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Men battling breast cancer
By Theresa Grimaldi Olsen

Richard Battles wishes pink wasn't the color representing breast cancer awareness month. The American Cancer Society campaign in Springfield this fall asked men to wear pink in support of women who have breast cancer. "Real men wear pink," the advertisements read. Battles says: "Real men have breast cancer."

"It's a little frustrating to me that breast cancer awareness month is using pink as its color," says Battles of Lake Petersburg. Breast cancer is not just a disease for women, he says.

Battles was caulking a bathtub in March 2007 when he leaned over, felt a pain in his chest and discovered a lump under his right nipple.

It was Saturday, but his doctor happened to be in the office that day, and Battles sought help immediately.

Within a week, he had a mammogram and a needle biopsy with the confirmation: Battles - a retired broadcaster and public information specialist with the state of Illinois, the father of three grown children and three grandchildren - had breast cancer.

Springfield surgeons, oncologists and the American Cancer Society acknowledge that breast cancer in men is rare. The doctors say they see the disease in one man for every 100 women who are diagnosed. Nevertheless, a man who discovers a lump in his breast should not ignore it. Breast cancer can be just as deadly for a man as it is for women.

"Stage for stage, the prognosis and treatment for men and women are similar," says Dr. Karen Hoelzer, a medical oncologist with Springfield Clinic.

For men, however, the treatment may need to be more aggressive than for women.

A lumpectomy, where the lump is removed but the breast remains intact, usually is not an option for men, Hoelzer says.

"There isn't enough breast tissue in a man for a lumpectomy, and the tumor is too close to the chest wall," she says.  

On March 28, 2007, Battles had a mastectomy, followed by 16 weeks of chemotherapy and 28 days of radiation. Battle's lump was small, a shade more than a centimeter.

However, the surgeon discovered cancer in one lymph node.

The median age for men with breast cancer is 65 to 67, according to UpToDate, a clinical information service on the Web. That's five to 10 years older than women. Battles is 74.

But that doesn't mean that younger men never get breast cancer.

David Brown, the owner of Brown's Automotive in Springfield, was 48 when he was diagnosed with breast cancer this past year.

He says he noticed the lump when he was scratching an itch. His tumor in the left breast was 4 centimeters, about the size of a golf ball. That's four times bigger than Battles' tumor.  

Because of the large size of the tumor, Brown's treatment started with chemotherapy to shrink the tumor before surgery, says Dr. Gary Dunnington, a surgeon with the Southern Illinois University School of Medicine.

The tumor virtually disintegrated with the chemotherapy. The mastectomy was done to ensure Brown was cancer-free, Dunnington says. Despite the large size of the tumor, the cancer had not spread. No lymph nodes were affected, Dunnington says. Dunnington used a procedure to test Brown's lymph nodes that did not require the invasive surgical removal of lymph nodes that can affect the use of the arm.

Both Battles and Brown, despite the different presentations of breast cancer, will take a pill called tamoxifen for five years to help prevent the development of more cancer cells. UpToDate says five years of tamoxifen is recommended for most men following a mastectomy.

Neither Battles or Brown considered breast reconstruction.

"I can't imagine that a man would want to add that additional agony," Battles says. Hoelzer says she knows of a bodybuilder who had breast cancer and considered breast reconstruction, but then decided against it.

Battles considers himself cancer-free now, but the cloud from breast cancer continues to ripple through his family. Further testing after his diagnosis led to the discovery that Battles is a carrier of the breast cancer gene.

"We are concerned that my daughter has inherited the gene from me," he says."She is concerned, and we share her concern."

Brown says he has not had the genetic tests.

The National Comprehensive Cancer Network guidelines recommend that gene testing be offered to men who develop breast cancer.

"Every man should be tested," Hoelzer says. Every man who develops breast cancer should be offered to test for the gene for breast cancer."

UpToDate says about 15 percent to 20 percent of men with breast cancer have a family history of the disease, compared to 7 percent of the general male population.

"This disparity implies that some families carry genetic mutations that increase their risk for both male and female breast cancer," UpToDate says.

The two breast and ovarian cancer genes called BRCA1 and BRCA2, which are inherited, account for 80 percent of multiple-case breast cancer families, UpToDate says: "The lifetime risk of breast cancer in affected women is 40 to 70 percent."

The American Cancer Society says studies show that early detection, when followed by appropriate treatment, saves lives and increases treatment options. The five-year survival rate for breast cancer is 98 percent among individuals whose cancer has not spread beyond the breast at the time of diagnosis.

The cancer society recommends yearly mammograms for women beginning at the age of 40. Because breast cancer in men is so rare, there are no screening guidelines for men. Mammograms also are difficult for men because they have so little breast tissue.

Nevertheless, Battles urges men to be aware: "I emphasize that men should self examine, and if they feel something - don't ignore it."

More often, he says, the subject of breast cancer arises in conversations with women: "I jump on the opportunity to tell them they aren't the only ones." 


Signs of breast cancer in men

* Lump (feels like a distinct hard BB) in breast tissue or under arm

* Dry rash over nipple area

* Thickening of the nipple

* Scaly, raised nipple

* Bleeding nipple


* One man for every 100 cases of breast cancer

* About 182,460 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S. during 2008, resulting in 40,480 deaths

* About 1,990 cases of breast cancer in men are diagnosed annually in the U.S., resulting in about 450 deaths. That represents less than 0.5 percent of all cancer deaths annually

* About 60 men and 8,800 women will be diagnosed with breast cancer in Illinois in 2008

* About 20 men and 2,000 women will die of breast cancer in Illinois in 2008

- Sources: The American Cancer Society and UpToDate, a clinical information service on the Web at www.uptodate.com.




Story published Friday, December 5, 2008 ( Volume 3, Number 7 )

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