Three local men, from left, Richard Schup of Broadway, Bill Tatham of Broadway and John Snipes of Harrisonburg share their stories about
finding a lump in their breast. In the case of Schup and Snipes, the lump turned out to be breast cancer. All three encourage other men
who may find similar lumps to have them checked by their doctor.
In early 1998, Harrisonburg clergyman John Snipes, then age 47, noticed a lump in his right breast. In March of that year, he was examined in a North Carolina hospital, where his doctor told him it was nothing to worry about.
“I was aware at the time that men could get breast cancer,” Snipes says, “but my doctor told me it was so rare that I didn’t think that’s what it could be.”
By September 1999, however, the lump was visible and growing. His daughter suggested he go for a biopsy. The biopsy showed the tumor was malignant, and Snipes had a radical mastectomy at a Virginia hospital to remove the breast tissue and lump. Testing revealed cancer cells in his lymph nodes, so he underwent chemotherapy and radiation therapy. He finished his treatments in June 2000.
For several years he thought he was cured, but the cancer returned. All through 2004, Snipes says, he had problems with his hand and arm, including lymphedema, or swelling of the lymph glands. A CT scan of his chest revealed another mass.
RMH general surgeon John Mansfield, MD
, performed surgery to remove the mass. The pathology report showed it was cancer. During surgery, Dr. Mansfield also found that the cancer had invaded glands and lymph nodes.
Snipes’ cancer is treatable, but not curable. The cancer has spread to his shoulder blade, ribs and spine. His physician, RMH oncologist Christine Urbanski, MD
, has told him that the spot on his spine has enlarged since it was found. But fortunately, the cancer has not spread to any major organs. He has taken chemotherapy for about five years, he says. He has a bone scan every six months, and periodic MUGA (multiple gated acquisition) scans to ensure that the chemotherapy has not damaged his heart.
“I get tired from the chemo, but thank goodness I’m not bedridden,” says Snipes, who pastors Antioch United Church of Christ in Harrisonburg. “I can get up and take care of things. I take it a day at a time, and my family and church have been really supportive.”
Snipes wonders what his prognosis would be now had he been told in early 1998 that he had breast cancer, and had he sought treatment for it then. “I wasn’t ready to die then, and I’m not ready to die now,” he says.
Men should pay attention to breast lumps
Men typically don’t think of getting breast cancer, and they don’t typically examine their breasts, but they should, says RMH breast surgeon Heidi Rafferty, MD. “Although male breast cancer is uncommon, it’s really not that rare,” she says. “Unfortunately, often when it is found it’s more advanced.”
Richard Schup, 68, of Broadway, was diagnosed with breast cancer in 2007. Today he is a patient of Dr. Rafferty’s. But, as in Snipes’ case, Schup’s story began more than a decade ago.
In 1998, when he was living in Northern Virginia, Schup found a lump in his right breast. The lump was removed, and Schup’s surgeon told him and his wife that it was a fatty tumor and they had nothing to worry about.
In 2007, Schup noticed a new lump in his right breast about the size of an acorn. “I thought it was just another fatty tumor,” he says.
RMH general surgeon Morris Fendley, MD, performed a biopsy that revealed the “fatty tumor” was actually cancer. Dr. Fendley then performed a modified radical mastectomy to remove Schup’s right breast tissue and axillary lymph nodes. Schup says the decision to have a mastectomy was not something he had to struggle with. “I knew it had to be done, so I just went with it,” he says. “But it has made me better understand what women often have to go through.”
Schup later learned that after the first mass had been removed in 1998, the biopsies that were performed had revealed the earlier mass to be cancer. But for some reason Schup was told differently, and he went for nearly a decade with no treatment, follow-up or lifestyle changes.
“This case illustrates why, after any surgical procedure, it’s prudent for the patient to request to review any pathology reports with the surgeon, and even to ask for copies,” advises Dr. Fendley.
After his mastectomy, Schup went through several months of chemotherapy at the RMH Hahn Cancer Center, followed by six weeks of daily radiation therapy. He now gets a yearly mammogram on his left breast, and he sees RMH oncologist Mary Helen Witt, MD, every six months. He is on a five-year regimen of tamoxifen to suppress the absorption of estrogen, a female sex hormone that is also naturally produced in men’s bodies.
“When men develop breast cancer, it typically starts in the duct cells and is sensitive to estrogen,” explains Dr. Witt. “Estrogen plays a role in stimulating breast cell division, and it may play a role in supporting the growth of estrogen-responsive tumors.”
Schup reports that the tamoxifen gave him hot flashes and other menopause-like symptoms, just as it often does in women.
