2.6 h o u r s Continuing Education o r i g i n a l r e s e a r c h

By Eileen Thomas, PhD, RN Men’s Awareness and Knowledge of Male Breast Cancer

A s t u dy o f m e n a t h i g h e r r i s k p r o v i d e s a n e v i d e n c e -b a s e d u n d e r - s t a n d i n g o f m e n ’s perceptions o f t h i s d i s e a s e .

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 high­er 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 cho­socially. 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 spec­tively.”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 com­parable 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. In men, surgery usually means Because men have very little breast tissue, it is a modified radical mastectomy—removal of the easier for men and their health care profession­ breast, the lymph nodes under the arm, the lining als to feel small masses (tumors). On the other over the chest muscles, and possibly a portion of the hand, because men have so little breast tissue, chest mus­­cles—although a breast-conserving lump­ cancers do not need to grow very far to reach ec­tomy might be an option in some cases.22 Because the nipple, the skin covering the breast, or the men with breast cancer are more likely to have hor­ muscles underneath the breast. So even though mone receptor–positive tumors, men typically have breast cancers in men tend to be slightly smaller a positive response to treatment with hormonal than in women when they are first found, they agents such as tamoxifen (Soltamox).3, 23 However, have more often spread to nearby tissues or because current hormone therapies are based on lymph nodes. studies of female breast cancer patients, additional research with male breast cancer patients is needed That said, the signs and symptoms of breast cancer to better understand how hormonal agents work in in men are essentially the same as in women, and in­ men. clude a lump or swelling in the breast area, reddening or dimpling of the skin or nipple, nipple discharge, and WHAT PROMPTED THIS STUDY nipple inversion. Diagnostic procedures, such as clini­ Literature search results. To learn what’s currently cal breast examination, conventional or digital mam­ known about men’s knowledge of male breast cancer mography, ultrasound, and needle or surgical biopsy, and their risk of developing the disease, I conducted a are also essentially the same for both sexes. literature search for articles published in 2007 using PubMed, Ovid, and CINAHL. Search terms used were “male breast cancer,” “breast cancer in men,” and “breast neoplasm–male.” Of the 1,697 articles Re s o u r c e s reviewed, only 52 (3%) addressed male breast can­cer in the United States; the remaining 1,645 articles fo­ American Cancer Society. Breast Cancer in Men: Detailed Guide cused on male breast cancer in other countries. www.cancer.org/Cancer/BreastCancerinMen/DetailedGuide/index Despite the large number of articles found, the ­top­­ics were limited in scope. Epidemiology and treat­ John W. Nick Foundation ment of male breast cancer were major foci. Two stud­ www.malebreastcancer.org ­ies sought to understand the personal experiences of men who have or have had breast cancer.24, 25 Only two Mayo Clinic. Male Breast Cancer studies addressed the information needs ­of men with www.mayoclinic.com/health/male-breast-cancer/DS00661 regard to male breast cancer.25, 26 Information on what the general public knows about male breast cancer Menstuff, The National Men’s Resource. Breast Cancer in Men was almost entirely lacking. Surprisingly, there was www.menstuff.org/issues/byissue/breastcancer.html even little research concerning men who are at higher risk for breast cancer. National Cancer Institute. Male Breast Cancer Treatment PDQ Only one study, conducted in the United Kingdom, www.cancer.gov/cancertopics/pdq/treatment/malebreast/Patient examined the information needs of men with breast (patient version) cancer. Iredale and colleagues analyzed data from www.cancer.gov/cancertopics/pdq/treatment/malebreast/ interviews with 161 men with the disease, and con­ HealthProfessional (health professional version) cluded that while the verbal and written information provided to the men was helpful, much of it wasn’t

34 AJN ▼ October 2010 ▼ Vol. 110, No. 10 ajnonline.com Ta b l e 1. Participant Demographics

Race or Ethnicity Number Age Range Family Member with History of Breast Cancera (%) (yrs) Mother Grandmother Aunt Sister Cousin

