By Jana Soeldner Danger
City & Shore Magazine
When Donald Kumin of Delray Beach first noticed one of his nipples turning inward, he didn’t think much about it. He was too busy worrying about his wife, who was fighting colon cancer. When he finally saw a doctor himself, he was astonished to hear some startling news: He had breast cancer.
“It was a big shock,” he says. “It’s not something I expected.”
It’s no wonder. Breast cancer is almost always thought of as a women’s disease. And it usually is. In fact, it is 100 times more common in women than in men. But men do get it, too.
“It’s a misconception that men can’t get breast cancer,” says Dr. Charles Vogel, professor of medicine at Sylvester Comprehensive Cancer Center in Deerfield Beach. “Everyone has some breast tissue. And because not a lot of men examine their breasts and they don’t have screenings like women do, it’s often discovered when it’s a larger size and at a later stage than in women.”
By the time Kumin’s cancer was discovered, the disease had already spread to his lymph nodes. After treatment, he remained cancer-free for several years, but since his initial diagnosis in 1997, he has had two recurrences.
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The disease is more common in older men, and is most frequently diagnosed between 60 and 70. But it can occur at any age. Other risk factors include obesity, a history of radiation therapy to the chest, estrogen therapy (an older form of treatment for prostate cancer), liver disease, and Klinefelter’s Syndrome, a rare genetic condition that results when a boy baby is born with an extra copy of the X chromosome.
A mutated BRCA1 or BRCA2 gene, which greatly increases the breast cancer risk for women, is a factor for men as well. The children of a man who carries the defective gene are at a higher risk of having the mutation themselves, thus increasing their risk of developing breast cancer. Anyone with a family history of the mutated gene should be tested for the benefit of their relatives, Dr. Vogel says.
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Treatments for breast cancer in men are much the same as for women. “There’s a higher rate of mastectomies compared to lumpectomies for men,”
Dr. Vogel says. “Men are not as wedded to their breasts as women, although some men have asked about reconstruction.”
Depending on the size and stage of the cancer, radiation and chemotherapy may follow surgery. Anti-hormone therapy is a frequently used weapon, because minimizing estrogen is important. One type of anti-hormone therapy blocks circulating estrogen from binding to estrogen receptors; another blocks the enzyme aromatase, which turns the male hormone androgen into estrogen.
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Because male breast cancer occurs infrequently, it is also rarely studied. “We’re way behind in what we know about male breast cancer,” says Vogel, who lost two patients to the disease last year. “Clinical trials are what tests treatment A vs. treatment B, and there are no clinical trials for male breast cancer. So we treat it much the same as we do in women.”
For Kumin, the disease is an ongoing struggle that he has simply learned to live with. “You have a goblin in the closet, and it’s locked up,” he says. “But you wonder if it will come out and bite you again. You have to fight it by putting yourself in the best physical and mental condition you can. If you dwell on your problem, life won’t be very pleasant or, I believe, very long.”