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Misconceptions about Male Breast Cancer

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Dr. Ellen Zakris, director of radiation oncology at Touro Infirmary (1401 Foucher St., 897-8387; www.touro.com), addresses misconceptions about male breast cancer and shares advice on keeping the disease at bay.

Q: How common is breast cancer in men?

A: It's very uncommon. It's a rare disease. There are 2,000 men diagnosed with breast cancer every year in the United States, and about 450 die per year. [Male breast cancer] is less than 0.5 percent of all male cancer deaths in the United States. It is becoming slightly more common, just like with female cancer — there's a slight increase in frequency. I've probably treated 25 men with breast cancer, and I've been doing this for 20 years. I've treated about 1,000 women or more.

Q: What are some common misconceptions about male breast cancer?

A: First of all, men don't even realize they can get breast cancer, so if they feel a lump under their breast or in both breasts, or under their arm or in their neck, or a skin change or nipple discharge, they don't even think breast cancer. In fact, some physicians don't even think breast cancer; they think there are other reasons for breast enlargement. Men may have to educate their physicians about (performing breast exams) if they have risk factors. Every man I've treated (for breast cancer) went to their primary care doctor with a lump, and it didn't get diagnosed right away.

Q: What are the risk factors for male breast cancer, and do they differ from those for women?

A: They're very similar. There seems to be a higher incidence of breast cancer if you've never been married, if you have liver disease or cirrhosis of the liver, if you're Jewish, if you've had previous benign breast disease, if you have the BRCA2 (breast cancer susceptibility gene 2) genetic mutation, or if you have a family history (of the disease). If you have a genetic disease called Klinefelter's syndrome, then you actually have a 20 to 50 percent higher chance of breast cancer. The more common risk factors in women are family history and not having children. Women who delay having children until they're older have a slightly higher chance of getting breast cancer. Breast cancer is higher in women who are obese, and that hasn't been found to be a risk factor in men.

What should men do to prevent breast cancer? Should they have regular breast exams?

A: They should be aware of their body. If they have a family history or some of the other risk factors, they might want to consider doing breast exams or having their physician do it. We don't really have any studies like we do for women about (whether men should) do breast exams. So, we don't have literature to support the need (for men) to have breast exams, but certainly if they feel a lump, they should bring it to their doctor's attention. If their doctor blows them off and it doesn't go away, they should ask to see a surgeon or someone who treats breast diseases.

What are the signs and symptoms men should be aware of regarding breast cancer?

A: Mass below the nipple, nipple discharge or any type of ulceration, tenderness in the breast or skin changes in the breast ... can be an early sign of breast cancer. Other things are a lump under the arm, which would be a sign of a lymph node that has spread ... or (a lump) below or above the clavicle. More common than breast cancer is something called gynecomastia, which is benign breast enlargement.

What are the common treatments for male breast cancer?

A: To diagnose it, you do a biopsy. The main treatment is a total mastectomy with sentinel node biopsy. If (the cancer) is too advanced, then you can't do a mastectomy; you might want to give chemotherapy first, or radiation. We treat (a man with breast cancer) very similarly to a woman with breast cancer.

What is the prognosis for men diagnosed with breast cancer?

A: The prognosis for men is the same as it is for women. Stage per stage, it's the same survival (rate). What that means is that if you're stage one, you have an 80 percent chance of five-year survival. (Male breast cancer) is one of the diseases that should be picked up early. Men don't have big breasts to examine, so if they get (breast cancer), you can feel it right away.

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