For Michael Smith, a day of fishing in Ocean City, Maryland, led to a moment that changed the course of his life. While helping his wife clean up their fishing gear, her shirt button brushed up against his right nipple and he felt a slight pain. Something didn’t feel right, so Smith, a retired flight engineer who had served at Dover Air Force base, decided to go to the Veterans Affairs Medical Center to get it checked out. What the doctor told him shook him to his core.
“The VA hospital doctor diagnosed me with stage 2 breast cancer and told me we needed to do surgery right away,” Smith recalls. “I thought I just had a cyst that would need to be removed—it was only about the size of [the tip] of a ballpoint pen—and it turned out I needed a total radical mastectomy. I was numb with disbelief, but I credit the VA doctors with saving my life. They didn’t waste any time and prevented the cancer from progressing to the next stage.”
Following the surgery, Smith took tamoxifen—a hormonal drug that blocks estrogen found in breast tissue—for 4 1/2 years. He’s now been cancer-free for more than 18 years. He has no family history of breast cancer and had no other risk factors for the disease.
“This was an eye-opener for me, my family and my friends,” Smith says. “Most men still feel like it’s a female disease, but we now know that although it is rare, it can happen to any of us.”
According to the American Cancer Society, less than 1 percent of all breast cancers occur in men. In 2021, about 2,650 men in the United States are expected to be diagnosed with the disease, and an estimated 530 men are expected to die from breast cancer. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 833. In the state of Delaware, only 36 cases of male breast cancer were reported between 2012 and 2016, averaging less than 11 cases per year, according to statistics from the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) Program.
Smith turned to the Delaware Breast Cancer Coalition for support and now works with the Wilmington-based nonprofit organization to help raise awareness of breast health issues through survivorship support services, outreach and education to help facilitate the early detection and treatment of breast cancer.
“I speak to a lot of different groups about my experience and educate men in particular to speak up if they feel anything unusual or abnormal,” Smith says. “My goal is to mentor others and encourage men to take responsibility for their own health.”
Male breast cancer can occur when there is an abnormality with men’s breast tissue due to hormonal issues, age, side effects from certain medications, genetic abnormalities, chronic liver disease, diabetes or obesity. Men don’t need to have a family history of breast cancer to be prone to the disease.
“A lump in a male breast is never normal and should always be evaluated,” advises Dennis Witmer, M.D., a board-certified general surgeon who practices breast surgical oncology at ChristianaCare’s Helen F. Graham Cancer Center & Research Institute in Newark. “A breast cancer mass almost exclusively occurs behind the nipple,” he explains. “Additional indicators include nipple pain, bleeding or discharge from the nipple, swelling of lymph nodes under the armpit or sores on the nipple or areola.”
“Most men still feel like it’s a female disease, but we now know that although it is rare, it can happen to any of us.”
While breast cancer in men may present slightly differently than in women, the course of identification and treatment is somewhat similar.
“If a man notices any kind of lump in the breast area, we recommend they start with a physical exam by their medical provider. This will most often be followed by some imaging, including mammograms of both breasts to make a comparison, ultrasound to find out if the mass is solid or fluid-filled, and a biopsy to distinguish normal tissue from cancerous tissue if needed,” says Renee
L. Quarterman, M.D., FACS, a board-certified breast surgeon and independent practitioner at Delaware Breast Care in Wilmington.
“More frequently, men will present with a condition called gynecomastia, or excess growth of breast tissue due to abnormally high levels of estrogen, which is not cancerous. This usually occurs on both breasts and feels more rubbery and tender,” she explains.
The treatment of male breast cancer typically parallels that of female breast cancer patients.
“While men tend to present at later stages with larger tumors and often require mastectomy, we can perform minimally invasive treatments, including anti-estrogen/hormonal treatment or removal of lymphatic tissue, and most men are candidates for additional treatments such as radiation and medications that improve survival,” adds Dawn J. Leonard, M.D., FACS, a fellowship-trained breast surgeon and chief of the Division of Breast Surgery at ChristianaCare in Newark. “We also recommend that any men diagnosed with breast cancer undergo genetic testing.”
The good news is that the majority of men diagnosed with breast cancer will survive the disease.
“Stage for stage, the prognosis for men diagnosed with breast cancer is no different than women,” says Witmer. “The outcomes are generally the same. If caught early, breast cancer is a very survivable type of cancer. Our goal is to take away patients’ fear, offer them the best options for treatment, provide a lasting cure and refer them to support groups to aid in their recovery.”
While the risk of developing male breast cancer remains small, there are a number of preventive measures men can take to bring down their risk even more.
“There are many lifestyle changes men can make to reduce their risk of developing breast cancer,” says Quarterman. “Exercising and staying active, eating a heart-healthy diet, watching your weight, minimizing alcohol consumption, and keeping your blood sugar well controlled if you have diabetes are important measures you can take to stay healthy, in addition to knowing your family history and performing self-examinations.” Leonard stresses, “If there’s a mass or change in your breast area, always seek medical attention. There is no stigma attached to male breast cancer. If you suspect a problem, don’t hesitate to have a discussion with your medical provider.”
Related: 4 Common Men’s Health Conditions and How to Combat Them