For months, Oliver Bogler ignored the lump he felt behind the nipple of his right breast, figuring it was just a weird little nuisance. But on a rafting trip in Idaho last summer, his T-shirt was stained by discharge when he took off his life vest. That got his attention.
"I'm kicking myself I had not gone earlier," said Bogler, 46. "I should have gone right away. [But] my major worry during this time — and I wrote this down — is looking foolish and having my wife look at me: 'Are you kidding?' So I didn't say anything to anybody."
Bogler, the senior vice president for academic affairs at MD Anderson Cancer Center at the University of Texas in Houston, is undergoing chemotherapy treatments; so far, his tumor had stopped growing. The next step in his treatment is a modified radical mastectomy, then radiation and five years of tamoxifen, which inhibits estrogen from stimulating the grown of breast cancer cells.
According to the American Cancer Society, Bogler's case is rare: About 2,240 cases of breast cancer are diagnosed in U.S. men a year, compared with about 232,000 cases of invasive cancer among women.
And because male breast cancer is rare, most men with the disease do what Bogler did and ignore the symptoms: lumps in a breast, discharge from a breast or other changes in a breast or nipple.
"Both the patient and the doctor often don't have a high level of suspicion it is breast cancer," said Sharon Giordano, Bogler's oncologist. "Some men don't come in, or some doctors don't get biopsies. It is not a common disease, which leads men to being diagnosed at more advanced stages," which are harder to treat.
Most of the time, women receive a diagnosis of breast cancer after a mammogram, said Robert Warren, oncologist and professor of medicine at Georgetown Lombardi Comprehensive Cancer Center. "Most male breast cancer is diagnosed with a presence of mass," he said, which means that "right off the bat, the lump or mass is going to be a later-stage tumor."
Men rarely get breast cancer because they produce very little estrogen, which is associated with female sexual characteristics.
"Exposure to estrogen is the ultimate risk factor for developing breast cancer," said Ben Park, a breast cancer specialist and researcher at the Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical School.
Whether there's a relationship between estrogen and the male hormone testosterone is unclear, Park said. But when breast cancer develops in men, it more often occurs in older ones, at a time when testosterone production is waning.
According to the American Cancer Society, the average age for the discovery of breast cancer in men is 68; the disease most commonly strikes men (and women) between the ages of 50 and 70.
Other potential risk factors, Park said, include a family history of the disease, obesity (fat cells can convert testosterone into estrogen), and alcohol abuse or cirrhosis of the liver. The liver helps metabolize estrogen. Men born with Klinefelter syndrome, a rare condition where men have an extra X chromosome, may be more susceptible to breast cancer, as well as men who inherit a mutated gene. The most common culprit, for men and women, is the BRCA2 gene mutation.
Most breast cancer cells start in the lining of milk ducts in the breast, and they sometimes spread to lymph nodes or other organs.
The size of the tumor determines the stage of cancer, said Vered Stearns, co-director of the breast cancer program at the Kimmel center. Stage II breast cancer, which Bogler has, indicates that the disease has spread into surrounding breast tissue and the tumor is larger than in Stage I.
Treatment, Stearns said, is "based on the tumor stage," which is calculated both on the size of tumor and the determination of how far it has spread.
"We look at how quickly the cancer is likely to grow," she said. "In Grade 3 — that is, a relatively faster-growing tumor — Grade 1 is less likely to come back. In post-menopausal women, the prognosis is a little bit better for older women than younger; same with men."
Much of the breast cancer found in men is receptive to tamoxifen, which works like a key blocking a keyhole, said Otis Brawley, chief medical officer of the American Cancer Society. Estrogen stimulates the growth of breast cancer cells; by inhibiting the growth of estrogen, the drug causes breast cancer cells to stop multiplying.
While tamoxifen is tolerated well by most men, the Lombardi Center's Warren said, some of his male patients have developed hot flashes, reduced libido, weight gain and changes in moods — the "same kind of menopausal experiences as women."
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