Breast cancer is essentially the same in women and men
|The incidence of breast cancer in both women and men rises with increasing age, says Dr. Rafferty. As with women, the greatest risk factor for male breast cancer is a strong family history of breast cancer, especially in pre-menopausal female relatives.
Breast cancer in men is the same disease process that occurs in women—an uncontrolled growth of breast tissue, says Dr. Witt.
“Men get breast cancer because they have a small amount of nonfunctioning breast tissue that consists mainly of undeveloped ducts,” she explains. “The most common presentation of male breast cancer is a firm, non-painful mass behind the nipple.” Other symptoms may
include a thickening of the breast or changes like dimpling, puckering or redness in the skin that covers the breast, or redness and scaling of the nipple or a nipple that turns inward.
Dr. Witt adds that male breast cancer accounts for only one percent of all breast cancers diagnosed in the United States—about 1,500 to 2,000 new cases per year. “We see on average about one case per year at RMH,” she states.
The incidence of breast cancer in both women and men rises with increasing age, says Dr. Rafferty. As with women, the greatest risk factor for male breast cancer is a strong family history of breast cancer, especially in pre-menopausal female relatives. Both Snipes and Schup say many of their family members have had breast cancer and other types of cancer.
When family history is a factor, genetic testing can often reveal whether a person is carrying breast cancer genes.
“I was with my wife at Dr. Rafferty’s office and happened to mention that I had had breast cancer,” Schup relates. “She was very interested, and did genetic testing on me to see if I had the breast cancer gene.”
But genetic testing showed he did not have the mutated BRCA gene. Dr. Rafferty explains that testing for hereditary breast and ovarian cancer (HBOC) is done in patients with pre-menopausal breast cancer (cancer before age 50), ovarian cancer at any age, two primary breast cancers in the same individual, male breast cancer at any age, or two or more cancers in their family, with one occurring under age 50 or where a mutation of the BRCA gene was previously identified in the family.
“These are the indications for testing,” says Dr. Rafferty. “However, just because a patient qualifies for the test does not mean he or she is going to be a carrier of the mutated BRCA [breast cancer] gene.”
Breast cancer is diagnosed in men the same way it is in women. “We do ultrasound, mammogram and minimally invasive biopsy,” says Dr. Rafferty. “About 98 percent of the time, it’s unnecessary to proceed beyond a minimally invasive needle biopsy to make the diagnosis.”
Treatment of breast cancer in men, however, is typically different from treatment in women. ”Because men have less breast tissue than women, they are less likely to be candidates for breast conservation,” explains Dr. Rafferty. “More commonly, breast cancer in men is treated with mastectomy, or removal of the breast tissue, along with testing of the lymph nodes and removal of any nodes that reveal evidence of cancer.”
Surgery is generally followed by chemotherapy, radiation therapy, and then hormone treatment with tamoxifen, depending on the stage (extent) of cancer and the characteristics of the tumor, adds Dr. Witt.
Not every lump in the breast is cancer
Early last November, William Tatham, 64, of Broadway, began noticing a lump in his right breast. There was no redness or inflammation, and no pain at first. But over three weeks it grew tremendously.
“It soon felt like a golf ball floating inside my breast,” Tatham says. “It began to hurt so that I couldn’t even carry my rifle during hunting season.”
Results of ultrasound were inconclusive. So on Dec. 29, Dr. Mansfield removed the lump from Tatham’s breast. The pathology report showed that it was not cancer. “My surgeon didn’t really give it a name, but he told me it was a large glob of tissue with fluid in it,” he says.
Tatham had no known injury to his chest, and his doctors were unable to tell him what caused the lump to form. He has been fine since his surgery.
“Most of the time, a lump in the male breast is not cancer,” says Dr. Rafferty. “I’ve treated quite a few men who have had non-cancerous breast masses. The mass can be gynecomastia, which is an overgrowth of normal cells. It can be an adenoma, which is a proliferation or overgrowth of a different type of normal cells. It can also be fibrosis from trauma or a fatty tumor. So a lump can be a lot of benign things. But it can also be cancer, so it should always be checked.”
Early diagnosis and treatment are always best
Snipes, Schup and Tatham hope sharing their stories will make men and their families more aware that breast cancer is not just a woman’s disease. They also hope their experience will encourage men to be more proactive about their health by having anything that seems suspicious checked out.
When Schup first learned in 2007 that he had breast cancer, he went online for information and found very little. Now, he says, he finds much more information about male breast cancer. “It seems people are more aware of it today,” he says. “The information is there for men
who want it.”
Men also need to understand that if they find a lump on their chest wall, under the arm or within their breast, they should not ignore it, adds Snipes. “Go see about it immediately,” he advises. “If it is cancer, you want to find that out early instead of after it has become advanced.”