Usually considered to be a woman's disease, breast cancer can also affect men. A campaign hopes to improve early detection rates, writes Ciarán Brennan
In the 1970s film of the same name, Shaft embodied the suave, ultra slick, cool, lady-loving male. It was somewhat ironic that Richard Roundtree, the actor who played John Shaft, was later stricken with a disease that is largely, but mistakenly, regarded as a women's-only ailment - breast cancer.
After undergoing a double mastectomy and chemotherapy to treat the disease, Roundtree survived and now campaigns to promote early breast cancer detection for males.
Breast cancer is largely viewed as a woman's disease because it is rare in men.
"People do associate breast cancer as a female disease and there is a lot of anecdotal evidence that men who had breast cancer had no idea they could get it until they got it. That is something we are trying to combat," says Ian Manley, spokesperson with the UK's Breast Cancer Care.
Of the 42,000 cases of breast cancer diagnosed in the UK each year, around 300 involve men, while 2002 figures from the US show that male breast cancer accounted for 1,600 new cases or 1 per cent of all breast cancer.
"Male breast cancer accounts for less than 1 per cent of all breast cancers diagnosed in Europe," says Dr Patricia Fitzpatrick, epidemiologist at BreastCheck and senior lecturer at the UCD School of Public Health & Population Science. "Figures from the National Cancer Registry show that in Ireland on average 14 men are diagnosed with breast cancer each year and five men die from the disease. There are some differences in rates between countries largely related to presence of risk factors."
Age is an important risk factor, according to Fitzpatrick. The average age at diagnosis in men in most series of cancers is 68 years, compared to 63 for women. However, younger men do present with the disease.
Family is also a factor and up to 20 per cent of men have a first-degree relative with the disease. "There are some families who carry a mutation of the BRCA2 gene and in those families male breast cancer is much more common," explains Dr John Kennedy, consultant medical oncologist in St James's Hospital.
"BRCA2 predisposes people to get breast cancer and a number of other diseases. People with Klinefelter syndrome are also predisposed to getting breast cancer. It's an extra X chromosome. Males are XY, females are XX and Klinefelters are XXY and they have a slightly increased risk of getting breast cancer and testicular cancer. Certainly males who carry these mutations should be aware of this risk that they have. But they are rare families. They're rare conditions."
Obesity and chronic liver disease, both of which cause high oestrogen levels, excessive alcohol consumption and repeated and prolonged exposure to radiation, such as radiotherapy treatment to the chest wall, particularly when young, are also risk factors, according to Fitzpatrick.
Treatment of the disease is the same for men as for women and, if discovered in time, the survival rates are similar. But men who have breast cancer usually discover the disease later than women, when the tumour is larger and the cancer has spread, according to the findings from the largest-ever study of male breast cancer in the US.
"It appears that clinical outcomes for breast cancer in men are similar to those for women when they are matched for age, treatment and for stage of cancer. The impression that male breast cancer has a worse prognosis may stem from the tendency toward diagnosis at a later stage. Men may delay presenting for treatment and so may be at a later stage when diagnosed, with resultant worse prognosis," said Fitzpatrick.
Kennedy agrees that men tend to present later, leading to a later diagnosis.
"Men with breast cancer tend to have a little more advanced disease in general maybe because they do not think of the possibility that they have breast cancer, but also because the breast is smaller in men and it is easier for it to involve the skin and easier for it to involve the muscles underneath the breast than it is in women," he says.
Apart from the physical challenges of overcoming the disease, some men find it difficult to deal with what society still sees as a woman's issue, according to Manley.
"With any cancer, there are also going to be psychological issues but I think one of the additions with breast cancer is that men with breast cancer can feel quite isolated. Only 300 are diagnosed in the UK each year and a lot of the material you see that cancer charities put out is very focused on women," he says.
Breast Cancer Care has developed a booklet especially for men with the information geared towards them, according to Manley. The key, he says, is to get any symptoms checked out as soon as possible.
THE COMMON SYMPTOMS OF BREAST CANCER
Lump around the nipple or any other area of the breast
Nipple discharge (may be bloodstained)
Tender or drawn-in nipple
Ulceration or swelling of the breast
q Swelling of the lymph nodes under the arm