John’s* patient documents made me pause. As I read over his new patient questionnaire, I found that this 52-year-old man had not seen a doctor since childhood – not until last month when his new primary care physician referred him to me after finding a large breast mass.
I walked into the examination room where a heavy-set man with an athletic build sat expectantly in a hospital gown. After some light conversation to help him relax, I examined him. I asked typical questions: “How long have you noticed this lump? Does it hurt when I touch it?”
“People don’t expect men to get breast cancer, but about 2,100 men are diagnosed with it each year.”
Michael Cowher, MD
Breast surgeon at Cleveland Clinic
Under my fingers, I could feel enlarged lymph nodes in both of his armpits, a frequent symptom of unaddressed breast cancer that has spread beyond the breast. Based on what I knew about this man’s history, this didn’t surprise me. This didn’t mean cancer – not yet – we’d only know after results came back from a breast biopsy.
People don’t expect men to get breast cancer, but about 2,100 men are diagnosed with it each year, with onset about five to ten years later than women.
Some reports even suggest that over the last 25 years, the frequency of new male breast cancers has gone up by about 26 percent.
With these male patients, which seem to be a growing population, we have to consider their unique needs. Just because it’s less common for men to experience breast cancer, it doesn’t mean men don’t have particular concerns that could surprise and challenge us.
A week later when John returned, I was able to give him some good news: only his breast biopsy, and not the lymph node biopsy, returned results highly concerning for cancer.
I started describing traditional treatments for male breast cancer, including the one I most often recommended as it offered the best outcome. “A mastectomy will…,” I began.
Then, he said something I didn’t expect.
“No, doctor. I have always said that I would rather die than have a visible part of my body, like my nipple, removed.” He blinked back at me as I swallowed my surprise. He seemed decided about this.
Saving his breast was the last thing I’d expected this stoic, physically powerful man to be concerned about.
But I always respect my patients’ wishes, as long as they are safe. So we agreed to remove the lump only, allowing us to be absolutely sure of a cancer diagnosis. Once we confirmed it was cancer, then, and only then, did John agree to remove the remaining cancer in his breast. After finishing his treatments, John has been cancer-free for two years.
A colleague, Trang Nguyen, MD, and I recently presented research about male breast cancer at the American Society of Breast Surgeons meeting, an annual medical conference.
We found that over the last five years, the percentage of male patients who showed an interest in conserving their breasts went up from 7 percent to 44 percent.
However, each of these patients eventually did require a traditional mastectomy.
To our knowledge, this was the first study evaluating whether desire to preserve the breast is a concern for male breast cancer patients.
John’s story reminds me of the need to customize traditional treatments with regard to patients’ values and beliefs without sacrificing their care.
Personalizing scientific knowledge with patient desires is one of the most rewarding aspects of my career as a breast surgeon.
Although breast conservation therapy isn’t an option for most male patients, I hope future research may allow us to offer it more readily to men like John. Whether male or female, it is no small thing to disfigure your body, even if it saves your life.
* Name has been changed to protect patient privacy.