September 6, 2004
Bob's Breast Cancer
Everyone is stunned when first diagnosed with breast cancer. I was probably more stunned than most. Being a 40 year old male, breast cancer was somewhere behind being hit by an asteroid on my list of worries.
Early in August of 1996, I noticed a small lump under my left nipple. I wasn't too concerned — I assumed it was a cyst or abscess that would go away in a week or two. Some 3 weeks later, I was driving home from work and felt some wetness on my chest. A quick peek inside my shirt revealed that blood was dripping from my nipple. My first reaction was not of worry, but of surprise at the fact that I had a working orifice there. My second reaction was the gut feeling that the bleeding was related to the lump and that this was not good news. I made an appointment later that week with my family practitioner who said that, although rare, breast cancer does occur in men and that my symptoms clearly merited further investigation. I saw a surgeon later that day and he did a needle biopsy that came back as being suspicious. That led to an excisional biopsy and the pathology report stated that it was malignant — an infiltrating ductal carcinoma — the most common form of breast cancer in both women and men.
Being an academic, I quickly researched the topic of male breast cancer. Roughly one per cent of breast cancers are in men and about one per cent of male cancers are breast cancer. There are about 1400 new cases in the United States every year, mostly in men over the age of sixty. In essence, breast cancer is the same disease in men and women — diagnosis, staging, and treatment are all the same (with the exception that a modified radical mastectomy is the usual surgical intervention since men have so little breast tissue). And, of course, the psychological issues are different. Losing a breast does not have the same significance for a man as for a woman. On the flip side, men are more likely to go around shirtless. I suspect that I'll be the only single-nippled man at the beach this summer.
I had that modified radical mastectomy in late August. Sixteen lymph nodes were examined and one was positive for malignancy. That made chemotherapy a reasonable option and brought me to an oncologist.
Ironically, I'm the first person on either side of my family to have breast cancer (at least, that we know of). In light of the lack of family history, the oncologist suggested that my cancer was probably a bad random event. Most every disease seems to affect some people outside the norm. Usually it's someone else. This time it was me. The oncologist recommended six months of chemotherapy that I recently finished. A person's first round of chemotherapy is an anxiety-producing event of the highest order because you have no internal frame of reference as to what to expect. In my case, actually getting the chemo was rather anticlimactic. It took a half-hour, they put on a band-aid and sent me home. But then it was time to wait and see what would happen once the drugs kicked in. It's an odd window of several hours in which you sit and prepare for bad things to happen. I cleaned my toilet — just in case. Fortunately, my side effects were relatively mild with fatigue being the primary problem. The new anti-nausea medications are wonderful. I never threw up once during all of chemo. Oddly, my dog puked that first night as I waited to be sick. Man's most empathetic friend.
My lowest point was when I examined the survival statistics. I remember reading a table that provided five and ten-year survival rates for people with different stages of breast cancer. The five-year survival rate for persons with my stage of breast cancer was about 80%. Sobering, but reasonably good news. Then I saw the ten-year survival rates. It was closer to 60%. That couldn't be right. We've all heard that, if you survive five years without a recurrence of cancer, you're home free. I assumed that the 60% figure in the table was a misprint. It wasn't. Although the five year benchmark is significant in some cancers, it's no cause for relief in breast cancer because the cancer can recur 10, 15, or 20 years down the line. For the first time, I realized that the five-year survival rates — often lauded in the popular media — weren't synonymous with cure rates. Living five years doesn't mean that I'll live ten years. Shortly after being diagnosed, I opened a fortune cookie and read a message that said, "You have yet to live the best years of your life." I'm still not sure if I should find that comforting or worrisome.
Having a life-threatening illness hasn't transformed my life. I haven't made plans to travel the world or learned how to juggle. But it has made me ponder my time horizon in unexpected ways. For example, how should I allocate the funds in my retirement account? I know that, over the long-term, stocks are generally the best investment and are recommended for planning for a distant retirement. But what if my health deteriorates and I need to leave work in the not-so-distant future? Perhaps I should reallocate the funds into bonds or other more stable investments. I expect to be around to retire at a ripe old age, but I say that with considerable less certainty than I once did.
Whenever I tell someone that I have breast cancer, there's an inevitable pause. The news is so completely out of the blue that everyone's initial reaction is stunned, open-mouthed, silence. I used to think that a person's jaw dropping open was a figure of speech, but I've seen it happen many times over the last few months. In all likelihood, some old friends and acquaintances are learning of my breast cancer by reading this article. Their jaws are likely wide open at this very moment.
I'm the first man to be a full-fledged member of the Ithaca Breast Cancer Alliance. Based on statistics, I'm probably not the only man in this area with breast cancer, but men with breast cancer are not likely to wear pink ribbons or join support groups. It's partly generational — most men with breast cancer are older and just aren't prone to talk about such personal matters. It's hard enough for men to discuss prostate cancer, let alone a female disease like breast cancer.
I've also found the internet to be extremely helpful. Shortly after I was diagnosed, I logged on and searched for the keyword breasts. There were three categories of response: pornography, information about breast cancer, and an astounding number of chicken recipes. Eventually, I joined a Breast-Cancer Listserv — a group of people who share information and support via the internet. For the first time, the notion of a virtual community was not an abstraction. I really do feel a sense of community by sharing with people who have been through the same journey. It's a wonderful resource because it's always available — 24 hours a day — which was especially useful because the chemo wreaked havoc with my sleep patterns.
A few weeks after my mastectomy, I went to a department store looking for a new navy blazer. But I was stumped when having to choose between single-breasted and double-breasted models. Whichever I chose would be making some sort of statement — perhaps the single-breasted would say that I'm proud of my single-breasted self or the double breasted would say that I'm still the same, complete person. But chemobrain made my thinking fuzzy, so I bought a sweater to avoid making a statement that I might regret later.
I'll soon begin taking a drug called Tamoxifen. One common side effect are hot flashes. Let me note that I'm learning more about women's health concerns than I ever imagined. As my women friends enter menopause, they may be calling me for advice. Not many men can make that claim.
There are certain indignities that happen to a man with breast cancer. I once went to the hospital for some lab work and the lab tech, noting the referral slip, asked, "Is this the correct diagnosis?" I suspect that she doesn't ask that question to women with breast cancer. And I felt a little odd going to a women's imaging center for a mammogram. And that center wrote a follow-up letter addressed to Ms. Robert Riter.
The radiology tech did note that I had the hairiest chest she's ever seen in a mammogram room. I think that deserves some sort of award.
Bob Riter is the associate director of the Ithaca Breast Cancer Alliance, Ithaca, NY. firstname.lastname@example.org.
A version of this essay appeared in Newsweek, July 14, 1997.