I had chest cancer because I just couldn’t go there with breast cancer. I felt like a freak. I felt extremely isolated.”

He was inspired to become an advocate for male breast cancer patients after watching a show that featured Bret Miller, the founder of the nonprofit Male Breast Cancer Coalition. Miller was diagnosed with breast cancer when he was 24 and had a mastectomy. He found a lump when he as 17, and experienced yellow-orange discharge from his nipples. “I want to tell men not to wait until it’s too late. Early detection saves lives, so go see a doctor if you find a lump, a discoloration or a discharge like I had.”

What does this mean for men and their breast cancer risk?

In the People piece, Free writes, “Although he’d lost his sister, Jo-ann Weiss, to breast cancer just two years before, it never occurred to Singer that breast cancer was an “equal opportunity” killer, with 2,600 men diagnosed yearly and about 440 of those dying…”

According to the American Cancer Society, the lifetime risk of breast cancer for men at general risk is about 1 in 1,000. Among 1,000 women at general risk, about 124 will develop breast cancer. This means that women are 100 times more likely to get breast cancer compared to men, so it is inaccurate to say that breast cancer is an “equal opportunity” killer. However, this does not mean that men do not get breast cancer—some men do, and it is important when men like Michael Singer and Bret Miller bring awareness to other men so that they know to act on symptoms such as lumps in their breasts and discharge from their nipples.

Mutations in BRCA and other genes increase cancer risk in men

The story mentions that Michael’s sister had breast cancer, but does not mention whether anyone in his family had genetic testing. Bret had breast cancer at a young age. A sibling with breast cancer and onset at an early age are both signs that there may be an inherited mutation in BRCA or another gene that increases cancer risk in the family. Not all men with breast cancer have inherited mutations, but those who do are at higher risk.

About 60 of 1,000 men with BRCA2 mutations will develop breast cancer, while about 10 in 1,000 men with BRCA1 mutations develop breast cancer. While this is much higher than men in the general population, it is important to note that these numbers are lower than the breast cancer risk of women in the general population. The National Comprehensive Cancer Network (NCCN) Guidelines for men with BRCA mutations include both breast self-exam education and annual clinical breast exam beginning at age 35. Men with inherited mutations in BRCA also have increased risk of aggressive prostate cancer at younger ages, and should consider regular prostate cancer screening. 

All men with breast cancer meet national guidelines for genetic counseling and testing

NCCN guidelines recommend genetic counseling and testing for all men with breast cancer, regardless of their age at diagnosis.  If you have an inherited mutation in BRCA1 or BRCA2 and develop breast cancer, you may qualify for certain clinical trials, such as those involving PARP inhibitors.  Men with mutations in genes that increase cancer risk also have a 50% chance of passing the mutation down to their sons and daughters. Genetic counselors can help men with breast cancer decide if genetic testing is appropriate.

Signs of breast cancer in men

The American Cancer Society notes the following signs of breast cancer in men:

  • Breast lump
  • Skin dimpling or puckering
  • Nipple turned inward
  • Redness on breast or nipple
  • Scaling on breast or nipple
  • Discharge from the nipple

Ultimately, men should be aware of changes in their body. “If I had known that the yellow-orange discharge I was seeing was a major sign of breast cancer, I would have been proactive and gone in much earlier,” Bret Miller shared in the People piece. Even though the risk of men developing breast cancer is low, it is not impossible, so men should report any of these changes in their breasts to a healthcare provider. 

Posted 11/29/16

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Expert Guidelines

The National Comprehensive Cancer Network (NCCN) is a network of top cancer centers. NCCN develops national guidelines for cancer treatment and prevention. In their breast cancer treatment guidelines they include the following considerations for men with breast cancer.

  • Few clinical trials have focused on men with breast cancer. Therefore recommendations regarding management are taken from findings from clinical trials in women. Therefore management is similar to management in women with these special considerations for men:
    • NCCN recommends genetic counseling and testing for all men with breast cancer.
    • In men with breast cancer, mastectomy is recommended rather than breast conservation surgery.
    • Indications for sentinel lymph node biopsy in men are similar to women.
    • Indications for radiation in men are similar to women.
    • Available data suggests that the 21-gene assay recurrence score (OncotypeDX) provides similar information for men with breast cancer as women with breast cancer.
    • Systemic therapy recommendations are similar to those for women with breast cancer.
    • For ER positive cancers, endocrine therapy options include tamoxifen for 5-10 years or a GnRH analog plus an aromatase inhibitor. Single agent aromatase inhibitors have shown a worse outcomes than tamoxifen alone in men.

Questions To Ask Your Health Care Provider

  • As a man with breast cancer, should I have genetic testing?
  • Can you refer me to a genetic counselor? 
  • What are the side effects that I can expect with my treatment?
  • Can you recommend a support group for me? 

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