Mammograms for Men?

Most men don't think they can get breast cancer. Yet each year, an estimated 1,300 males will be diagnosed with it and some 400 will die.

The diagnosis usually comes as a shock. "Breast cancer is the last thing they are thinking about," says Sharon Giordano, M.D., an epidemiologist at The University of Texas M.D. Anderson Cancer Center in Houston. She has conducted the largest study of breast cancer in men. Even physicians and nurses who treat breast cancer expect the patient to be a woman. "They're always called Mrs. Jones when they're sitting in the waiting room," says Giordano.

Male breast cancer is rare, accounting for only about 1 percent of cases each year. But men tend to have larger tumors and more serious cases than women even though male cancer is more easily detected. Researchers don't know if that's because male breast cancer is more aggressive or because men simply go to the doctor later than women.

There's reason to believe that risks related to male breast cancer differ significantly from those associated with the disease in women. For females, major factors include family history, lifetime exposure to hormones, and age at various biological milestones such as first menstrual period, childbirth and menopause.

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Although many tumors in men are "hormonally driven" (and can be treated after surgery with hormone blockers like tamoxifen, a drug widely used in women), male breast cancer largely afflicts men older than 65 and is very rare in young men. It is associated with breast and testicular abnormalities, infertility and Klinefelter's syndrome, a genetic abnormality in which men have one or more extra X chromosomes. Klinefelter's syndrome is often marked by gynecomastia, an enlargement of the breast tissue, which Giordano says may also turn out to be a risk factor.

Does this mean men should get mammograms? Considering the low risk for males in general, a self-exam is probably enough, says Giordano, because lumps are more easily felt on a man's chest. Men can also get genetic tests to screen for risks such as the BRAC2 gene, a known risk factor for men and women. Giordano offers the testing to all her patients, male or female. According to her, "Men who have children, especially daughters, are more likely to want to be tested" in hopes of giving their kids a head start detecting the disease.

Men tend to have larger tumors even though male breast cancer is more easily detected.

Cancer cases in men:

1. Prostate - 220,900

2. Lung - 91,800

3. Colon - 72,800

4. Bladder - 42,200

5. Melanoma of skin - 29,900

38. Breast - 1,300

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