David: My mom and two of her sisters have each had double mastectomies. My mom's first cancer was at age 35, which is my age now.
I don't have any lumps, but should I be examined for breast cancer?
Dr. Dean: The answer to your question is yes. Men are only about two percent of all breast cancer cases, but breast cancer in men is often fatal because the symptoms are ignored.
You would be wise to do a self-exam when you take a shower. Your chest, being flat, will be easier to examine than a woman's chest is. Soaping your breasts makes them slippery and helps you feel the details of the tissue better. This is true for women, too, of course.
If you find a lump, you should get a mammogram. Believe it or not, they can pinch enough tissue in a male's chest for a mammogram. I don't think there is a recommendation for routine mammograms for men, but because so few protocols exist, I suggest you do your own extensive literature search.
Even with your family history, not enough is known about male breast cancer for me to tell you how high your risk is. I do think your risk for prostate cancer might be elevated, so you should be vigilant about getting your examinations.
We're entering the second decade of public and professional education and awareness regarding breast cancer. There are 17 major national nonprofit cancer organizations working to ensure that the media and communities everywhere focus a spotlight on the problem of breast cancer (in women.) So why are we talking about this subject in a men's site? Because, while it is a relatively small number Breast Cancer Kills Men, Too. (2007 - 1,990 new cases of breast cancer in men and 450 deaths.) So, if all of this awareness is out there why haven't I found a man yet that wasn't amazed to know that men can even get breast cancer? And, here's the BIG ONE. Relative delay in diagnosis of men versus women: 18 months. So, chances are, our cases are more advanced resulting in higher mortality rates.
I once went through the many men's health books looking for information on breast cancer. Most of the indexes go from "breakfast" to "breath, bad". The Man's Health Book by Michael Oppenheim is the ONLY one that even acknowledged the possibility, and it was published way back in 1994. Here's what they say: "Male breast cancer is about one fourth as common as penile cancer. The mortality rate is greater in men because they lack the frightening awareness that's almost universal among women. A soft lump behind the nipple is probably gynecomastia; a hard lump points to cancer. Either is worth a trip to the doctor." That's it for breast cancer in men. They do have several pages concerning Gynescomastia (abnormal breast swelling) for men. What we do know is that, generally, breast cancer is usually more common in men over 60 with higher than normal levels of estrogen. Personal and family history of breast cancer is a factor. Signs are a lump, thickening, swelling, discharge or other changes in the breast.
Ladies, give your breasts a rest, research says
Permission to skip self-exams a relief for some, perplexing for others
So it was with a certain amount of relief that I read a new analysis confirming that the breast self-exam (or BSE) truly doesn’t make much of a difference after all.
According to a review by the Cochrane Collaboration, an international organization that evaluates medical research, there’s no evidence that self-exams actually reduce breast cancer deaths. In fact, the often-recommended monthly chore may even do more harm than good, according to the group’s analysis of a pair of studies of nearly 400,000 Chinese and Russian women.
“Data from two large trials do not suggest a beneficial effect of screening by (BSE) but do suggest harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed,” concluded the authors in Tuesday’s issue of The Cochrane Library. “At present, screening by breast self-examination … cannot be recommended.”
One fewer thing to do?
Chris Herget, a 44-year-old notary public from Bellevue, Wash., says while she’s surprised to hear this news, she, too, feels relieved.
“I’ve never really felt competent doing it myself anyway and I have very fibrous breasts so everything feels like a ‘pea,’” she says. “In fact, the first time I told a doctor that I thought I’d found a lump, he was like, ‘That’s nothing, that’s a fat cell.’”
But the news that the BSE is officially on the way out perplexes others.
“I guess it’s one less thing that I need to be doing, but it is a little confusing,” says Liz Lane, a 29-year-old public relations manager from New York City. “Now I’m not sure what I am supposed to do to check myself.”
The issue is complicated, acknowledges Dr. David B. Thomas, breast cancer epidemiologist at Seattle’s Fred Hutchinson Cancer Research Center and professor of epidemiology at the University of Washington.
“It’s important to separate out the public health implications from the implications for an individual woman,” says Thomas, who is also the author of the 2002 landmark study involving more than 250,000 Chinese women that was analyzed and affirmed by this latest review.
“If a woman is highly motivated — let’s say her mother or sister has been diagnosed with breast cancer — then of course she should practice breast self-exam. But that’s a different situation than trying to reach women on a mass scale. Our study shows that that’s probably a waste of time. You’re not going to get women sufficiently motivated to practice it well enough and frequently enough to make that big of a difference.”
Lumps and bumps can be normal
What’s more, Thomas says BSEs can be problematic because the lumps and bumps women do report often turn out to be benign.
“The price you pay for doing more thorough breast exams is you’re going to find more benign lesions and that will result in unnecessary surgical procedures,” he says.
Rhebe Greenwald, a 65-year-old retired art director and systems analyst from Port Townsend, Wash., has experienced this firsthand.
“I’ve never felt breast self-exams were that useful for me,” she says. “I’m extremely lumpy and I’ve had three benign tumors removed that were all found through self-exams. The last time, they removed about a quarter of the tissue in my breast and found nothing.”
But others, like Dianne Pomon, a 59-year-old registered nurse and breast cancer survivor from Pottstown, Pa., swear by the BSE.
“I’ve been diagnosed with breast cancer three times and found the lumps myself every time,” she says. “I would strongly encourage women to check themselves every month.”
What's a woman to do?
What’s a woman to do? It all depends on your age and family history, says Thomas.
“Women in their 20s and 30s rarely get breast cancer,” he says. “But they do have a lot more benign lumps and bumps. It’s not worth emphasizing breast self-exams for women at this age.”
As we get older, though, the benign lumps tend to go away and the breast cancer risk goes up.
After age 50, though, an annual mammogram is a proven lifesaver, he says, reducing the risk of breast cancer death by about 30 percent to 40 percent. And women who know they’re at high risk for breast cancer may be able to enhance the benefit of mammograms with diligent BSEs between screenings.
As for me, while I'm relieved to scratch breast self-exams from my to-do list for good, I’ve got no problem putting my girls into the hands of true professionals. I’m heading for the local breast health care center for my annual mammogram. It’s time.