Breast cancer is rare in men but, as 49-year-old Mike Nelsen discovered, it happens and, as with women, it is important to catch it early
THE CASE was fairly routine: the patient felt a lump smaller than a pea, had a mammogram, received a diagnosis of breast cancer and then quickly underwent a mastectomy.
What was different was that this patient was a man: Mike Nelsen, a 49-year-old high-level sales executive from the US, who never saw himself at risk. “I remember distinctly sitting in a conference room when my cell phone rang,” says Nelsen.
It was his doctor calling, so Nelsen walked out into the hall to hear the news. “I guess I don’t get shocked by a lot, but I didn’t even think men could have breast cancer. I’d never heard of it before. He said, ‘There are 180,000 women and 2,000 men – and you’re one of them’.”
THE DIAGNOSIS put Nelsen into an overlooked and understudied group. While decades of research into breast cancer in women has led to more effective treatments and improved outcomes for patients, comparatively little attention has been paid to the disease in men.
The common lack of awareness about male breast cancer can be lethal. Diagnosed at the same stage of cancer, men and women of the same age do equally well.
But the disease tends to be caught later in men, giving it time to grow, spread and wreak havoc in the body.
“Men are different to women. They think it’s not really a lump. It’ll go away . . . ignore it,” says Dr Michael J Schultz, Nelsen’s oncologist at the Breast Center unit at the St Joseph Medical Center in Towson, Maryland. “Women are conditioned: if it’s a lump, I have got to take care of it.
“Men just can’t believe it. They say, ‘I’m not a woman. How can I have this?’ It’s sort of a challenge to their masculinity, but any cell type in the body can develop a mutation and develop into a cancer cell. It’s all around us.”
SCHULTZ SAYS that although male breast cancer is something to be aware of – men do have breast tissue – it is not something to add to men’s list of worries. The diagnosis is rare.
Still, efforts are under way to learn more about male breast cancer. Up until now, the data have been limited and collected over so many years as to not be valuable.
An international consortium is now collecting 1,000 tissue samples from male breast tumours from 100 medical institutions across the globe in the hopes of learning more.
“The whole trend in cancer treatment in general, and breast cancer in particular, is about trying to individualise therapy for the individual patient’s cancer-targeted therapy,” says Dr Monica Morrow, chief of the breast service at Memorial Sloan-Kettering Cancer Center in New York.
Little is known about how to do that for men. “There is something fundamentally different about the hormonal environment in men.”
Dr Sharon H Giordano, an oncologist at the University of Texas MD Anderson Cancer Center in Houston, says a clinical trial was opened to study a hormonal breast cancer treatment in men.
But without enough cases of the disease to enrol enough men in the trial, the study was called.
Nelsen, a healthy, vigorous man, felt the lump underneath his right nipple last autumn as he lay on his stomach in bed. “It felt tender,” he recalls. “I thought, ‘that doesn’t seem right.’”
Nelsen procrastinated a bit about going to see a doctor: he didn’t have one. Within a month, though, he had an appointment. It was a good choice, he figured, when, a few days before his scheduled visit, he took off his T-shirt and found a wisp of blood on it.
HIS DOCTOR SENT him to Schultz, who ordered a mammogram and diagnosed the cancer. Last December Nelsen had a mastectomy.
Schultz removed the breast tissue on Nelsen’s right side and 14 of his lymph nodes. His nipple has gone, but he has decided against reconstructive surgery: “I’m not a surfer dude,” he says.
Nelsen spends a lot of time on the road, selling spices. So he was back at it in no time, flying across the country still fixed with drains used to draw lymphatic fluid from his wound.
There was work to be done. He started chemotherapy in early February and was told that seven days later he probably would feel terrible.
But he had a meeting in Chicago and then plans to entertain clients in Colorado. He just figured he just wouldn’t ski as hard as usual.
He ended up in intensive care in a Chicago hospital for days; the chemo had damaged his large intestine.
IT WOULD BE his last round of chemotherapy. He was concerned he wasn’t doing enough to keep the cancer from coming back, but genetic testing of his tumour indicated it was unlikely to return.
“I could get hit by a bus just as easily as I could die from cancer, based on this report,” he says.
Now he is taking tamoxifen, a drug that interferes with the oestrogen that fed his tumour. Tamoxifen is used to shrink existing tumours and to prevent them from coming back. He will be on the drug for the next five years and it does have side effects.
“How I got a women’s disease from the start, I don’t know,” Nelsen says. But because of the tamoxifen, “I get flushed from time to time. As my female friends say, ‘Now you know what it’s like to have hot flushes.’”
Although there are data showing tamoxifen can shrink breast cancer tumours in men, Giordano says little was known about its prevention properties in men, or what the side effects – which can include blood clots, increased risk of uterine cancer and vaginal dryness in women – might be for men.
Nelsen doesn’t know whether he inherited his disease. But he knows his mother had breast cancer while in her 40s, melanoma in her 50s and she died of ovarian cancer at 63.
An aunt of his had ovarian cancer too. His daughter, 23-year-old Megan, plans to start getting routine mammograms when she is 25, much earlier than average.
For now, Nelsen spends his good days at work – and they are mostly good days.
He plays golf. He works in the garden at home. He plays with Mikayla, the two year old from Guatemala who he and his wife adopted.
IT IS NOT Nelsen’s way to fret about his health. He’s worrying more these days about whether he’ll get the ball over the plate than if there is more cancer is in his future.
“I try to take everything in my stride. You run into issues your whole life. Instead of feeling sorry for yourself, you just have to go on. I don’t know how else to do it,” he says. “I’m not very good at sitting still.”