Men who are more likely to get breast cancer

A majority of men dismiss changes in their breasts or may be embarrassed to see a doctor, resulting in delay in diagnosis of breast cancer. To many, this is a woman’s disease.

“Just today I was counselling a young man diagnosed with breast cancer at only 28. He was traumatised on how and why he had a woman’s disease,” said David Makumi, an oncology manager at Aga Khan University Hospital.

Official data shows that one in every eight women is likely to have breast cancer and one in every 100 men has breast cancer — an indicator that the disease is rare in men but it still affects some.

“I have treated five men in the last six years. I saw a 28-year-old man last week. He is the youngest male patient I have ever seen with the disease. Other patients were aged 65, 44, and 42,’’ said Prof Ronald Wasike, a breast surgeon at Aga Khan University Hospital.

So when should one worry?

Breast cancer in men usually presents itself like a painless lump — just like in women. Some men have lumps at puberty but those are normally uniform enlargement of the breast tissue.

Lumps that may be cancerous are usually hard and do not move around.

“All cancerous lumps in men and women are not painful. This is only the case in inflammatory cancer where the disease has spread to other organs,” Prof Wasike said.

Other men have bloody nipple discharge and if there is a delay in diagnosis, the lymph glands swell.

It is easy to notice changes in men’s breast tissue unlike in women where the small lump can easily hide in the breast tissue. But the challenge is that men are less likely to go for screening, thus end up going to hospital with advanced breast cancer which is mostly at stage four, said Prof Wasike.

But some men are more at risk than others. Prof Wasike said men with XXY Syndrome are more susceptible to breast cancer since they have high estrogen levels like women. They are also unlikely to sire.

“This group of men if well observed look like women and their XXY chromosomes factor is a risk factor for them acquiring breast cancer. But that does not rule out the disease in other men.”

“Some men also produce a little more estrogen than usual and if they are overweight the fat converts the male hormones into female hormones —making them susceptible to breast cancer,” he added.

Liver-related ailments in men can also be a sign of underlying breast cancer. He said the liver helps in the breaking down female hormones and if it is sick then the higher the malignancy risk in males.

Genetic structure also makes men susceptible to breast cancer. Those whose parents (or family line) have a history of prostate or breast cancer tend to have the cancer genetic mutation, but this accounts for only about five to 10 per cent of every incident.

Prof Wasike said although breast cancer is less common in men, it is more aggressive when it strikes.

“Breast cancer moves easily and faster in men due to their physical attributes (small breasts) and a man with breast cancer is most likely to die from the disease than a woman because it presents itself when it is at an advanced stage,” said Prof Wasike.

Support groups

The biggest challenge that Kenyan men diagnosed with breast cancer face is lack of a support group and many may not be comfortable joining women’s groups.

Currently, there is no specific support group for men but Prof Wasike advises men not to fear attending sessions with women because the experiences and challenges they face are similar and the meetings help to ease stigma.

To reduce the risks of getting the disease, Prof Wasike advises men to exercise regularly, reduce alcohol intake and do monthly breast checks just like women.

“Stand in front of the mirror with arms raised and look for any possibilities of a lump,” he said.

For men above 45 years, they should go for mammogram screening. This test is done depending on maturity and texture of the breast and it brings out the best results of any malignancy.

A mammogram test costs between Sh1,500 and Sh8,000 depending on the hospital. It is done just like in women where the breast tissue is stretched on the scanner for accuracy.

Men below 45 years can do ultra sound scans or if they are high-risk patients (those with family history) they can go for MRI tests.

Treatment for breast cancer in men is the same as that for women. Men undergo mastectomy and those with bigger breasts can do breast configurations— cosmetic surgeries later on.

Mastectomy costs between Sh90,000 and Sh200,000 for both genders but surgeries for men take less time because they have less tissue compared to women.

“A mastectomy in a male patient can take less than 30 minutes but in a woman, depending on the size of the breast, it can take up to two hours,” he said.

Chemotherapy between Sh16,000 to Sh40,000 per session— if a patient is bigger in terms of weight and between Sh16,000 to Sh20,000 for small- bodied patients per session.

Male breast cancer patients also undergo radiotherapy which ranges from Sh600 per session in public hospital and Sh20,000 in private hospitals.

A patient is required to go for between 20 to 35 sessions depending on how far the disease has progressed.

The recurrence of breast cancer is higher in men than in women because males have little tissues and by the time they see an oncologist the disease has spread.

Men also have lymphedema— swelling of the hands— as during surgery some of the 34 lymph nodes in the armpit are removed.

Cause malformations

While receiving chemotherapy, male patients are advised not to sire children until five years after treatment. This, Prof Wasike said, is because of the hormonal therapy drugs and toxins which can cause malformations in unborn babies.

“I have seen those who go ahead to make babies who turn out without malformations but I would not advise them to reproduce after they finish treatment,” Prof Wasike said.

He said although Kenya continues to make commendable strides in fighting breast cancer, there is need for more awareness.

The health sector is still grappling with cases of misdiagnosis because of lack of information.

Many doctors misdiagnose men with lumps with gynecomastia or estrogen issues. Gynecomastia is the enlargement of a man’s breasts, usually due to hormone imbalance.

“The young man I diagnosed last week had gone to various hospitals in Nairobi, more than four times and in the last prognosis he was told he had gynecomastia and now the tumour has grown.’’

“Many doctors still overlook breast cancer in men,” he said.

Prof Wasike urged the Health ministry to do evidence-based research for non-communicable diseases especially breast cancer in men as a majority of patients come from Mombasa.

He said he will make a presentation on April 1 at a doctors’ conference in Mombasa to create awareness on the disease.

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