Patrick was an interesting interview, not only because it was a fun conversation and he’s a great guy, but because he’s a man, and men are far less likely to get breast cancer than women. They are also a lot less likely to talk about it. Patrick talked about it. I listened. I learned that about 1 in 100 people diagnosed with breast cancer are men. I learned that, like women under 40, insurance won’t pay for a man of 49 to have a mammogram, even if there is a lump (at least not without a fight). I learned there was such a thing as an ultramarathon. And I learned that Patrick, who struck me as normally calm and laid back, speaks animatedly, gesturing with his hands and arms, when explaining something of import, something I’m prone to do.
Patrick’s chest became sore after lifting weights in his home gym, and as he is accustomed to doing, he began to rub it out. That’s when he felt the tiny bump near his nipple. “That was mid-January [2024], and it drew my attention because I listen. The earlier you catch stuff, the better, and guys can get [breast cancer].” He talked to his wife about it, and she reminded him that he could talk with his PCP at his next appointment which was a couple of weeks away.
“So, I went to that appointment. And it was a normal check-up, things were good. And I’m like, ‘Oh yeah. By the way, there’s a little lump in here.’” He pointed to his chest. Patrick laid back on the examination table and the doctor tried to find it but couldn’t. Patrick thought he might have a better time finding it if he sat up, so with his eyes closed and with a little concentration, the doctor homed in on it. It was tiny, but he could feel it.
Men are more likely to be diagnosed later than women leading to more advanced-stage cancer.
Men are more likely to be undertreated than women.
Men are more likely to die within five years of diagnosis than women.
The doctor gave him two options: He could wait a couple of months and see if it goes away on its own or he could go get a mammogram. “In an instant, knee jerk reaction, I was like, ‘mammogram.’ The earlier, the better.” Patrick has had friends with cancer, one in particular had breast cancer. He followed her through the process and remembers what she went through. “I might as well be safe. Gotta be safe.”
Men get mammograms too
Five days later he got his mammogram. This is where I interrupted him for a moment to ask how a man gets a mammogram, because I sure didn’t know. Believe it or not, they do exactly what women do; they get their breast squished. “I had to stretch and pull the skin to put it in there. It’s probably a lot easier when you have a breast to put in there.” Patrick illustrated with his arms how you have to stand close to the machine with your arm up and around it while holding on to a bar. And I’m like, “Yeah, yeah, that’s exactly how women have to do it,” while at the same time mirroring him with my own arm gestures.
“After [the mammogram], I sat there in the waiting room, and they came out and said, ‘Yeah, we wanna do an ultrasound.’ I’m like, ‘Oh God, here we go,’ the whole time thinking, ‘No, please no, please no.’ …then doctor did the ultrasound and he’s like, ‘Yeah, we have a suspicious area. We’re gonna call for a biopsy.’” All the while Patrick was thinking, “My God. Boy, here we go. Okay.”
“The [biopsy] results came back as invasive ductile carcinoma. It was small. They presumed it was 1cm, so like a pea. It had well-defined edges. [It was] round which is interesting cause I guess they’re normally not like that.” The results, which were delivered quickly showed he was HER2 negative and both estrogen and progesterone hormone receptor positive. And as with women, hormones play a role in not only the cancer but in the recovery process. Patrick will be taking Tamoxifen, a selective estrogen receptor modulator, for the next five years as part of his treatment. Nearly 85% of women with breast cancer also take Tamoxifen.
Men have mastectomies too
He met with the surgeon for a consult, and they scheduled the mastectomy for February 26, less than a month after Patrick’s PCP appointment. The surgery took 2 ½ hours and was pretty straight forward. The surgeon made two small incisions, one for the tumor in his breast and one for three sentinel lymph nodes in his armpit. They removed the tumor and found an additional small tumor measuring .03 cm in one of the nodes, but nothing else. The cancer was considered Stage 2A because of the tiny tumor in his lymph node.
Possible symptoms of breast cancer to watch for include:
- A lump or swelling, which is often (but not always) painless
- Skin dimpling or puckering
- Nipple retraction (turning inward)
- Redness or scaling of the nipple or breast skin
- Discharge from the nipple
“It was an easily accessible area, very easy to have surgery on. It’s outside of the muscle, it’s not internal. If you were gonna have a spot to have it, it would be there, especially as a guy, because you don’t even need your nipple. They only take that much by that much,” he explained using his fingers to show me an area that looked to be about 4” wide and 1” tall. “It’s like an eyeball shape, big in the middle and small on the sides, and then they close it. And that’s a male mastectomy.” He explained that because men only have a small number of ducts in their breasts, a few small ones around the nipple, that cancer tends not to be very invasive, and recovery is faster and easier.
Patrick did have to have drain tubes though and explained them, rather creatively, again using gestures. “Anyway, you know where the incisions are, they have this tube up in your chest and it comes out, like, four inches below that. And then just sticks out of your body. You know, surgical tubing, like rubbery stuff that kids make water weenies out of? … and then it went to a bag that I had to drain all the time and keep track [of].” Patrick was a novice at this medical stuff. “Boy, I’m a guy [whose] never had an IV in my hand until that surgery. You know, I’m a healthy dude. I’m an athlete.”
