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Although rare, men can have breast cancer

For Michael Fleisher, retirement couldn’t arrive soon enough. Working for a local gaming company, he hadn’t enjoyed much time off in years and was looking forward to escaping his long six-day workweeks.

Originally from Michigan, Fleisher and his family relocated to Southern Nevada 16 years ago for his job. With his final day of work slated for Sept. 30, 2017, he and his wife had planned the retirement trip of a lifetime for the following spring — an activity-filled vacation to South America, where they planned to hike, see the sights and even visit the famed Galapagos Islands. Life was great.

But his body threw him a curveball.

“In October, just a few weeks after I retired, I noticed a hard bump close to my armpit. It was like a red, hard pimple,” Fleisher said.

He made an appointment at his dermatologist’s office, where the bump was removed and sent in for a biopsy. It came back as possible cancer of the sweat gland.

“When I returned for a second appointment, the dermatologist conducted a minor surgery in which he removed the sweat gland and surrounding tissue for biopsy and did another biopsy on the area near my right nipple, which I had told him had become very hard.”

Fleisher and his wife were visiting family in Michigan for Thanksgiving when they got the news that he had cancer. The news put a somber mood on the holiday.

“My brother and I had watched my mother go through breast cancer … first, when she was only 40 years old and, again, fatally, when she was 62.”

Their father had also been affected by cancer, passing away from a rectal form of the disease. “So it wasn’t that surprising, given our family history; but for me as a man to have breast cancer, now that was a shock,” Fleisher said.

Returning from Michigan, Fleisher contacted the Comprehensive Cancer Centers and saw Dr. Souzan El-Eid, a breast surgeon who also serves as the medical director of the Breast Care Center at Summerlin Hospital.

“She sent me to get a PET scan and some MRIs, but she told me straight out, ‘You have breast cancer,’” Fleisher said.

“Men deal with stress and pain differently than women,” El-Eid said. “Even though they’re feeling numb from receiving the news, they think it’s the end of the world and that this diagnosis will automatically be responsible for their death. In Michael’s case, I sensed that he was feeling that way. I knew that I needed to put it into perspective for him. … This is not the end, and you will get to enjoy your retirement.”

After his official diagnosis, Fleisher underwent a full mastectomy on his right breast. El-Eid removed a sentinel lymph node, which turned out to be cancerous. The surgeon then removed the four smaller surrounding lymph nodes, which were sent to the lab.

“The great thing is that the pathologist was right there so they were getting results right on the spot,” he said.

When men go through a mastectomy, it’s obviously a little different than for women. “We don’t have that fatty breast tissue so, after surgery, my chest looks a little sunken in,” Fleisher said. “Even now, months after the operation, my surgical site is still reddish and healing.”

“When we do a mastectomy, we are really taking out the whole breast tissue,” El-Eid explained. “We just leave skin and muscle and we put in a drain.”

Fleisher’s cancer was diagnosed as type 3A, which normally calls for a course of chemotherapy. However, the pathology report that came out of his surgery showed that it was a nonaggressive type of cancer with only a 2.5 percent chance of returning within five years. All that was needed was a course of radiation — five days a week for six weeks — which Fleisher completed in May.

While his radiation went fairly smoothly, one hiccup did occur: Fleisher developed lymphedema in his right hand and arm, the same side as his mastectomy.

“My arm and my hand were absolutely huge from the fluid buildup from my lymph nodes being removed,” he said. “This is apparently a pretty common side effect and, in May, I started going to therapy twice a week to combat it.”

Now, months later and almost finished with therapy, he is using a pneumatic pump at home for further treatment.

“It pumps air from my fingers to my shoulder to pump out the fluid. I’m also wearing a compression sleeve during the day, probably until the end of the year,” Fleisher said. “After that, I’ll need to wear the sleeve when I’m flying or in a city with a high altitude.”

Knowing his parents’ proclivity to the disease, Fleisher opted to undergo the BRCA gene test, a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. The test is offered only to people who are likely to have an inherited mutation based on personal or family history or who have a specific type of breast cancer.

“Everyone naturally assumed that it would be positive and when it turned out to be negative, nobody could believe it,” he said. “My family history had nothing to do with the fact that I got breast cancer.”

“Genetics is an ever-evolving field and we are learning every day. Right now, we have more awareness and better tools to catch and prevent cancer with prophylactic surgery,” El-Eid said.

“The two BRCA genes were discovered in the 1990s, and since then, approximately 80 genes have been identified by the National Cancer Institute associated with cancers in the human body. Michael’s cancer, though not associated with the cancer-causing genes we currently know about, could be caused by a gene that just hasn’t yet been identified. What we know today is not what we will know tomorrow, or next year, or years down the line.”

Only approximately 1 percent of all breast cancers show up in men. It is predicted that in the United States in 2018, an estimated 2,500 breast cancers will be diagnosed in men and approximately 500 men are expected to die from the disease. Data from the Surveillance, Epidemiology, and End Results program indicate that the age-adjusted incidence rate has increased from 0.85 cases per 100,000 men in the general population in 1975 to a high of 1.43 cases per 100,000 in 2011.

As with many forms of cancer, breast cancer in men seems to be an age-related disease with incidence rates rising steadily with age. The average age at diagnosis is approximately five years older for men (67 years) than for women (62 years), according to a June 14, 2018, New England Journal of Medicine article entitled “Breast Cancer in Men” by Sharon H. Giordano, M.D.

Fleisher said being a recent retiree was fortunate as he may not have gone to the doctor as quickly as he did.

“Who knows if it would have spread to other organs? Men don’t take care of themselves the way women do” he said. “It’s OK to see a doctor if there is something unusual going on with your body. Early detection is key. If you have a bump, a lump, or both, go see a doctor.”

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