A Guy's Breast Cancer and Hot Flashes

The case was fairly routine: The patient felt a lump smaller than a pea, had a mammogram, got a diagnosis of breast cancer and quickly underwent a mastectomy.

What was different is this patient was a man -- Mike Nelsen, a 49-year-old high-level sales executive who never saw himself at risk. "I remember distinctly sitting in a conference room when my cell phone rang," Nelsen said recently. It was his doctor, so Nelsen walked out into the hall to hear the news. "I guess I don't get shocked by a lot but I didn't even think men could have breast cancer. I'd never heard of it before. He said, 'There's 180,000 women and 2,000 men -- and you're one of them.'"

The diagnosis put Nelson into an overlooked and understudied group. While decades of research into breast cancer in women has led to more effective treatments and improved outcomes for patients, comparatively little attention has been paid to the disease as it strikes men.

The common lack of awareness about male breast cancer can be lethal. Diagnosed at the same stage of cancer, men and women of the same age do equally well. But the disease tends to be caught later in men, giving it time to grow and spread and wreak havoc in the body.

"Men are different than women. They think it's not really a lump. It'll go away. I'll ignore it," said Dr. Michael J. Schultz, Nelsen's oncologist at the Breast Center at St. Joseph Medical Center in Towson. "Women are conditioned: If it's a lump, I've got to take care of it."

Men "just can't believe it -- I'm not a woman [they say]. How can I have this? It's sort of a challenge to their masculinity but any cell type in the body can develop a mutation and develop into a cancer cell. It's all around us."

Schultz said that while male breast cancer is something to be aware of -- men do have breast tissue -- it certainly should not be added to the list as yet another thing to worry about. The diagnosis is a rare one.

Still, efforts are under way to learn more about male breast cancer, which kills fewer than 500 men each year in the United States. Up until now, the data has been limited and collected over so many years as to not be valuable. An international consortium is currently in the process of collecting 1,000 tissue samples from male breast tumors from 100 medical institutions across the globe in hopes of learning more.

"The whole trend in cancer treatment in general and breast cancer in particular is trying to individualize therapy for the individual patient's cancer -- targeted therapy," said Dr. Monica Morrow, chief of the breast service at Memorial Sloan-Kettering Cancer Center in New York. And little is known about how to do that for men. "There is something fundamentally different about the hormonal environment in men."

Dr. Sharon H. Giordano, an oncologist at the University of Texas M.D. Anderson Cancer Center in Houston, said a clinical trial was opened to study a hormonal breast cancer treatment in men. But without enough cases of the disease to enroll enough men in the trial, the trial was canceled.