White, non-Hispanic 14 (50) 35–60 13 1 3 4 1

African American 9 (32) 46–60 2 2 2 2 1

Hispanic 4 (14) 30–57 0 1 1 1 1

Asian or Pacific 1 (4) 50 1 0 0 0 0 Islander a Some men had more than one maternal relative with a history of breast cancer. relevant because it was specific to women with breast The theoretical framework for this study—critical cancer.26 For example, one man reported that the social theory—takes into consideration the social con­ in­formation explained how to select a proper bras­ text of the lived experience of the participants. Subjec­ siere. The authors recommended further research to tive human experience has often been ignored as a determine men’s information needs so that gender- source of knowledge. But critical social theory rests appropriate educational materials could be developed. on the conviction that “no aspect of social phenomena Iredale and colleagues’ work was part of a larger can be understood unless it is related to the history study investigating psychosocial distress, in which the ­and social structure in which it is found.”27 161 participants also completed a cross-sectional ques­ Hegemonic (traditional) masculinity, a concept ­tionnaire that included measures of anxiety and de­ from gender studies, also helped guide this study. Heg­ pressive symptoms, cancer-specific distress, and body emonic masculinity has been defined as the idealized, image.24 Almost one-fourth (23%) reported traumatic socially dominant concept of masculinity at a given stress symptoms specific to having breast cancer. In a place and time.28 It refers to the fact that culture small, qualitative study of men with breast cancer, shapes our sense of what’s “masculine” (and for that Do­novan and Flynn found that “the idea of living matter, what’s “feminine”)—and this in turn affects with a feminized illness was very distressing and stig­ relationships between men and between men and matizing for some men.”25 They reported that some women. As Donovan and Flynn’s findings indicate, study participants experienced the disease and its treat­ beliefs about masculinity also influence men’s physi­ ­ment as an “assault upon their sense of gen­dered self,” cal health. Courtenay and colleagues state that men resulting in significant changes to body image and who “adopt traditional or stereotypic beliefs about sexuality; indeed, one of the themes identified was “a masculinity have greater health risks than their peers contested masculinity.” One man said, “They [other with less ­traditional beliefs,”29—in part because men] would laugh at you if they saw it [mastectomy they’re less likely to practice good self-care and more scar]. Some people think that a man with breast can­ likely to engage in risky behaviors such as smoking.30 cer cannot be a ‘real’ man.” Psychological health is also affected. Gillon writes that In short, the literature search turned up intriguing in times of crisis, many men will avoid asking for help but limited information about male breast cancer; I because “help-seeking denotes vulnerability, failure wanted to learn more. This study sought to determine and hence weakness, attributes that run contrary to what men know about breast cancer and to offer new the terms of hegemonic masculinity.”31 insight into men’s perceptions of male breast can­cer. The primary goal was to elicit information to guide METHODS both clinical practice and the development of gender- A purposive sample of self-identified English-speaking specific educational interventions. men, ages 30 years or older, without a personal history [email protected] AJN ▼ October 2010 ▼ Vol. 110, No. 10 35 of breast cancer themselves but with at least one mater­ were arranged for completing the informed consent nal blood relative with a history of breast cancer, were procedure and conducting the interview. Once con­ recruited from a large southwestern city (Denver) and sent was obtained, the participants were asked to its suburbs. “Maternal blood relative” was defined as select a pseudonym for identification purposes and to a mother, sister, brother, maternal aunt or uncle, or complete a brief demographics form. ma­­ternal cousin of either sex. This study was approved Data collection. Participants were asked a series by the Colorado Multiple Institutional Review Board. of 15 minimally structured questions, starting with, A total of 28 men participated in this study; of these, “Were you aware that men could develop breast can­ 14 self-identified as white non-Hispanic, nine as black cer?” Several questions were supplemented with fur­ or African American, four as Hispanic or Latino, and ther probing questions or statements the interviewer one as Asian or Pacific Islander. Ages ranged from could use, if needed, to elicit additional information 30 to 60 years. Occupations varied from blue-collar before proceeding to the next question. For the com­ workers to professionals, including a physician and plete list of interview questions, go to http://links. two RNs. All of the men reported having at least one lww.com/AJN/A16.

