HAVE A CLOSER LOOK AT YOUR NIPPLES: IT COULD SAVE YOUR LIFE
Next time you look in the mirror, take a look at your chest – particularly at your nipples. Many people are unaware that men can get breast cancer too and that it is just as serious for them as it is for women.
Some men are more at risk than others, and the earlier their breast cancer is treated, the better are their chances of survival. Male breast cancer can be familial, as in the case of a West Australian father and son. In 1969 the father had a mastectomy after discovering a 4 cm lump under his right nipple. Despite the surgery, he died in just 2,5 years from widespread cancer.
About 25 years later his son, then a 40-something gardener, was lying in bed reading when his arm brushed against his chest and he felt a small, firm lump about 1 cm in diameter near his right nipple. From his father’s experience he knew not to ignore the lump and promptly reported it to his general practitioner. When it was found to be malignant, he went on to have a mastectomy, followed by radiotherapy. Within a year he was declared clinically free of cancer. His small tumour had been found very early, while it had still been confined to the breast. There was no evidence that it had spread.
Men who have a family history of breast cancer, among either male or female relatives, are at a greater than average risk of getting the cancer. Accordingly, this man’s older brother was checked. No evidence of breast cancer was found. However, his son and daughter are regarded as being at risk and have been advised to start being screened regularly in their early 20s.
There are mounting numbers of cases of familial breast cancer in men, including cases of brothers with the cancer and a case of an uncle and nephew who both had the disease. About 60 per cent of men in these cases also have female relatives with breast cancer.
The risk of breast cancer in men increases as they age. The cancer usually appears 5 to 10 years later in men than it does in women, with most men being diagnosed between the ages of 59 and 64. Treatment commonly involves surgery, radiotherapy and, if necessary, chemotherapy and hormone therapy.
According to the National Breast Cancer Centre (NBCC), 70 Australian men were diagnosed with breast cancer in 1994 and 20 died. By comparison, that year 9694 women were diagnosed and 2669 died.
The male breast is similar to that of a prepubescent girl. It is capable of responding to hormones, and during adolescence, about 40 per cent of boys experience temporary breast enlargement. These swellings are not just fat but are distinct small breasts composed of real breast tissue. They usually occur on both sides and can be as small as a button or as big as an inverted saucer. This male breast enlargement is known as gynaecomastia and usually disappears spontaneously after 1 or 2 years. But it commonly returns in older age. It is estimated that 30 per cent of Australian men over the age of 50 have some breast swelling. Mostly the swelling is a response to a change in hormonal balance, but it can also indicate a problem with the liver, adrenals, thyroid, kidneys or testes.
Commonly prescribed drugs also cause this enlargement. Some antidepressants, tranquillisers, amphetamines and heart and anti-ulcer medications can affect hormone levels, as can recreational drugs like marijuana, alcohol and heroin.
The NBCC says the relationship between gynaecomastia and breast cancer is unclear. Sometimes the two are associated, but mostly they are not. However, if the gynaecomastia occurs on one side only, it could be a sign that something is wrong. While gynaecomastia produces a well-defined tender swelling, a malignant lump is more likely to be hard, irregular and painless.
Men with a malignancy are more likely than women with the same condition to have nipple discharge (sometimes bloody) and signs of local spread such as a retracted nipple and skin ulceration. Because the male breast doesn’t have the bulk of a female breast, the tumour is closer to adjoining structures and can invade these more readily.
Men who discover their own breast cancer tend to delay seeking medical help. For some the delay may, in part, occur because they consider breast cancer a sign of compromised masculinity and are loath to acknowledge its existence.
The NBCC says breast cancer affects 14 black men in every million and 8 white men in every million. Some studies have suggested the incidence is higher among Jewish males of European ancestry.
There arc pockets around the world where the incidence of male breast cancer is unusually high. In Egypt males account for 6 per cent of all breast cancers. In Zambia this figure is 15 per cent. Because the incidence is generally so low, there is very little research being conducted into male breast cancer in the world today.
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