Experts weigh in on male breast cancer, from diagnosis to research

Jul. 6—In 2009, Kokomo resident Rick Shuck — a physical education teacher at the time — was playing basketball with a group of students when he got hit in the chest.

He didn't really think anything of it until a couple months later when he felt the same spot on his chest and flinched.

After some prodding from his wife, Shuck went to the doctor to have the area checked out, and it came back positive for breast cancer.

"It was quite surprising," Shuck noted. "And of course all my friends and colleagues, they were surprised as well. Breast cancer?"

Shuck — who ended up undergoing 33 rounds of radiation, 12 rounds of chemotherapy and a mastectomy — even provided an anecdote to further his point.

"Before I had the surgery, I went down to Indianapolis," he said. "They put me through a battery of tests, and I had to have a mammogram. It's the first thing in the morning, and the nurse came out. All she did was read the report about breast cancer. My wife was with me at the time. And so the nurse said, 'OK, Mrs. Shuck, we're ready.' I looked at my wife and said, 'So you're going to take this one for me, huh?'"

According to the American Cancer Society, about 1 in 833 men will develop breast cancer in their lifetimes.

For women, that number is about 1 in 8.

But while breast cancer in men is relatively rare, its consequences can still be deadly.

And perhaps that's what prompted the Susan G. Komen Tissue Bank at Indiana University Simon Comprehensive Cancer Center in Indianapolis earlier this month to invite several Hoosier men to provide healthy breast tissue to further along research into the disease.

Since its inception, the facility has collected thousands of healthy tissue samples, which then get dispersed to researchers and scientists throughout the globe.

Because, as experts in the field note, the only way to cure cancer is to find out what makes it happen in the first place.

BEHIND THE DIAGNOSIS

Dr. Annette Moore, a board-certified physician in medical oncology and hematology at Community Howard Regional Health, sat forward in her chair inside Community's MD Anderson Cancer Center and began to gesture with her hands as she talked about the similarities and differences between the presentation of breast cancer in men as opposed to women.

"It's almost always a painless lump near the nipple areolar complex," she said. "Most men have it centrally located as opposed to women, and it's almost always a painless lump."

And because mammograms are not part of routine health screenings for men, these lumps are often disregarded as nothing out of the ordinary or just something to perhaps keep an eye on, Moore added.

"Not a lot of men are thinking it's breast cancer," she noted, "so a lot of times it will get diagnosed later, when there's already lymph node involvement."

The histology, what a pathologist sees under a microscope, is also different, she added.

"Women, we have lobules where the breast milk is made, and then it's delivered to the nipples through the duct," Moore explained. "Women can get ductal carcinoma or lobular carcinoma, and then there are also some rare types. Most women tend to get ductal carcinoma, but we see a fair amount of the other too.

"In men, lobular is very, very rare," Moore continued. "They're almost all ductal carcinoma. But the way they present, that's pretty similar across both men and women. And after that, men are also pretty much treated the same, surgery, radiation, chemotherapy if needed. If it's estrogen positive, which a lot of them are, then they get a tamoxifen, which is a pill that targets estrogen."

But even though it's rare, why are some men prone to get breast cancer and some are not?

Moore said genetics often plays a role.

"That doesn't mean you have an inherited breast cancer gene," she pointed out, "but we see breast cancer more commonly in men who have a family history of breast cancer. And we definitely see it in the BRCA2 gene. Men with liver disease, for example, have higher levels of estrogen, or men with obesity. Those are risk factors, too."

ASSISTING IN THE RESEARCH

Dr. Michele Coté, professor of epidemiology at the Fairbanks School of Public Health and director of the Susan G. Komen Tissue Bank, agreed with Moore.

As the tissue bank's director, Coté helped oversee the facility's recent male breast tissue collection, which was long overdue, she noted, and she said a couple more collection events are set to take place over the next few months.

"Over 5,000 women to date have donated normal and healthy tissue," she said, "but what we realized is that men can get breast cancer, too, and there was this whole section of the population that we weren't addressing."

So last November, the Susan G. Komen Tissue Bank successfully collected healthy breast tissue from 10 men throughout Central Indiana, and 21 men participated in the collection event in early June.

Coté then took a few moments to explain how the tissue collection actually works.

From beginning to end, the process takes anywhere from 60 to 90 minutes, and Coté added that the men can opt out at any time.

"Because men have less breast tissue than women do, we have to do an ultrasound guided biopsy," she said. "It's kind of this little wand or machine that they run over the area, and they're able to distinguish whether the tissue is breast tissue or muscle or fat.

"Once they identify where they're going to get tissue from, they put a little nick in the skin and insert a long needle," Coté added. "That's hooked up to a machine, and it's vacuum assisted, so it happens pretty quickly. They then take three cores of the breast tissue, and those cores are immediately taken to a lab to be processed."

The participants are then provided cold packs and a little piece of surgical tape before being told to take it easy the rest of the day.

And then the real work begins, Coté explained, the work of helping to save lives.

"We already have research ongoing with one of the investigators at IU," Coté said, when asked if the tissue recently collected has already helped promote change. "The very first thing he did was he took it to see if he could grow cell lines out of it. The tissue is very little in amount, so it's a resource that will eventually go away. We'll collect it, people will ask for it, and we'll distribute it.

"But with the creation of these cell lines, you can get them to grow really forever," she added. "They're sustainable. So just being able to do that would allow you to do things like test different drugs and see how the breast cells in men differ from the breast cells in women."

And though there is no cure, those interviewed hope that at least getting the topic out in the open will help erase the public misconceptions that still surround male breast cancer.

"I hope the message is that hopefully become more aware that men get breast cancer too, and there's something we can do that will help in the fight against it," Coté said. "We will do what we do, which is try to drive the science forward. What we need from people (at the tissue bank) is a little bit of time and a little bit of tissue."

Until then, be your own best healthcare advocate, like Shuck.

"I think men should have a yearly exam with their doctor," he said, "a full exam. And don't be afraid of it either. Awareness is the number one thing. In the end, you are the person that knows your body best."