Dr. Mark Levine
BRIGHT Run 2020 is turning out to be unique for a couple of reasons.
As you know, because of COVID-19, we are going virtual on Sept. 12, rather than congregating at the Dundas Valley Conservation Area as we have for the past 12 years.
And this year’s survivor spokesperson is also a change of pace over previous years. Steve Ewoniak, a married father of two and a recent breast cancer survivor, is our first male spokesperson and we appreciate his willingness to take on this important role.
Breast cancer in men is not common. For every 100 women who develop breast cancer, only one man will develop it. During my 36 years in clinical practice, I saw about a dozen men with breast cancer. Their ages ranged from about 45 years to 80 years, with most being over 65 years. When they first came to the cancer centre, they were a little bewildered because they thought that breast cancer was a disease only in women.
The cancer typically presents as a lump near the nipple or in the ring of brownish coloured skin surrounding the nipple (which is called the areola). Ninety-five percent of male breast cancers are estrogen receptor (ER) positive, that is they have a protein that binds estrogen. This is in contrast to female breast cancer where approximately two thirds are ER positive.
For many years, it was noted that men with breast cancer often had a family history of breast cancer. Years later it was discovered that there is a genetic predisposition to male breast cancer. About 20% of men with breast cancer will have a hereditary genetic predisposition through carrying the BRCA2 gene mutation. As a result, genetic testing is very important in men with breast cancer. If the BRCA gene is present, this would have implications for the patient’s children.
When I first started practicing oncology in the early 1980s, the treatment of breast cancer in a man was by surgical removal of the lump with a mastectomy. This is still performed today. Staging of the axilla (finding if the cancer had spread to the lymph glands under the arm) was also performed by axillary dissection. Removal of the testicles was the usual treatment of cancer that had spread (metastases), as this operation was a way of removing hormones that the cancer needed for its growth.
There are too few cases of male breast cancer to do large clinical trials to evaluate specific therapies for men with breast cancer. Over the years, the only option for oncologists was to use the information we learned from clinical trials in women with breast cancer, and apply it to men with breast cancer.
Early in my career, I offered chemotherapy after the surgery (referred to as adjuvant) to men in whom the cancer had spread to axillary lymph nodes to prevent recurrent cancer. Tamoxifen is an estrogen blocking drug. In the 1990s as more information became available on the role of tamoxifen as adjuvant therapy in women, it also became the standard post-operative adjuvant treatment in male breast cancer. In men with metastatic breast cancer, tamoxifen has replaced the removal of testicles to treat metastases. Chemotherapy is also used sometimes for metastatic disease.
In conclusion, it is my impression that men with breast cancer experience the same side effects of treatment and have similar emotional and psychological needs as women with breast cancer. And I salute Steve for taking on the role of BRIGHT Run 2020’s survivor spokesperson.