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Why winning breast cancer battle among men is an uphill task


Charles Maina, a breast cancer patient, during an interview on November 7, 2020. PHOTO | FRANCIS NDERITU | NMG

When he was diagnosed with breast cancer last year, at first, he was scared and wondered how a man could get such a disease.

But for Charles Maina, 60, a resident of Kieni in Nyeri, he did not have a choice but to accept it, at least so he could start and follow up on his treatment, as soon as possible.

It all started on August 31 last year, when he began experiencing some pain on his left breast.

“At first, I just thought it was normal pain that would later disappear, but it didn’t. It became so unbearable that I had to go to the hospital,” explains the grandfather of five.

Initially, the doctors had some difficulties knowing exactly what was ailing him, and so there were a lot of speculations.

“I remember them telling me numerous times that my problem had to do with too much body fat, considering that I was overweight at the time,” he says.

Mr Maina was given pain killers and allowed to go home. But by December last year, the pain just got worse. He went back to the hospital and requested more tests be done.

“Here the doctors took their time and began doing more cancer tests, but still they were unable to pinpoint what the problem was. This went on as the experts were now forced to use ultrasound-guided needle biopsy, and by the end of February this year, I was officially diagnosed with breast cancer,” he narrates.

But by this time, he says, cancer had already metastasised to the lungs. The doctors had to start the treatment immediately.

“In March of this year, I started my medication. I was getting better, but by September, my left breast burst and became a wound. When I went to the hospital, they started radiotherapy, where I completed the last session three weeks ago.”

Mr Maina has, so far, gone through 10 radiotherapy sessions. He began his chemotherapy treatment on Wednesday.

He expressed optimism he is on the road to recovery but admits it has not been an easy journey from him.

“From the financial burden that comes with cancer treatment, to the stigma associated with this illness that many consider being a “woman’s disease”, this breast cancer journey has been far from easy,” says Mr Maina.

He says he was afraid of stigma after he broke the news to family and friends.

“When breaking such news, you’re afraid that people might think that may try to associate your illness with some funny things they think you might have done.”

And that is why, he says, he has come out publicly to talk about his condition, to encourage men to come out and get tested for this disease.

“I am more than certain that if I had been diagnosed earlier, the situation would have been arrested before spreading to the lungs.”

The American Cancer Society estimates that this year, new cases of breast cancer in men in the US will reach 2,620, with about 520 expected to die from the disease.

In Kenya, male breast cancer data remains scanty. However, data still suggests worldwide, it represents a small percentage of breast cancer cases.

According to Dr Miriam Mutebi, a breast surgical oncologist and assistant professor in the Department of Surgery at the Aga Khan University Hospital, the disease is more aggressive among men than women despite the low numbers.

“As compared to female breast cancer, in men, there is little breast tissue. That is why in men cancer may spread quickly to other areas of the body as compared to women. This explains why breast cancer in men may behave more aggressively or spread earlier,” explains Dr Mutebi. Also, the little breast tissue may make it easier and quicker to pick up the signs.

“They include, a painless lump, alteration in shape, size or appearance of the breast like dimpling, inverted nipples, skin changes, just to name a few,” she explains, insisting that all changes need to be evaluated by a physician.

According to Dr Mutebi, there are both modifiable and non-modifiable risk factors for cancer.

“The risk factors, other than gender (which carries the highest risk) are similar in both men and women. These include increasing age and family history. In Western countries, it has been estimated that 10 per cent of men with breast cancer have a genetic predisposition and family history of breast cancer or ovarian cancer. BRCA2 mutation and Klinefelter’s syndrome (XXY) are established risk factors for male breast cancer.

Genetic factors

“However, the relative contribution of these genetic factors to male breast cancer in Africa is unknown.”

Dr Mutebi says, even though one cannot change one’s family history or the fact that we are all growing older, which is in itself a risk factor for many cancers, lifestyle measures like healthy diet and exercise can decrease the risk of breast and other cancers.

According to the World Health Organisation, detecting cancers early remains the cornerstone of breast cancer control.

There are two key strategies employed. The screening, which involves mainly mammography, is the gold standard where available. Early detection methods like clinical breast examination and self-breast examination and breast awareness are also used as the main strategy in settings with limited resources and access to mammography screening.

But while these strategies have contributed immensely to reducing mortality rates among female patients, in men, this could be a challenge as breast screening for men is not recommended routinely due to the low incidence

Catherine Wachira, chairperson of Kenya Network of Cancer Organisation, says, the biggest challenge has been getting men to get tested, so as(that) the disease is diagnosed early enough and the situation is tackled on time.

“It’s not easy for men to accept or even think of going through screening, because they have this misconception that it is a women’s disease. “We have begged and pleaded with men to come out, but our efforts haven’t been successful due to stigma,” she says.

It is such stigma that Dr Mutebi says has become a hurdle in the fight against the disease, not just among men but also women.

“For men globally, there is layered stigma, because of the additional perception and embarrassment around having a ‘women’s disease,” she says.