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Breast cancer often a surprise diagnosis for men

Breast cancer not as common in men as in women, but does occur

MORRIS – Hank Englehaupt, who lives between Seneca and Marseilles, never dreamed he’d hear his doctor give him a diagnosis of breast cancer.

But Englehaupt heard it in 2002. Now 71 – despite neuropathy in his feet from chemotherapy treatments, and the fact he still is alive to care for his 34-year-old disabled son – Englehaupt still believes breast cancer is a woman’s issue.

“They have it a lot more than men,” Englehaupt said.

Dr. Nafisa D. Burhani of Joliet Oncology-Hematology Associates began seeing Englehaupt for his follow-up visits in her Morris office in 2007. Englehaupt’s cancer was at Stage 2B when he was diagnosed, Burhani said, meaning the cancer had spread to some lymph nodes.

Because most breast cancers in men have estrogen receptors, follow-up treatment includes Tamoxifen, which blocks estrogen’s effects on their cells, Burhani said. Women whose breast cancer also is positive for estrogen also take Tamoxifen, Burhani added.

Englehaupt took Tamoxifen for five years, the recommendation at the time, Burhani said. Some clinical trials now suggest patients do better at the 15-year mark if they take Tamoxifen for 10 years, Burhani added.

Burhani sends Englehaupt for periodic mammograms, since he does have some breast tissue left, but overall, she is not concerned about a recurrence.

“He’s done very well,” Burhani said.

Rare occurrence

Breast cancer is far less common in men than women. Dr. Leela N. Rao, an oncologist at Adventist Bolingbrook Hospital, said she has seen only three men with breast cancer since she began practicing in 1993.

According to the American Cancer Society at, breast cancer is about 100 times more common among women than men, with a lifetime risk of 1 in 1,000. Those statistics have not changed in 30 years.

Risk factors include aging; family history; mutations in the BRCA2 (lifetime risk of 6 in 100) and BRCA1 (lifetime risk of 1 in 100); certain congenital conditions; testicular disorders; obesity; heavy alcohol use; liver disease; and past estrogen treatments, according to the American Cancer Society.

Still, preventative screenings have no known benefit for men and generally are not recommended. One reason, Rao said, is because cancer is readily found in men because they have less breast tissue than women, making tumors easily seen and felt.

However, less breast tissue also means less supportive tissue, so the cancer may attach itself to the chest wall, Rao said. This means a mastectomy usually is the only way to remove all of the cancer, she added.

Lymph node evaluation is the same for men and women, Rao said, and treatment is based on those findings. Reconstruction surgery is available for men, but none of Rao’s patients ever has requested it, Rao added.

As with women, early detection is key to survival. Men with breast cancer may notice a hard nodule, like a hard pea, Rao said, in their breast. The nodule is not generally painful, she added.

“Because men often tend to be bare-chested,” Rao said, “they do notice and take care of it.”

Englehaupt noticed his nodule in May 2002 when he was at work and carrying a stack of tall boxes outside. He felt discomfort in his right breast where the boxes leaned against his chest. So he set the boxes down and pressed on the area, but he felt nothing.

“About the middle of June, I could feel something about the size of a BB,” Englehaupt said. “I thought, ‘I have a doctor’s appointment in August. I’ll talk to him then.’ ”

At the appointment, Englehaupt said his general practitioner also felt the lump and told Englehaupt he was sending him to the hospital for some pictures. Englehaupt said he assumed “pictures” meant standard X-rays.

Englehaupt said he didn’t understand why he was the only man sitting in a waiting room of women, and why those women didn’t appear happy he was there. Finally, his name was called, and he followed the technician to the imaging room.

“She told me I was going to have a mammogram,” Englehaupt said. “I said, ‘Whoa! Wait a minute.’ ”

Next, Englehaupt had an ultrasound for an intensified look at the nodule. A subsequent biopsy diagnosed it as cancer. Englehaupt never returned to work, because of shortness of breath and severe neuropathy in his feet, which he believes was caused by the radiation and chemotherapy.

Still, Englehaupt considers himself lucky. He’s since learned about two other men who died from breast cancer. Although his cancer treatments caused severe fatigue and joint pain, Englehaupt said he never required a blood transfusion, which he attributes to the red wine he makes and drinks.

Englehaupt said one oncologist even was impressed with the results of his routine blood tests.

“He said, ‘My God, you must have a marrow factory in your bones,’ ” Englehaupt said.

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