Stranger than a talking dog

More men die of breast cancer than testicle cancer. Yes, you read that right. Every year, more men in the UK die of breast cancer than of testicular cancer. And the numbers - although small - are growing. Jim Pollard reports.

Breast cancer image Richard Francis's comic novel Taking Apart The Poco Poco begins inside the obsessive mind of a character called Raymond.

Raymond sleeps in his kitchen, spends his first waking moments savouring smells and howls when he finds a chicken on the washing-machine. It's a page or three before the reader realises that Raymond is actually a dog. It's neatly done.

However, this surprise is nothing compared to the stunt the author pulls 150 pages later. Margaret, the novel's central female character, is in hospital to have a lump in her breast examined. She strikes up a conversation with someone she takes to be a waiting husband and is amazed - as we are - to find she's talking to a fellow patient.

A bloke with breast cancer? Most of us find it easier to get our heads around the idea of a talking dog.

Male breast cancer is like open government, British manufacturing or President Bush, words that just don't go together. I mean, you can't call those little things breasts, can you? You can and they do.

Doctors diagnose over 250 men with breast cancer every year. That's a tiny number compared to the thousands of women but for the blokes concerned, each has to deal with a disease he thought he had no chance of ever getting.

Stuart Gilder was one. And the former policeman was honest enough to admit 'I burst into tears the moment the door was closed.

'So did my wife. I had had a feeling that it was cancer but when they tell you it's still a terrible shock. You wonder fleetingly "how long have I got?â€. We hadn't said much on the way home but we both thought a lot. I kept thinking how each journey begins with a single step and I had no intention of giving up.' He was just 51.

Male breast cancer currently accounts for around 1% of all breast cancer in the UK but this figure is rising. The disease kills around 70 men every year.

Dr Eadie Heyderman, author of 'Coping With Breast Cancer', says women and men have almost opposite attitudes to their breasts. 'Women think every breast lump must be cancer while men think a lump in the chest can't be cancer and ignore it,' she says. 'The outcome for men and women is actually pretty similar for the same type and stage of the disease but men are more likely to wait before seeking treatment until the lump has broken through the skin to form an ulcer or become attached to the chest wall.'

The risk of breast cancer increases with age. In female breast cancer, hormones, particularly oestrogen, play a major role. They don't cause it but do appear to encourage its growth.

Men have far, far lower levels of oestrogen which probably explains breast cancer's later age of onset and far lower incidence among them but hormones are still involved.

Prof. Fentiman However, Professor Ian Fentiman, right, who has treated several men with breast cancer stresses that 'male breast cancer is not a sign that you're less of a man. It's just bad luck. In most cases of male breast cancer there is no hormonal abnormality.'

The most common signs of male breast cancer are:

painless lumps in the chest;
a nipple which has turned inwards.

The signs can be similar to gynaecomastia, a harmless swelling under the nipple which is why it is so important to visit your GP as soon as possible.

Professor Fentiman says: 'Half the men who get breast cancer in the UK are not diagnosed until their cancer is very advanced, and men are dying unnecessarily because they are unaware of the symptoms or because they are too embarrassed to seek help.

'If diagnosed early enough, a man with breast cancer has between 75% - 100% chance of making a full recovery, but this can drop to as low as 30% for men with very advanced disease.'

When it comes to breasts, size matters. Women have far more breast tissue for lumps to develop in whereas for most men, self-examination is as simple as putting a flat hand on the chest.

However, men with larger breasts are also at marginally greater risk. Firstly, examination may be a little less easy and, secondly, fat, which, of course, is what tends to cause enlarged male breasts, produces oestrogen.

'Nine out of ten lumps in women aren't malignant,' says Kate Law of Cancer Research UK, 'but in men a lump is more likely to be cancerous. Because they have less tissue, men can more easily tell the difference between a cyst and a growth. Cysts are moveable and free from the underlying tissue whereas a malignant growth clings and doesn't budge.'

Liver disease can also increase male oestrogen levels. Egypt has one of the highest rates of male breast cancer — 5% of cases compared to 1% in the UK - because of the prevalence of the infectious liver disease bilharzia. For most men in the UK, booze is the most likely cause of liver disease.

Genes are also involved. About 5-10% of women who develop the disease come from families with a history of female breast cancer. Among men this rises to 20%. Mutations in two genes - BRCA1 and BRCA2 - have been identified and a test is now available for them.

Stephen Wilshere was 69 when he was diagnosed with breast cancer, having already lost his mother and a daughter to the disease.

He had the test and the varying reactions of his family are a case study in the issues surrounding genetic testing.

'When I was told I had a breast cancer gene, my eldest daughter, who has her own children, decided to have the test too,' he says. 'She was told she hasn't got it. But my son, who has no children, and my youngest daughter both decided not to be tested. Although my youngest is concerned about breast cancer and gets herself checked out regularly, she says she's comfortable at present and doesn't want to find out something she might not be able to handle.'

Because the numbers involved are so small even men in a high risk family are not themselves considered by the medical profession to be at high risk which can make some doctors as stubborn as some men in their refusal to recognise breast cancer as a possibility.

Diagnosis for one Oregon man took over ten years despite repeated consultations with some half a dozen doctors. The reason? He was a young man - just 36 when his disease was finally identified.

Of course, breast cancer is embarrasing for a man.

The male breast cancer patient In Taking Apart The Poco Poco is desperately worried about being a bloke with a woman's disease. 'I keep imagining what it would look like if they put it in the local rag' he says. 'Stockport Man Dies Of Breast Cancer. What a way to go. Sometimes I think that's the worst part.'

But talking to doctor is still easier than dying. And things could be a lot worse.

Apparently, until relatively recently, the treatment for advanced male breast cancer in the USA was an orchiectomy - better known as castration!

Gulp. These days it's a far less sensitive part of the anatomy that's removed.

'Losing a breast is a shock, of course,' one male breast cancer told me. 'But it's nowhere near as traumatic as for a woman for whom it's the loss of a part of her personality as well as part of her body. Men just wind up with a scar instead of a nipple and you soon get used to that.' After all, as every teenager wonders: why do men have nipples anyway?