Breast cancer more aggressive in men

As we mark the breast cancer awareness month,  Health&Beauty honours those we have lost, lends strength to those who carry on with the fight and pledges to create awareness on the fatal disease. Today, we focus on men.  Agnes Kyotalengerire explores breast cancer, the silent killer among men

My name is Alfred Nyeko. I am aged 48, and have four children. I vividly recall the fateful evening in May 2010. As I put off my shirt, I noticed a swelling on my right breast. I ignored it, hoping it would clear on its own, but the next morning it was still there.

Though not painful, I was uncomfortable, so I consulted my neighbour, who is a senior medical officer.
He advised me to go to St Mary’s Hospital Lacor in Gulu for a check-up, saying one should never ignore a swelling in the breast.

The doctor at Lacor recommended a biopsy (an examination of tissues from a body part to determine the existence or cause of a disease). 

I got the results after two weeks; I had a clean bill of health, which restored my hope. However, the doctor was not convinced and ordered for a repeat of the biopsy, which was done early in September.

Two weeks later, the results were released. The report revealed I had cancer of the breast. I was so worried as I had never thought I would suffer from cancer, moreover of the breast! Besides, we do not have a history of cancer in my family.

However, later, I came to terms with the news and chose to focus on fighting for my life by seeking treatment. I was booked in for surgery on October 8, 2010 at Lacor. The surgery was successful and a week later, I was discharged and referred to the Uganda Cancer Institute at Mulago Hospital.

I was started on chemotherapy (treatment of cancer with drugs). I was given six cycles in intervals of three weeks, which I completed after seven months. I managed to complete the cycles, but the treatment left me weak. I lost all my body hair and my skin darkened.


Later, I was started on radiotherapy (treatment by exposure to a radioactive substance) for six weeks, which also left me feeling very weak. On completing radiotherapy, I was put on Tamoxifen tablets which I have to take for five years. Tamoxifen is an anti-oestrogen treatment; it blocks the effects of oestrogen

The doctors advised me to keep going back to Mulago after every four months for review.
 
However, before I could even go back for my third review, I felt pain in the lymph nodes, around the arm pits. I immediately went back to Lacor Hospital and another biopsy was done. The results confirmed I had cancerous cells in the lymph nodes. The doctors advised me to go back to Mulago for treatment. I am currently undergoing treatment.

As told to Agnes Kyotalengerire

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Factors that fuel the cancer

By Agnes Kyotalengerire

Often people think that breast cancer is a disease that affects only women, which is far from the truth. Dr. Victoria Walusansa, an oncologist (cancer expert), at the Uganda Cancer Institute, Mulago Hospital, explains that breast cancer is a disease of the breast tissue, therefore, both men and women are prone to it.

However, though men are also prone to breast cancer, the condition is more common in women. Worldwide, one out of every 100 cases of breast cancer will be male. According to Mulago Hospital records, since the year started, they have treated two cases of breast cancer in men.

According to records from the radiotherapy department at Mulago Hospital, it is estimated that five to six new cases of male breast cancer are registered in a year.

In addition, the Kyadondo County Cancer Registry 2002 to 2006, reveals that about two in every 100,000 men in Uganda suffer from breast cancer.

Breast cancer more aggressive in men

Uganda Cancer Institute’s Fred Okuku says when breast cancer occurs in men, it is more aggressive than when it affects women. “This is because the male breast is small tissue, hence is quickly ravaged by the cancer.”

He adds that most male breast cancer patients tend to seek treatment in advanced stages. Okuku attributes this to the fact that men rarely get screened for breast cancer, and women are more  likely to feel the tumour while breastfeeding, bathing, or through self-breast examination. The risk factors include;

Age

Dr. James Kafeero at the Uganda Cancer Institute says the risk of men developing breast cancer increases with age. He says men above 45 years are at higher risk. Dr. Jackson Orem, the head of the Uganda Cancer Institute, says as one grows older, the mechanism of controlling growth of the cells weakens.

