When the Doc Thinks You Have Male Breast Cancer
Note: For the purpose of this series, gendered nouns and pronouns are intended to refer to people with a Y-chromosome, not to the accepted definitions of gender by medicine and psychology.
This is a personal story of a man thought to have a “woman’s disease” and how that was sorted out.
Breast cancer can appear in both men and women, though in men it is much less common as men have less breast tissue than women. The American Cancer Society has a good explainer of male breast cancer here.
Diagnosis of breast cancer in men is the same as in women, by mammograms. There are two types of mammograms: a) Screening tests, which are those women get on a regular basis to ensure they do not have suspicious areas of breast tissue which may develop into cancer or already have, and b) Diagnostic tests, which employ far more powerful X-ray pictures to pinpoint the location of problematic areas.
The disease is frequently more severe in men, because men have much less breast tissue. As such cancer quickly invades other structures outside the breast, such as the skin, sternum, lymph nodes, &c.
Men will also ignore (or not recognise) problematic areas in the breast, so often do not seek a physician for advice until the disease has progressed much later.
In my case, pain behind the nipple began back in March. It quickly spread into my armpit and the entire surface of my breast area. It was accompanied by a hard lump behind the areola (the area surrounding the nipple).
I called in to the Veterans Administration seeking an appointment to diagnose the pain and swelling. After hearing my description of the symptoms, the VA skipped the “go to the doctor” part and went straight to “get a mammogram” part. They explained the concern the symptoms might indicate breast cancer and the need for a quick diagnosis.
For men, treatment options are similar to women: Radiotherapy, chemotherapy, hormone therapy, or a radical mastectomy (so-called lumpectomies are not done on men as men have so little breast tissue).
The VA here is not set up to do mammograms, so they set about finding a hospital or clinic in the three-state area around me which could perform a mammogram on a man.
In the days the VA was doing that, I started looking into the issue, and reading support groups for men on-line who were diagnosed with the disease. Most men in those groups spoke of poor treatment by medical personnel and rejection by friends.
Those fortunately weren’t my experience. The hospital’s personnel were extremely sympathetic to my plight, and treated me with dignity and respect. Friends and family also have been sympathetic.
Most of my check-in with the breast health clinic concerned verifying I was who the VA sent there for the examination. The VA had already sent them my relevant health records and voucher for payment.
The mammogram itself was not hard to do and only took a few minutes. Unlike all the horror stories I received, the device was not particularly painful (though manipulating my breast to get good pictures was).
After waiting some time, the radiologist told me that the likelihood of breast cancer based on the pictures was very small. His provisional diagnosis was gynecomastia (breast growth in men caused by hormonal imbalance between testosterone and oestrogen). The disorder is not related to obesity-related growth (I am underweight); actual breast structures are created rather than the deposition of fat.
That disorder is most common in teenage boys and aging men. For teenage boys the problem usually goes away at the end of puberty; for aging men a drop in testosterone or increase in oestrogen triggers gynecomastia.
That trigger can also be caused by medications used to treat certain diseases or disorders (I do not take any of those). It can also be caused by cancers in other hormone-producing organs. In about 25% of cases the cause is ideopathic (duh, we don’t know).
As such, the hospital will send those materials back to the Veterans Administration, and they will consider the next steps to take.
The photograph is of the mammography machine at Regional West Medical Center which I took before the procedure started. The device in the centre is the actual X-ray machine; the console to the right (cropped to remove the X-ray technician’s face at her request) is the control panel for the machine.
Thanks to Regional West Breast Health Center in Scottsbluff, Nebr. for their kind, dignified, and efficient care.