ALBUQUERQUE, N.M. — Robert LaMance says matter-of-factly with his slow cowboy drawl, “I’ve had every bone in my body broke twice.”
A former professional rodeo bronc and bull rider and now-retired ranch hand, LaMance has taken his hard knocks. So it’s not surprising the 62-year-old Los Lunas resident has a bit of arthritis. And that’s what saved his life.
An arthritis specialist found a knot in LaMance’s left breast, a knot that LaMance says formed 30 years ago after he was kicked by a horse. Further tests, including a biopsy of the lump, revealed that he had breast cancer.
Robert Plunkett, 88, a retired professional chef at Kirtland Air Force Base Officers Club, was doing repairs to the roof of his Albuquerque home when he accidentally plunged through a skylight, injuring himself severely.
“I went to the hospital and they did every kind of test and scan and X-ray you can imagine. That’s where they discovered lumps in my right breast,” he says.
Plunkett also received a diagnosis of breast cancer.
While it is not on most men’s medical radar, it should be, says Dr. Jane Kanowitz, a medical oncologist specializing in breast cancers at Presbyterian Medical Group who has treated both men. “It is extremely rare, with a female-to-male occurrence ratio of about 100 to 1. There are only about 2,000 new cases of male breast cancer per year in the United States. … For reasons we don’t entirely understand, the incidence of male breast cancer has increased about 25 percent over the last 25 years, or about 1 percent a year.”
Who’s at risk
Men share some risk factors with women, Kanowitz notes. These include a family history of breast cancer; being of Jewish ancestry; having a sedentary lifestyle; being obese; or having previous chest exposure to radiation for treatment of such diseases as Hodgkin’s lymphoma.
This last risk factor more frequently occurred “in the olden days, 10-15 years ago, when beams of radiation were not as precise,” Kanowitz says, and radiation therapy directed at zones of the chest may have washed over and affected nearby breast tissue.
Genetics, of course, is another risk factor for men and women, she says. Both can carry the BRCA gene mutation, which has been linked to hereditary breast cancer (as well as hereditary ovarian cancer in women).
“Of every 100 women diagnosed with breast cancer, 15 of those cases are linked to the gene and of every 100 men diagnosed with breast cancer, seven of those cases are gene linked,” Kanowitz says.
But men face breast cancer risk factors specific only to them, including gynecomastia, the abnormal development of male mammary glands; chronic liver disease; and testicular conditions, such as inflammation, injury or undescended testes.
Estrogen plays a role in female and male breast cancers. Women generally have more estrogen but still have some testosterone; likewise, men have more testosterone, but they too produce a small amount of estrogen (some of which is produced by fat cells, which is why obesity is a risk factor).
“Many breast cancers receive chemical signals from estrogen to grow, but not all,” Kanowitz says. “Those that do tend to be slower growing and less aggressive. More male breast cancers have that feature present in which the cancer is getting the signals from estrogen, so they’re slower growing. But it is still a growth signal.”
The bottom line, Kanowitz says, is when cancer is found at the same stage among men and women, the survival rates are similar.
Because women and their doctors have been conditioned to look for breast cancer with self-examinations, doctor examinations and routine mammograms, ever more women are diagnosed earlier. The female survival rate ranges from 87 percent to 95 percent, depending on the type and aggressiveness of the cancer, at what stage it was diagnosed, and which treatment options are selected.
But often male breast cancers are diagnosed at later stages, quite simply because “men don’t look for it and doctors don’t normally check for it until it’s pretty far advanced,” Kanowitz says. Because the male breast is smaller than the female breast and has far less tissue, the disease often spreads to the chest wall.
The traditional surgical approach to breast cancer is a mastectomy, removal of the breast tissue. Women who are diagnosed early and have localized cancer can have a lumpectomy, which conserves much of the healthy breast tissue, she says. That’s usually not an option for men.
Radiation therapy sometimes follows surgery but seldom do doctors opt for that as a lone treatment. That’s because the cancer can spread, so it’s more common after surgery to to attack the cancer systemically. Those therapies aim “to eradicate rogue, microscopic cancer cells that could gravitate to other parts of the body, even if those cells cannot be detected by imaging or laboratory tests,” Kanowitz says.
Systemic therapies include administering hormones as a pill to diminish or block estrogen signals that tell cancer cells to grow; chemotherapy with anti-cancer drugs usually administered through an intravenous drip, to prevent fast-growing cancer cells from reproducing; and targeted therapies in which those cancers that have cells containing surface receptors can be treated with specific IV anti-cancer drugs designed to target those specific cells.
Just as women, who 30 years ago began taking breast cancer out of the closet by talking about it, putting a face to the disease and pushing for more research and treatment options, men, too, have to come out of their mancaves. More are pushing the topic into public dialogue and talking about it with their doctors.
“It’s not in their consciousness, it’s not in their vocabulary, and that’s the first thing that has to change to raise awareness,” Kanowitz says.
Neither LaMance nor Plunkett, both of whom underwent mastectomies, have to be convinced.
“I couldn’t believe it. I thought it was a woman’s disease,” says LaMance. “The cancer was going on what they call Stage 4, so it was pretty advanced. They removed my left breast and three lymph nodes. I have a huge scar and there’s some numbness. It’s not too pretty and I don’t sit around the house without a shirt anymore.”
Currently, LaMance is on a regimen of post-operative chemotherapy, once every three weeks for a year. It is administered intravenously through a portal in his chest.
“The surgery was nothin’ compared to that damn chemotherapy,” he says. “I’ve never felt this sick in my life. Some days I can’t even put my pants on; hell, some days I can’t even get out of bed. I lost all my hair. It’s done a number to me, but they tell me that’s the way it has to be so I’m optimistic. I ain’t never let anything beat me in my whole life and I’m not going to let this beat me now. I’m too old and ornery, that’s what kept me alive; but even a tough, old cowboy can get breast cancer. I’m living proof of that.”
Plunkett’s breast cancer was caught quickly, even if inadvertently, and he did not require post-operative chemo or radiation therapy.
“I never thought about breast cancer before, it was no concern of mine whatsoever. What man does think about it?” he asks rhetorically. “They should, but they don’t and doctors don’t look for it during a man’s yearly physical. I’m just lucky mine got caught mine early enough, so, of course, now I’m grateful for what took place – not that I enjoyed falling through a skylight.”