One participant who’d found a lump in his breast said, ‘I felt like all the testosterone drained out of my body.’

maternal blood relative who’d been diagnosed with Analysis. All interviews were transcribed verba­ breast cancer. Sixteen (57%) identified their mothers tim by a member of the research team. The transcripts as that relative. All of the men identified their sexual were compared and similarities identified. Tran­scripts preference as heterosexual. (For more demographic were reviewed by the female primary investigator (me), data, see Table 1.) a male research assistant, and a female colleague with Recruitment and consent procedures. Recruitment qualitative data analysis experience. The approach flyers were posted in local community businesses and was inductive, using specific pieces of information to churches. The flyer was also distributed through the develop broader themes. Interpretation of findings University of Colorado Denver’s research-subjects- was based on both contextual analysis and frequency announcements listserv and printed in local commu­ of similar responses to the interview questions. nity newspapers (including one for the area’s large The original plan was to analyze the individual in- Spanish-speaking population, although it publishes person responses to the interview questions, coding in English). Men who met the inclusion requirements the data using codes I developed after direct examina­ contacted a member of the research team by telephone. tion of the data. But because many of the men re­ Prospective participants were screened with the ques­ sponded to questions briefly and didn’t elaborate, tions “What is your age?” “Have you ever been told I decided to aggregate all responses to each of the that you have breast cancer?” and “Who in your fam­ questions and summarize the findings. From these ­ily has or had breast cancer?” If the prospective par­ clus­ters, themes emerged as the researchers recog­ ticipant met the inclusion criteria, a time and place nized repetitions within and across the interviews. These themes were “awareness,” “knowledge,” and “educating oth­ers.” Typically, qualitative researchers use participants’ ac­­tual words in naming themes, and In v i t a t i o n t o Sh a r e Yo u r Ex p e r i e n c e w i t h I did this as well in naming the overarching theme, “They haven’t told me anything,” described below. Ma l e Br e a s t Ca n c e r Rigor. Member checking is a way to strengthen the If you’re a man at risk for or with a history of breast cancer, or a family rigor of qualitative studies. Copies of the study find­ member of a man who died from breast cancer, and are willing to share ings, with the investigator’s interpretation and emer­ your experiences with the author for a book she’s writing, please contact gent themes, were shared with five randomly selected Eileen Thomas at [email protected]. study participants for review. All five returned the sum­ ­­mary of the findings without making any significant

