Dubai: One of the lesser-known truths about male breast cancer, according to experts, is that many health care professionals will not have come across a single case in their entire lifetime. And herein lies the cause for concern.
Due to the number of male breast cancer cases being very low in comparison to the number of cases detected in women, the statistical narrative of breast cancer tends to divert attention away from the fact that this form of cancer can, and does, occur in men too.
This is not all. Another big concern troubling many medical professionals: the paucity in the number of clinical trials undertaken for male breast cancer. Some medical experts even put forth the argument that many breast cancer treatment drugs are approved only for women.
So, what’s the way forward?
Raising awareness is the first step, say doctors.
“Some men are not even aware they have breasts which makes them ignorant about the chances [of getting breast cancer],” says Dr Wadeh Shaker Aljudi, Consultant General Surgeon, Prime Hospital, Dubai. “Many health care professionals wouldn’t have seen a case of male breast cancer in their entire career. This definitely needs to change.”
Awareness is a must
According to Dr. Pranay Girdhari Taori, Specialist, Medical Oncology, Zulekha Hospital Dubai, health care professionals may miss signs of breast cancer in men “since they have not seen many male breast cancer [cases] in their lifetime ... because the eyes see what the mind knows. This may be a causative factor in an improper understanding of [it]. The solution is [raising] awareness among health care personnel and the public.”
Most men, says Dr Taori, assume that breast cancer is not a concern for them because till now, the media has [mostly] highlighted breast cancer in women only.
“The change has to be brought about through increased awareness about male breast cancer, in people, and among health care professionals,” he says.
“Breast cancer awareness campaigns should include the men in order to educate, spread awareness, which will aid in early diagnosis and increase the overall disease-free survival,” says Dr Verushka Mansukhani, Specialist General Surgeon, Prime Hospital, Dubai. “With this initiative, the male population with breast lumps or any other breast symptoms will come forward without being embarrassed.”
Men in clinical trials
Awareness should be augmented with the inclusion of men in clinical trials for breast cancer, a practice that has yet to be regularised. “This has resulted in infrequency in early diagnosis,” says Dr Mansukhani. “Men tend to be older and more in the advanced stage of the disease at the time of diagnosis, with proportionately higher mortality, although outcomes for male and female patients with breast cancer are similar when survival is adjusted for age at diagnosis and stage of disease,” she says.
Says Dr Taori, “It is not that pharmaceutical companies do not want to invest in male breast cancer studies but as cancer numbers are low, the studies mostly do not reach statistical significance. We oncologists [would] definitely welcome the step of including male breast cancer patients in trials.
“Also, since it is a rare cancer, no single institution can complete any study on male breast cancer. Multiple institutes from multiple countries should participate in trials for male breast cancer so that the results can achieve statistical significance,” says Dr Taori.
Dr Mansukhani advocates support groups for men detected with breast cancer. “[This will] encourage them, once diagnosed, to have the right treatment plan and follow-ups to deal with the emotional and financial stress which this disease can carry.”
Dr Taori concurs. “During treatment, a lot of psychological support from counsellors and psychologists is needed. The support group can also help in uplifting them mentally.”
New treatments
Gita Ghaemmaghami — Regional Communications Director, TikTok MENA, one of the partners for the Pink It Now campaign with Zulekha Hospital, referring to the American Society of Clinical Oncology statistics, said, “For the earliest stages of breast cancer in men, Stages 0 and 1, the five-year survival rate is 100 per cent. Approximately 47 per cent of men with breast cancer are diagnosed with this stage.
“The five-year survival rate for men with Stage 2 disease is 87 per cent and Stage 3 disease is 75 per cent. When the disease has spread to other parts of the body, the stage is called Stage 4.
“The five-year survival rate for men with Stage 4 breast cancer is 25 per cent. Even if the cancer is found at a more advanced stage, new treatments help many people with breast cancer maintain a good quality of life, at least for some time.”
WARNING SIGNS
Painless lump or thickening in breast or in armpit.
Bloody discharge from nipple.
Nipple retraction.
Change in the size or shape of the breast.
Male breast cancer is seen in patients with gynaecomastia or kleinfelter syndrome.
RISKS AND FAMILY HISTORY
Breast cancer has an increased risk with high oestrogen in men and definite familial tendencies are evident, with an increased incidence seen in men who have a number of female relatives with breast cancer, says Dr Mansukhani.
“High-risk factors comprise: family history of female breast cancer, radiation exposure, oestrogen use, diseases associated with hyperoestrogenism such as cirrhosis or Klinefelter syndrome, genetic mutations. [Men with risk factors] should undergo check-ups, radiological examinations and further testing,” she says.
“Most breast lumps in men are actually a condition called Gynaecomastia, a button-like growth that can be felt and is sometimes visible to the naked eye. This is not a tumour and occurs due to changes in hormone balances. It’s not unusual and it’s temporary. Hence a proper clinical examination is required to distinguish between the two conditions,” she says.
Dr Taori: “Male breast cancer is linked to family history. It is better if men go for annual check-ups after the age of 50 to be aware of warning signs.”