Aside, Kafeero adds that with increasing age, the ability of the body to expel toxins (waste) reduces. “The toxins have the potential of destabilising the cell’s DNA.”
 
Family history

“Family history, especially breast cancer in first degree relatives ( for instance; father, mother, sister and brother) is also a risk factor.” Kafeero says daughters of men with breast cancer are particularly at higher risk because they tend to have very aggressive form of breast cancer — BRAC, a gene-driven breast cancer.

High oestrogen levels

Like the case is with women, an increase in unbalanced oestrogen levels in men has been associated with higher risks in the development of breast cancer. Oestrogen is the female steroid sex hormones that are secreted by the ovary and responsible for typical female sexual characteristics.

“This is because oestrogen switches on and promotes breast cell growth. This implies that any factor that increases male hormonal levels of oestrogen will directly increase the risk of breast cancer development,” Okuku explains.

Other factors include; a diet full of fatty foods, which can eventually lead to obesity. “For some obese people, the body breaks the fat and turns it into oestrogen hormones, which make the cancer very aggressive,” Okuku explains.

Smoking

Kafeero says though not a major risk factor, smoking is associated with breast cancer.” Most of the male breast cancer patients at the cancer institute have history of smoking,” he says.

According to online sources, experts have not established how smoking increases breast cancer risk, but they say cigarette smoke contains compounds called aromatic amines that are known to cause cancer.

Sedentary lifestyle

This includes not exercising, which increases chances of gaining excessive weight, hence predisposing one to breast cancer.

Consumption of alcohol

Heavy alcohol intake is not only linked with liver disease, but also interferes with, and limits the liver’s ability to regulate blood oestrogen levels. This, therefore, increases one’s chances of getting breast cancer.

Gentic disorders

Okuku says rare genetic disorders like Klinefelter’s Syndrome, a condition where men have low levels of androgens (male sex hormone that is produced in the testes and responsible for typical male sexual characteristics) and high levels of oestrogen, increases the risk of breast cancer development.

Radiation

Okuku says repeated radiation exposure to the chest tissue before the age of 30, particularly during adolescence, increases the risk of developing cancer of the breast.

Symptoms

Walusansa says common signs include;

A painless breast lump

Nipple pain

 Nipple discharge which could be clear or cloudy

 Sores on the nipple

 Enlarged lymph nodes in the underarm of the affected side.

Diagnosis

Okuku says diagnosis of breast cancer in men, just like in women, is done by biopsy, where a small tissue from the breast mass is taken to confirm cancer and assess how far it has spread.

He adds that an ultra-sound scan of the breast is done if a suspicious symptom is found after physical examination. An X-ray of the breast (mammogram) is then used to complement the ultra sound findings.

Precaution

Just like it is for women, Okuku says men should endeavour to do regular screening for breast cancer as well a s a self-breast examination, especially if there is a family history of breast cancer.

Exercise regularly at least three times a week, preferably aerobics, for at least 20 minutes.

 Avoid alcohol intake and smoking

 Avoid eating red meat because it has bad cholesterol.

 Eat healthy — less animal fat and more plants, for example, fruits and vegetables.

Treatment

Kafeero says choice of treatment modalities depends on the stage and the hormonal status as well as other illnesses that the patient may have. The modalities used include surgery, chemotherapy, radiation and hormonal treatment.

He says the outcome of breast cancer treatment in men depends on the stage at diagnosis, hormone receptor status as well as the other illness the patients may present with at the time of treatment initiation.

Dos and Dont’s

Avoid alcohol

Eat more plants, for example fruits and vegetables.

Do not smoke

Exercise regularly at least three times a week preferably aerobics for at least 20 minutes

Eat less animal fat and avoid over consumption of red meat because it has bad cholesterol

Do regular screening for breast cancer as well as doing self-breast examination, especially if there is a family history of breast cancer