Let’s take a moment to get to know Patrick
Patrick is a healthy dude. He used to skateboard and surf, now he snowboards and is an ultramarathon runner. “So, I run distances further than marathons. [I’m] doing a hundred miler in October that I’m training for. I had one booked for the end of April, a 50 miler on Orcas Island, but because of this…” He points to his chest. (And if you heard a muffled, “WOW,” during that paragraph, that was me. I didn’t mean to be so loud.)
Patrick, at 49 and 220 pounds, has for the first time in his life been eating a vegan diet. He says it can be a little difficult to get 150 grams of protein each day on a plant-based diet, but he’s been doing it successfully for a couple of months now. “I feel good, and I definitely don’t regret it. I miss some of the tasty stuff, like ice cream, but I mean that’s a breeding ground for cancer, you know, sugar and inflammation. Being a man that has breast cancer is akin to being a vegan in Boise, Idaho. You know what I mean? There’s nothing to be ashamed of, eating a plant-based [diet] or being a man with breast cancer.”
Patrick has his own business selling insurance but is in the process of making a big career move. “You know, during my midlife crisis I went back to college. I got my bachelor’s and master’s in political science, and then went to law school instead of buying a Porsche. That’s what I did.” He graduated from Concordia Law School in 2020 after three years, during which time he worked. He was planning on taking the bar exam this summer, but because of the cancer, he’s pushed it out to next February.
Back to treatment
After the surgery they tested the tumor to determine what treatment he would need. His Oncotype DX test (a test that predicts how the cancer will respond to treatment and how likely the cancer is to spread) was low meaning he could skip the chemotherapy because it would be of no benefit. “I was really happy and blessed not have to do chemotherapy. Not that it would mess with my hair,” he said as he lifted his ball cap to show me his bald head. “I mean there [are] benefits, it’d get rid of my ear hair.”
At the time of our interview, Patrick was on his 13th of 30 radiation treatments which he is doing 5 days a week for 6 weeks. “It kinda feels like going to the dentist every day. I’m looking forward to being done, it’s kind of wearing me out. It zaps my energy. It’s like when you’re out in the sun all day, a really long day with a lot of sun exposure, and you’re just zapped by the end of the day. That’s how I explain it to people.” He was told exercise would help his fatigue and he marveled at the dichotomy of the two; how could exercise possibly help with fatigue? But he tried it by running maybe an hour or two, several days a week, and it did indeed reduce the fatigue radiation was zapping him with.
Getting the word out to men
“You know, they ought to have a big RV that drives around, kind of like the blood mobile, only called the Screen Mobile that screens guys.”
I thanked Patrick for doing the interview and speaking up for men while we were talking, and I asked him if he had any hesitancy doing it. “It’s kind of a greater good thing, because if I don’t talk about it, or it doesn’t get out there, then maybe someone [else] suffers. You know, I had a tiny little bump, smaller than a pea, and another one that’s the size of a little piece of pepper in my armpit, and I’m going through all this. And mine’s not a fast grower. What happens when it’s the size of a golf ball?”
Our discussion moved on to what it is like to have breast cancer as a man in a masculine world. He pointed out that one percent of those diagnosed with breast cancer are men; that’s 1 out of every 100. “That’s a lot of guys! And my assumption is that they’re not checking themselves. They’re not feeling. And if they do feel, they don’t want to talk about it. You know, I wish you could just call it chest cancer. I think the stigma would be gone.”
“There are [other] issues with being a guy, aside from walking into the surgery office with the receptionist looking at my wife, asking, ‘What’s your name?’ There just isn’t that much data, right? They do the same stuff with guys as they do with women. You know, there are differences.” Even though there was nothing unusual in his diagnosis or prognosis, his tumor went to the Tumor Board, because he’s a guy.
Advocating for men
1 in 5 men with breast cancer have a close family member with the disease.
Like women who find a lump at a young age, Patrick got a bill for a $600 mammogram because insurance wouldn’t cover it. It took a bit of a fight, but it was resolved after he had the positive biopsy results; he’s quite sure the only reason it got approved was because the mammogram found cancer. He’s come to believe all men should get regular breast cancer screenings covered, not just those with the BRCA gene in their immediate family. He met a genetic counselor and nurse practitioner during his many appointments who want to see men get the screenings as well, and the three of them have discussed working together to get men covered through their hospital’s medical plan. “It’s a start, anyway.”
Patrick is halfway through his radiation treatments and by my calculation, he should be done May 10, 2024, the day before this year’s Flock Cancer Street Stroll, which he is planning on supporting. Speaking of support, he got this far with the unwavering encouragement of his wife, family, and friends. “I also felt very supported by Leslie Scantling* when I was not very familiar with what I would be facing as far as treatment. She gave me an outline for how it would likely go for me. And it was very accurate.” He also relied heavily on the specialists he met along the way, “Everyone I have interacted with has been very knowledgeable, professional and personable.” Come May, it’ll be time to take a stroll, get back to running, study for the bar exam and go on to live the second half of his life.
*Leslie Scantling is the founder of Flock Cancer Idaho.
American Cancer Society. “Breast Cancer in Men | Male Breast Cancer,” n.d. https://www.cancer.org/cancer/types/breast-cancer-in-men.html.
