Men not exempt from breast cancer, but no standard guidelines for screening

When Tom Welch, 57, takes off his shirt you can see that something is missing.

It’s not noticeable at first, but behind the thick chest hair, there are no nipples, only two faded scares just below where they would be. This is the reminder of the time eight years ago when breast cancer shook up his life for the third time. His diagnosis didn’t shock him since his mother died of breast cancer when he was a child, and then breast cancer took his wife’s life years later, but it scared him.

When he felt a tenderness in his chest, he knew breast cancer had come for him, too.

“I probably knew more about it than most people,” he says.

An elementary school principal in the Ludlow area, Welch, is a husky man who wears a suit to work. Sometimes he wears his black tie with rows of tiny pink breast cancer awareness insignias.

“Men need to be aware, too,” he says. “We are not always quick to go to the doctor.”

This year, an estimated 2,470 men in the United States will be diagnosed with breast cancer, according to the American Society of Clinical Oncology, a resource organization in Virginia for people living with cancer. This is only 1 percent of breast cancer cases, but men with a BRCA gene mutation do face a higher risk, says Dr. Richard Arenas, chief of surgical oncology at Baystate Medical Center. “I recommend that men who have a family history get genetic testing.”

For those men with a family history, knowing their BRCA status is especially important because there are no standard guidelines for them to be screened, says Arenas. Mammograms are a regular screening tool for women, but these scans can be hard to administer on men since they depend heavily on squeezing the breast tissue between two plates, which is difficult to do on men, he says. MRIs also are effective at detecting breast cancer in women, but data hasn’t shown that they also work in men, he says. And ultra sounds, another screening method, don’t always pick up all the changes you would expect to find in breast cancer at an earlier stage, he adds. “There is no given protocol as how they should be screened.”

After Welch’s mother died when he was just 14, he began reading about breast cancer and was well aware that he wasn’t immune just because of his gender. Unlike women in his circumstance who might begin regular screenings, he didn’t know what precautions to take. But when he felt pain in his breast one day, he didn’t wait to call the doctor.

“In my mind, I knew before I saw my primary care doctor,” he says.

Welch was fortunate to have caught the breast cancer early, but even men with breast cancer in their families are not looking out for the pain or changes in breast tissue that can be symptoms of the disease, Arenas says. As a result, many wait longer than they should before getting it checked out, he says, and end up having more advanced cancer when they finally do. The average five-year survival rate for women with breast cancer is 90 percent, while the average five-year survival rate for men with breast cancer is 84 percent, according to the American Society of Clinical Oncology.

In Welch’s case, symptoms came on suddenly. One day after playing baseball he felt tenderness in his right breast, as if he had been hit in the chest, only he couldn’t remember getting hit. He checked out the spot in the bathroom mirror, pressing his hand over the sensitive area. To his surprise, a secretion emerged. “That’s not supposed to happen,” he remembers thinking.

Within days he was diagnosed at the Baystate Breast & Wellness in Springfield with a cancerous tumor in the milk duct the size of the tip of a pencil. When a mastectomy was recommended, he agreed without hesitation, “Yeah, get it out of me, I don’t need my breast,” he recalls saying.

He started on a daily chemotherapy pill, but since the cancer was stage 1, he didn’t need radiation.

At his doctors’ suggestion, Welch had the genetic test done in order to provide information for his only biological child, a son who is 25. It was positive, Welch says, and he hopes his son will be tested when he is ready.

“The more you know about your history, the more ammunition you have to make decisions,” Welch says.

Northampton physician Dr. Henry Rosenberg, 65, is another breast cancer survivor who learned after his breast cancer diagnosis that he has a BRCA gene mutation.

Ten years ago, he says, his nipple became irritated when his cell phone in his breast pocket rubbed up against his chest. It was a minor discomfort, he says, so he put off getting it checked. 

“I kept thinking, ‘oh, it’s nothing. Oh, it is the phone rubbing.”

But moving the phone to his pants pocket didn’t alleviate the problem.

A visit to his physician resulted in his cancer diagnosis along with the news that the disease had not spread to the lymph nodes. He underwent three months of chemotherapy, followed by a sequence of five weeks of radiation treatments, before his mastectomy at Cooley Dickinson Hospital in Northampton.

Rosenberg followed his surgery up with the genetic test. “It turns out I am BRCA positive.” It’s information, he says, that is important for his family.

Both men are living cancer free, but they make a point to tell their stories, so that other men are aware that it can happen to them; Rosenberg wrote a letter in his college alumni newsletter asking that men be aware of the danger.

“If something is funny about your breast — it might not be funny – it might be serious,” he says. “You should pay attention to it.”

He suggests that men with a family history learn how to do self breast exams or ask their doctors to do an annual exam. 

“Don’t ignore it, don’t pretend it’s not there, don’t deny it — go get checked out.”

Lisa Spear can be reached at Lspear@gazettenet.com.