36 AJN ▼ October 2010 ▼ Vol. 110, No. 10 ajnonline.com changes and all agreed that the themes were an accurate representation of their x a m p l e s f r o m t h e a w a t a interview responses. E R D The following are examples of participants’ responses to selected RESULTS interview questions. Awareness. Twenty-two men (79%) re­ ported that they weren’t aware, and were Question 1: Were you aware Question 13: If you were told surprised to find out, that men could get that men could develop that you have breast cancer, breast cancer. One stated, “Men get pros­ breast cancer? do you think it would cause tate cancer and women get breast cancer.” Participants’ responses included: you to question your identity An­­other said, “Men don’t have breasts, “Saw an episode about breast as a man? they have chests.” Although at higher risk cancer in men on a TV show—I The majority of participants (16) for developing breast cancer than the gen­ eral male population, all 28 re­­ported that was shocked.” reported that being diagnosed their health care providers had never dis­ “College friend had breast cancer.” with breast cancer wouldn’t cause cussed male breast cancer with them. Thus, “Read about it somewhere.” them to question their identity as the overarching theme that emerged— “First heard about it when I saw men. “They haven’t told me anything”—was the research recruitment flyer.” conveyed by 100% of participants. Responses from the other 12 Knowledge. Two men reported some Question 3: What has your ­partic­ipants included: knowledge of breast cancer in men. One health care provider told you­ “I would feel like my manhood reported that while his mother was under­ about breast cancer in men? was taken away.” going treatment for breast cancer, he’d All the participants said “Nothing” “I would be worried about the asked her physician whether men could or “Never talked about it.” stigma and teasing.” develop breast cancer and the physician “I felt like the testosterone was had said yes. Another man reported that Question 7: What are the drained out of my body.” he’d found a lump in his breast and had risk factors for male breast “I would feel different about hav- un­dergone diagnostic testing for breast cancer? ing a female disease.” can­cer; the lump was found to be benign. Twelve participants said, “I really “I wouldn’t tell anyone.” When asked “How do you believe breast don’t know,“ “I don’t think they do “It depends on your cultural back- can­cer is detected in men?” 16 men re­ mammograms on men,” or “I don’t ground, I would worry about the sponded that it’s usually detected by “find­ have a clue.” stigma.” ing a lump.” One also said “soreness or “People would think I was jok- ­enlargement—but my first thought would Responses (both accurate and ing.” “I’d be crushed. Yeah, I be that I pulled a muscle,” and two men­ inaccurate) from the other 16 would. I would think, wait a tioned mammograms. Twelve men re­ ported a lack of knowledge, saying “I participants included: “obesity,” minute—­what is this, why? really don’t know,” “I don’t think they do “hereditary,” “smoking,” It’s something ­a man doesn’t mammograms on men,” or “I don’t have “poor health,” “lack of exercise,” get, maybe a ­homo­­sexual might. a clue.” One added, “They find it on the “family history,” “pollution,” I would be embarrassed, wouldn’t autopsy table.” When asked what the “high testosterone,” “breastfeeding.” tell anyone.” symp­­toms of breast cancer are in men, 21 men said in essence, “a lump, the same as in women.” None of the study par­­tic­ ipants were able to identify other symptoms of breast my body.” Another man reported, “I wouldn’t tell any­ cancer in men, such as nipple discharge. ­one, I would be afraid of the stigma.” We also noted There was one question to which men’s responses that none of the men interviewed by the male re­search differed markedly. When asked whether being diag­ assistant said they would question their masculinity if nosed with breast cancer would cause them to ques­ diagnosed with breast cancer, whereas several men tion their identity as men, 16 (57%) indicated that it interviewed by the female primary investigator did would not; their responses showed that they didn’t voice such concerns. associate cancer with gender. But 12 (43%) indicated Educating others. Participants were asked to share that being diagnosed with breast cancer might cause their ideas about how health care providers might them to question their masculinity. One participant bet­­ter educate men about male breast cancer. All of stated, “Masculine men most likely will not get breast the men stated, in essence, “Just get the word out!” cancer, only men with feminine ten­­dencies [can get Every participant talked about how important it is ­it].” One participant who’d found a lump in his breast for peo­ple to know that men can get breast cancer, stated, “I felt like all the testosterone drained out of and that it’s imperative to educate men who have a [email protected] AJN ▼ October 2010 ▼ Vol. 110, No. 10 37 family mem­ber with the disease. The men suggested One participant’s response to the question about producing brochures and pamphlets that could be left how male breast cancer is detected—“They find it in places men frequent, such as sports bars, bowling ­­on the autopsy table”—suggests that some men have alleys, and barbershops, and at professional basket­ fatalistic views about breast cancer. It’s important for ball and football games. The participants also rec­ health care professionals to understand that interven­ ommended placing signs on buses and including ­more tions designed to educate women about breast cancer information more prominently in the media during aren’t necessarily effective for men. Providers should National Breast Cancer Awareness Month (October) be encouraged to consider how men tend to view this as well as year-round to carry the message that breast disease; when educating patients it’s not enough to cancer can occur in both men and women. simply change the word “female” to “male.” Educa­ See Examples from the Raw Data for participants’ tional materials should be sex specific and gender ap­ responses to selected interview questions. propriate.

Asked how he thought breast cancer was detected in men, one participant said, ‘They find it on the autopsy table.’

