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Of Male Breast Cancer 2.6 HOURS Continuing Education ORIGINAL RESEARCH By Eileen Thomas, PhD, RN Men’s Awareness and Knowledge of Male Breast Cancer A STUDY OF MEN A T HIGHER RISK PROVIDES A N EVIDENCE -B A SED UNDER - ST A NDING OF MEN ’S PERCEPTIONS OF THIS DISE A SE . reast cancer in men is uncommon, account - ABSTRACT ing for less than 1% of all breast cancers This article reports on the findings of a qualitative Objective: and less than 1% of all carcinomas in men.1 study that explored the awareness and knowledge of male breast In­­cidence trends are less clear. One large U.S. cancer among English-speaking men. The primary goal was to elicit population–based study by Giordano and information to guide both clinical practice and the development of Bcolleagues revealed that, between 1973 and 1998, the gender-specific educational interventions. incidence of male breast cancer increased by 26%, Methods: Interviews with 28 adult men, all of whom had no while that of female breast cancer rose by 52%.1 More history of breast cancer themselves but had at least one maternal recently, the American Cancer Society (ACS) has re - blood relative with the disease, were conducted and analyzed, using ported that although the rate of female breast cancer qualitative methods, to describe participants’ awareness of male has been declining,2 “the number of breast cancer cases breast cancer, their knowledge of the disease, and how they thought in men relative to the population has been fairly stable awareness of male breast cancer could be increased in health care over the last 30 years.”3 The ACS also estimates that, providers and the lay public. worldwide, approximately 1.3 million women are di - 4 Results: Nearly 80% of participants weren’t aware that men agnosed with breast cancer annually. That figure has can get breast cancer; and although all were at higher risk given disturbing implications for men as well, since 15% to their positive family history, all reported that their providers had 20% of men with breast cancer have a blood relative with a history of the disease.5, 6 For both sexes, the in - never discussed the disease with them. A majority couldn’t identify cidence of breast cancer varies by geographic location, any symptoms other than a lump in the breast. About 43% voiced “with higher rates in North America and Europe and concerns that a diagnosis of breast cancer would cause them to lower rates in Asia.”6, 7 question their masculinity. Participants also suggested ways that Unfortunately, male breast cancer has received rel- men, as well as providers and the lay public, could be better made atively little attention in both the primary health care aware of and educated about their risk for this disease. community and the general population. Both groups Conclusion: This study provides much-needed insight into lack an awareness of the disease and are often ill-­ men’s awareness and knowledge of male breast cancer. While fur- informed about its potential physical and psycholog- ther research with larger samples is needed, these findings offer a ical implications.8 Whether because breast cancer in starting point for the development of evidence-based, gender-specific, men is uncommon or because people often assume health promotion and disease prevention interventions for men. that men can’t get the disease, male breast cancer has Keywords: male breast cancer; breast cancer, male; breast neo- been widely ignored by the lay public, the media, and plasms, male; men’s health; patient education; qualitative research many health care professionals. New public health in - itiatives are needed to educate the public and health 32 AJN ▼ October 2010 ▼ Vol. 110, No. 10 ajnonline.com care providers, to raise awareness and fa­­cilitate early Risk factors. Genetics research is providing mount- detection. If men knew they might be at risk for devel- ing evidence that men who have a relative of either oping this disease, they might be more likely to learn sex with a history of breast cancer are themselves at its signs and symptoms, perform routine breast self - high er risk for the disease.5, 6, 11-13 Research also indi- examination, and seek care without delay if signs and cates that from 4% to 40% of all cases of male breast symptoms arise. cancer are due to mutations in the tumor-suppressing Differences in how breast cancer af­­fects men and genes known as BRCA2 or (less often) BRCA1.6, 14 women are evident not only phys­­ically but also psy- There’s evidence that by age 80 a man with a BRCA2 cho socially. Probably because the disease is often mutation has a 7% risk of developing the disease, perceived to be “a woman’s disease,” there has been which is higher than that for men in the general pop- little research