Though rare, male breast cancer causes concern

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SHREVEPORT, La. (AP) — "Hey, you've got an innie and an outie."

With those words, Jane Jackson may have saved her husband's life 15 years ago.

"We were swimming and she looked down at my chest," said Dr. Robert Jackson, 57, a Shreveport internal medicine specialist. "Inversion of the nipple is a common sign of breast cancer. So I looked down and sure enough, one of my nipples was inverted. That was new. I naturally put my hand up there. It was the first time I felt a lump that was noticeably a lump."

So began more than five years of treatment for Jackson, who graduated from the medical school in Shreveport in 1982 and joined its faculty in 1986. He had a modified radical mastectomy, six months of chemotherapy and five years of hormonal treatments.

"I did not have to get radiation," said Jackson.

Now he just sees his primary care doctor annually.

Despite advances in treatment and detection, that doesn't mean he breathes easy.

"Breast cancer is known for its late recurrences, so that old story about 'if you're cancer free for five years it's OK' isn't true.'"

He continued to see his specialist, Dr. Gary Burton, oncologist at Feist-Weiller Cancer Center, for another five years.

Like most men, he hadn't seen a doctor regularly. Cancer changed that.

"The need for some regular follow-up caused me to get a primary care doctor," he said. Annual visits for cancer checks are now his norm, but it doesn't keep him awake nights.

When he was diagnosed, Jackson and and another Shreveporter who has been vocal about his battle with male breast cancer, retired LSU Shreveport Chancellor Vincent Marsala, were Burton's only active male patients, but six other men with more advanced cases were being treated symptomatically.

Burton, also a professor at LSU Health Shreveport, said prostate cancer is the most common tumor in men, and lung cancer kills more men and women than any other cancer. "But when you're talking about breast cancer, it's a little less than one percent of all the breast cancers we see in a male," he said. Nationally, he said, fewer than 2,000 a year are diagnosed, with about 450 deaths a year.

Despite advances in its visibility — men now take part in the Susan G. Komen events that have made breast cancer a very high-profile illness — and advances in treatment and research, it remains more deadly for men.

"It's very treatable," says Burton. "If a woman has a breast lump, the chance of it being breast cancer is very low, way less than 10 percent. But if a man has a breast lump it is more likely to be cancer than in a woman." About half of all breast lumps in men are cancerous, he said.

It also may be discovered at a more advanced, and thus deadly stage, than with woman because most men put off treatment.

Burton said that when he was younger, many family doctors didn't believe men could get breast cancer. "The idea, even in the medical community, was breast cancer is a woman's disease, prostate cancer is a man's disease. Well, that's true and not true. Prostate cancer is a man's disease — there's no prostate in a woman to get cancer — but breast cancer is for men and women."

Risk factors for men and women are the same: Family history of breast cancer, smoking and alcohol consumption. Both Jackson and Burton noted that while there's no proven link between gynecomastia, or the development of female breasts in men, and breast cancer, that condition — outside its most frequent manifestation in boys just after puberty — warrants medical investigation. Later in life, gynecomastia can be evidence of changes that could affect a man's health, including the chance of developing breast cancer.

"Men who have breast cancer often have higher estrogen levels than what you would normally see in the male population," Burton said. "That usually means there something else going on hormonally you wouldn't be aware of."

Jackson said, "It's pure speculation on my part, but chronic marijuana use can cause gynecomastia," he said. "With the current movement around the country to legalize marijuana I have to wonder."

Promising research is underway into the genes that trigger the hectic cell growth that can become cancer and genes that apply the brakes to that growth. The genetic abnormality called Klinefelter's Syndrome increases the risk of breast cancer to one in 30, Burton said.

"Normally a female has two X chromosomes and a male has an X and a Y," Burton said. "With Klinefelter you have two X chromosomes and a Y chromosome." That increases estrogen levels, "one of the culprits" in the higher risk, he said.

Some medications, including anabolic steroids, also can cause gynecomastia, Burton said. Studies differ about whether they can lead to male breast cancer, Burton said.

The low incidence makes meaningful studies difficult. Burton estimated in the Shreveport area there are probably 20 to 30 male breast cancer patients, most like Jackson, in remission and monitoring their condition through regular checkups.

"I don't have anybody right now with male breast cancer who has metastatic disease," he said. "Most (are) on follow-up."

There's not enough data, says Jackson, who despite his own brush with male breast cancer says most men should not live in fear.

"I see so many people that are freaked out about everything with health," he said. "I don't think that male breast cancer is something that men need to worry about, but a man well past puberty who notices an unusual appearance or lump that is not symmetrical, needs to go to a physician and have it looked at."

Or, as in his case, if there's a sign like a nipple inversion on one side only.

He paid special attention in part because his mother died at the same age he was diagnosed, 42, and he knew the risk factors.

Points to remember, Burton said, are "One, a breast lump in a man is bad. Two, treatment is very effective, just as in women. Stage for stage, there is no difference in outcome. Take men as a group and women as a group, however, and men do a whole lot worse. They don't get diagnosed early enough.

"If you have gynecomastia, go see your doctor. If it's asymmetric or there's a hard lump it ought to be biopsied. (But) the prognosis for breast cancer has improved a lot. The therapies are making a big impact."

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Information from: The Times, http://www.shreveporttimes.com

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