DISCUSSION While there are no standard guidelines for breast The majority of men in this study weren’t aware that cancer screening in men, the ACS states that mam­ men could develop breast cancer. Although all of the mography “might be useful for screening men with a participants are at a higher risk for developing breast strong family history of breast cancer and/or with cancer than the general male population, all reported BRCA mutations.”3 It’s my belief that providers should that their health care providers had never discussed discuss breast cancer with all men, especially those male breast cancer with them. Socioeconomic status, who have a family history of breast, ovarian, or pros­ as indicated by occupation, and religious affiliation ­tate cancer, or have other known or suspected risk weren’t indicators of participants’ awareness or knowl­ factors for breast cancer. During routine physical ex­ edge of male breast cancer, although three men were aminations of these men, providers should consider health care providers. One participant, a physician, including a clinical breast examination and advising stated that male breast cancer was never addressed monthly breast self-examinations. during his medical training. Limitations of this study include its small sample It was anticipated that each interview would take size and limited diversity. Further research with a from 30 to 60 minutes to complete; but the majority of larger, more racially and ethnically diverse sample of interviews took from 15 to 30 minutes because many men is needed. This study also recruited participants participants responded to questions briefly and with only from an urban area; and although the area has little elaboration. Coates reported that men often have a large Spanish-speaking population, recruitment was difficulty expressing emotions and vulnerability, even conducted only in English. Future research should in­ when among friends.32 It’s likely that such difficulty clude men from rural communities and those whose would also affect what men might say to researchers first language is not English. during interviews. In this study, interviewers asked This study represents a first step toward an im­ participants whether they would have felt more com­ proved, evidence-based understanding of men’s per­ fortable discussing male breast cancer with an inter­ ceptions of and experiences with male breast cancer. viewer who was female (if the interviewer was male) It’s hoped that these findings will induce providers or one who was male (if the interviewer was female); to consider gender when developing health promo­ all of the men said the sex of the interviewer didn’t tion and disease prevention interventions, and will matter. However, since only men interviewed by the encourage them to improve their communication female interviewer said that a diagnosis of breast with male patients who have a family history of ­can­cer might cause them to question their mascu­linity, breast cancer. As there may be cultural differences in it’s possible that participants were less comfortable how men of different racial or ethnic backgrounds disclosing such concerns to a male interviewer. view male breast cancer, further quantitative and [email protected] AJN ▼ October 2010 ▼ Vol. 110, No. 10 39 qualitative re­search with larger, diverse samples is 10. Hill TD, et al. Comparison of male and female breast cancer needed. incidence trends, tumor characteristics, and survival. Ann Epidemiol 2005;15(10):773-80. There are indications that male breast cancer is 11. Ewertz M, et al. Risk factors for male breast cancer—a case-­­ starting to gain increasing attention. Indeed, a later control study from Scandinavia. Acta Oncol 2001;40(4): search for articles addressing male breast cancer in |467-71. the U.S. population, published from January 2008 12. Hill A, et al. Localized male breast carcinoma and family through May 2010, yielded 264 articles in the Ovid ­history. An analysis of 142 patients. Cancer 1999;86(5): database alone—a marked increase over the 52 such 821-5. articles found during the initial search. But many 13. Johnson KC, et al. Risk factors for male breast cancer in Canada, 1994-1998. Eur J Cancer Prev 2002;11(3):253-63. health care professionals and funding agencies aren’t 14. Thompson D, Easton D. Variation in cancer risks, by muta­ yet convinced that male breast cancer is a significant tion position, in BRCA2 mutation carriers. Am J Hum Genet problem worth researching. Nurses can be instrumen­ 2001;68(2):410-9. tal in improving efforts to educate the public about 15. Tai YC, et al. Breast cancer risk among male BRCA1 and this disease and should be encouraged to promote BRCA2 mutation carriers. J Natl Cancer Inst 2007;99(23): breast health in both women and men, particularly 1811-4. 16. Anderson WF, et al. Male breast cancer: a population-based those at higher risk for developing breast cancer. To comparison with female breast cancer. J Clin Oncol 2010; learn more, and for a list of Web sites and private foun­ 28(2):232-9. dations dedicated to addressing male breast cancer, 17. Thomas DB. Breast cancer in men. Epidemiol Rev 1993; see Resources. ▼ 15(1):220-31. 18. Brinton LA, et al. Prospective evaluation of risk factors for male breast cancer. J Natl Cancer Inst 2008;100(20): For 34 additional continuing nursing education ar­ 1477-81. ticles on research topics, go to www.nursingcenter. 19. Boudreau A, Bronstein S. Male breast cancer patients com/ce. blame water at Marine base [part 1 of a two-part series].­ CNN health.com 2009 Sep 24. http://www.cnn.com/2009/ HEALTH/09/24/marines.breast.cancer/index.html. 20. Boudreau A, Bronstein S. Poisoned patriots? Stricken Eileen Thomas is an assistant professor at the College of marines seek help with illnesses [part 2 of a two-part Nursing, University of Colorado Denver, in Aurora, and series].­ CNN health.com 2009 Sep 25. http://www.cnn. serves on the advisory board of the Colorado Department com/2009/HEALTH/09/25/marines.breast.cancer.folo/ of Public Health and Environment’s Breast and Cervical index.html. ­Cancer Screening Program. Contact author: eileen.thomas­@ ucdenver.edu.The author acknowledges Stephen Schoen, RN, 21. Daly MB. Addressing the needs of men in BRCA1/2 fami­ who served as research assistant for this study and assisted lies. Breast Cancer Res Treat 2007; 106 Supplement 1: with literature searches, participant recruitment, and data S98. ­collection; and Phyllis Graham-Dickerson, PhD, RN, CNS, 22. National Cancer Institute. Male breast cancer treatment who assisted in reviewing and analyzing the data. 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