into the perspectives and needs of men ula­­tion.14, 15 It’s worth noting that having a BRCA2 with breast cancer. This qual­­itative study used a de - mu­­tation is also associated with a higher risk for other scriptive study de­­sign to explore awareness and knowl- cancers, including ovarian and prostate cancers.3, 14 edge of male breast cancer among English-speaking Research suggests that some risk factors for breast men. It focused primarily on a specific­­ subgroup: adult cancer, particularly estrogen receptor–positive breast men with no history of breast cancer themselves, but cancer, may pertain to both sexes; but more research Asked whether he knew that men could get breast cancer, one participant stated, ‘Men don’t have breasts, they have chests.’ who have at least one maternal blood relative with is needed to clarify this.16 Suspected risk factors for the disease. It was in part inspired by the work of Kiss male breast cancer include older age; high alcohol and Meryn, who have sought to better understand con­­sumption; conditions that can cause or are associ- “the effect of gender on psychosocial differences in ated with hormonal imbalances (such as obesity, liver men and women with prostate and breast cancer, re- disease, and Klinefelter’s syndrome); and treatments spec tively.”9 that alter normal male hormones (such as estrogen treatment for prostate cancer).3 Other possible risk BACKGROUND factors include a history of testicular disorders (such Men with breast cancer are significantly more likely as cryptorchidism or mumps orchitis) or of radiation to have hormone receptor–pos­­itive tumors, to have exposure.3, 17 One recent study found that a history of nodal metastases, and to be diagnosed at a more ad - bone fracture was associated with increased risk of vanced stage than are women with breast cancer.1 breast cancer in men ages 45 years or older.18 Certain Men with breast cancer also have a higher occurrence occupational factors, such as working in hot environ- of invasive ductal carcinoma—­­it accounts for “at ments or with gasoline, may also increase risk.3 And least” 80% of all cases of male breast cancer, accord- many believe that a cluster of more than 20 cases of ing to the ACS,3 and some studies have found it pres- male breast cancer identified among U.S. Marines ent in as many as 87% of such cases.1 Breast cancer who were based at Camp Lejeune, North Carolina, in men is more likely to start near, and spread to, the between the 1960s and the 1980s can be attributed to nipple.3 contaminated water there, although Marine Corps Men are typically diagnosed at an older age than studies failed to establish a link.19, 20 are women. One large study found that the median Despite this extensive list, there’s little evidence that age at diagnosis was 67 years for men and 62 years men are aware of these risk factors. In one study, re - for women1; another study determined that the mean searchers reportedly interviewed 24 men, each of age at diagnosis was 65 years for men and 61 years for whom had a first-degree female relative known to women.10 However, breast cancer has been reported have a BRCA1 or BRCA2 mutation.21 Although all of in men ranging in age from five to 93 years.5 the men had been told of their relative’s genetic test [email protected] AJN ▼ October 2010 ▼ Vol. 110, No. 10 33 results, only 18 remembered being told—an indicator There has been considerable research on the treat- that men experience “a level of cognitive and emotion- ment of male breast cancer. Treatment options are al distance” from the genetic testing process. Of these similar to those used to treat female breast cancer; 18, only five correctly stated their chances of also hav- the first-line choice usually depends on the stage of ing the mutation; nearly half (seven) didn’t believe that the cancer at time of diagnosis. However, men with having it increased their chances of having the disease. breast cancer are often diagnosed at a more advanced Diagnosis and treatment. There are no standard stage of the disease than are women. Although for any clinical practice recommendations for breast cancer given stage of breast cancer, men and women have screening in men. Even in cases of men with known com parable survival rates, it’s also true that cancers risk factors, clinicians typically don’t perform breast found later require more aggressive treatment and examinations, nor do they advise regular breast self- gen­­erally have poorer prognoses than those found examinations. The ACS has identified important dif- earlier.3 ferences in the male and female breast that can affect The four most common treatments for male breast early detection3: cancer are surgery, chemotherapy, hormone therapy, and radiation therapy.
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