June 15, 2016 | by Stephanie Smith
Don Hoffman had just gotten out of the shower when he caught a glimpse of something strange in the mirror. His left nipple and areola were flatter than usual and smooth to the touch, while his right side poked out normally.
“I thought ‘Gee that’s strange,’” said Hoffman, who was 71 at the time. “I remember turning to my wife Lois and asking, ‘Does this look strange to you? Should I be concerned?’” Lois, he says, figured it was a consequence of aging: “We’re getting older, our bodies are changing. It’s probably nothing to worry about.”
Hoffman, who started noticing the anomaly late in 2010, took his wife’s advice and shrugged it off. But after two weeks he could not shake the feeling that something was wrong. He decided to get his left breast checked. After examining him, Hoffman’s primary care doctor agreed that something was amiss and suggested a mammogram. The scan revealed a mass in his left breast the diameter of a penny.
Despite having a family tree sagging under the weight of cancer – both of his parents died of lung cancer and a sister was diagnosed with two different types – Hoffman was surprised he got cancer, especially the type he got. “You feel like ‘Golly, how did I get this? It’s supposed to be a woman’s disease,” said Hoffman, now 77. “When I was diagnosed it was like, ‘Wow, this is really unusual.’”
Not just ‘a woman’s disease’
Male breast cancer is unusual. Less than 1 percent of cases appear in men – about 2,600 will be diagnosed this year in men compared to 246,660 in women, according to the American Cancer Society. Still, despite the paltry number of cases, being vigilant is important for men. Breast cancer being cast as “a woman’s disease” means men aren’t checking for it and therefore tend to be diagnosed later.
“The message is the same for men and women, if you notice a new lump or bump in your body – any distortion of what is normal – it should be brought to the attention of your doctor,” said Joanne Mortimer, M.D., director of the Women's Cancers Programs at City of Hope, and a member of Hoffman’s treatment team.
Another wrinkle in the men’s breast cancer story: Studies show that few men are aware that if they carry a BRCA mutation – an abnormality in cells that dramatically increases the risk of breast and ovarian cancer in women – they too are at increased risk of cancer. In men, testing positive for a BRCA mutation means a higher risk of developing not just breast but pancreatic, prostate and other cancers.
Family history, being Ashkenazi Jewish matter
Hoffman’s surgeon, Laura Kruper, M.D., says that among her male breast cancer patients about 60 percent are BRCA carriers while the other 40 percent develop the disease spontaneously. She adds that men should consider getting tested for the mutations if they have multiple family members who have been diagnosed with breast or prostate cancer –especially if they are Ashkenazi Jews, since the risk is higher in that group.
“What I’ve noticed with the men that I’ve seen who’ve developed breast cancer is they had family histories but didn’t think they would be a potential risk,” said Kruper, head of breast surgery at City of Hope. “Men should pay a little more attention to family histories, and if they develop a mass, come in and get evaluated.”
Men: ‘Be aware of your body’
Hoffman fits the profile of someone who should have BRCA on his radar: He is Ashkenazi Jewish and has that family history of cancer. He was not tested until after his diagnosis – he tested negative for the mutation – but he was lucky: He noticed something amiss with his body and got it checked early, so his cancer was caught at a very early stage before it could spread to other organs. Hoffman had a radical mastectomy of his left breast three months after noticing a problem, and now takes the hormone therapy tamoxifen to keep cancer at bay.
He says men should shed any shame they have about breast cancer and be just as aware as women when it comes to their bodies.
“If you consider all the conversation about ‘Be aware of your body’ who are they talking to? Women,” said Hoffman. “Women are much more aware of the fact that they should be examining their bodies. Guys just don’t get it.”
In Hoffman’s view, it is time for men to become a part of that conversation – and start getting it.
This piece is one in a series about men and cancer. Men are diagnosed with cancer later and have higher death rates than women. During Men’s Health Week and Month, City of Hope is offering tips to make men more aware of their risk and to encourage screening. Tomorrow: “Talking to your man about cancer screenings.”
Learn more about City of Hope's breast cancer treatment and research program. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.