Breast cancer isn't just a woman's disease.
Boris Subbotin was relaxing at home in Tarzana last year when he felt a tiny, firm, painless lump on the left side of his chest, below his nipple. He wondered--could this be breast cancer? His mother had died of the disease at 52, but Subbotin, now 65, said he figured the lump was probably benign.
He was wrong. His family physician sent him to Tarzana-based surgical oncologist Dr. Frank Candela, who took a sample of the tissue with a small needle, right in the office. Weeks later, Subbotin had a total mastectomy--on both sides.
Subbotin was lucky. The lump he discovered was caught early and was only eight-tenths of a centimeter wide; there was no involvement of the armpit's lymph nodes. But Subbotin, a retired electrical engineer, said he feels that because most people with breast cancer are women, men at risk are easily overlooked.
"Men tend to be more macho about a lump on their chest, and are more likely to say, 'I'm not going to worry about this,' " Subbotin said.
Dr. Gregory Senofsky, a surgical oncologist at The Breast Center in Van Nuys, and a member of the board of directors of the San Fernando Valley American Cancer Society, said the men he has treated with breast cancer typically say they thought only women could get the disease.
It's uncommon for men to get breast cancer, said Candela, a specialist in breast cancer surgery. "For every 100 women with breast cancer, there will be one man with the disease," he said, which adds up to about 900 cases a year in the United States. The average man with the disease is between the ages of 50 and 65--10 years older than the average woman--and typically, Candela said, the disease is more advanced in men than in women when it is discovered.
"It's not that the disease is more aggressive in men, but that men tend not to get treatment as early as women do," Candela said. Men don't get mammograms, and they may ignore early signs, he said. "And some physicians will tend to blow off a breast problem in a male," Candela added. "But stage for stage, the survival rates for men are identical to the rates for women, with 90% of people with Stage I (no lymph involvement), infiltrating breast cancer surviving five to 10 years," he said.
The cause of breast cancer in men is unknown, and with the incidence of the disease so low, data is hard to come by. Candela said some research suggests genetics may play a role, especially in men who have a mother and a sister or a mother and a daughter who have had breast cancer.
There is also a suspicion that the disease may be related to rare infectious diseases, said Candela. Egypt has a 5% to 6% incidence of breast cancer in men--compared to the U.S. rate of 1%--and that difference may be explained, he said, by a disease that is common there that raises the estrogen level in the blood. Such elevated levels of estrogen may be linked to a greater risk of breast cancer, Candela said. And men who have Klinefelter's syndrome, a rare chromosomal abnormality, have the same risk for breast cancer--one in every 14--as do women.
Because the cause is unknown, breast cancer cannot be prevented, said Candela, and the best a man can do is to get a lump detected and evaluated early. Routine mammograms for men are not recommended, he said, because the disease is so rare.
Senofsky suggested that men with a strong family history of breast cancer should do a monthly self-examination of their breasts--just like a woman's self-exam--systematically checking the breast, looking for lumps or changes.
Is there a stigma for a man to get a disease so closely associated with women? Candela said he hasn't noticed that's a problem. "Men appear to be unaffected by the diagnosis and have not said they felt less manly," he said.
It is possible for a man to have nipple and breast reconstruction surgery, but few men opt for such a surgery after mastectomy, he said. Only about 20% of women get reconstructive breast surgery after mastectomy, nationwide.
Subbotin said he wants to help educate men about the facts of breast cancer. "The odds may sound small, but I figured it out," he said, "and about 25 men--just in Los Angeles--will get breast cancer every year."
WHERE TO GO
Information: To find out more about breast cancer in men, contact the American Cancer Society, (818) 989-5555.