SCIENCE / MEDICINE : Breast Cancer in Men Rare, but Often Deadly : Disease: Only about 900 males a year in the U.S. are diagnosed with the illness. But 300 of them die.

Some of Alvin Burkett’s co-workers thought he was kidding when he told them the diagnosis. Even some nurses didn’t believe him.

Burkett, a 51-year-old computer specialist from Bellevue, Neb., had breast cancer. And last June he had a mastectomy.

As a man, “You’ve got to be careful when you tell people you’ve had a mastectomy,” he said recently. “They think ‘vasectomy.’ ”

In the United States, only about 900 men a year are diagnosed with breast cancer and 300 die of it annually, compared with about 142,000 diagnoses and 43,000 deaths in women.

Experts say it is too rare in men to justify widespread screening, as is urged for women, and that few doctors check for it while doing physicals.

Burkett, now 52, had never heard of breast cancer in men when he noticed a lump near his right nipple, beneath the surrounding areola. An internist sent him to a surgeon for a biopsy, in which a piece of tissue is removed for microscopic inspection.

Even before the diagnosis, Burkett had started checking around for information about male breast cancer, and found little available. By the time the lab reported the lump was cancerous, he said, “I sort of suspected it.”

He spent two days in the hospital after a modified mastectomy. Tests at the time and since have shown no evidence of any remaining disease.

“My doctor says I’m a very lucky fellow,” Burkett said.

In fact, the prognosis for men as a group is worse than for women, experts say. One reason is that men tend to be diagnosed in later stages, because few men or medical personnel are watching for it earlier.

In addition, because men have less breast tissue than women, it is easier for cancer to spread to adjacent tissue, said Robert Crichlow, professor and chairman of surgery at Dartmouth-Hitchcock Medical Center in Hanover, N.H.

Why is breast cancer so rare in men?

It doesn’t appear to be simply that men have so much less breast tissue, because risk is not related to breast size in women, said Arthur Holleb, a retired American Cancer Society official who has studied male breast cancer.

Instead, the key seems to be hormonal. A man’s breast is not the target for hormones that a woman’s breast is, and the changes hormones induce in a woman’s breast may make cancer more likely, he said.

Any lump in a man’s breast is reason to consult a doctor, especially if under the nipple, said William Donegan, professor of surgery at the Medical College of Wisconsin in Milwaukee. Most breast cancer diagnoses in men are made around ages 60 to 65, but men in their 20s can develop the disease as well.

Doctors treat breast cancer in men just as they do in women, with surgery and sometimes follow-up chemotherapy or radiation treatment. A mastectomy removes the nipple and leaves a scar, Donegan said.

NEW CANCER CASES AND DEATHS--1990 The American Cancer Society has estimated the number of new cases and deaths from major types of cancer in 1990.

Estimated New Cases Estimated Deaths Type of cancer Men Women Men Women Oral 20,400 10,100 5,575 2,775 Lung 102,000 55,000 92,000 50,000 Breast 900 142,000 300 43,000 Uterus -- 46,500 -- 10,000 Skin 14,800 12,800 5,700 3,100 Colon-Rectal 76,000 79,000 30,000 30,900