Father And Daughter Both Cope With Breast Cancer

By SCOTT TERRANELLA, M.D., ABC News Medical Unit

For Walter Crate, this is an especially happy Father's Day: Not only is he free of his breast cancer - yes, that's right, breast cancer - his adult daughter recently recovered from breast cancer surgery herself.

"I was blessed, I really was," he said.

While male breast cancer is uncommon, accounting for less than 1 percent of all breast cancers, it is a disease men need to know is possible and is often linked to one's genes, as was the case with Crate and his daughter.

The problem, said Dr. Marisa Weiss, a radiation oncologist in Philadelphia and founder of BreastCancer.org, is men think of breast cancer as a female disease, and as a result, they don't go to their doctors when they have a problem.

"Male breast cancer is not routinely screened for," said Dr. Judy Boughey, a surgeon at the Mayo Clinic in Rochester, Minn. "This means men usually have a more advanced stage of breast cancer than women at the time of diagnosis. ... Their overall prognosis tends to be poorer than that of women."

However, "the sooner it's diagnosed the sooner it can be treated, and it's highly treatable when discovered early," said Weiss. According to the National Cancer Institute, there are approximately 1,500 new cases of male breast cancer in the United States every year, and 400 men die from it each year.

A Stronger Genetic Link?

In some cases, breast cancer has a genetic link, and this appears especially true for male breast cancer, said Dr. Harry Bear of the Massey Cancer Center at the Medical College of Virginia in Richmond. As many as one in five male cases have a genetic cause, while only one in 20 female cases are genetic, he said.

"When you see a man diagnosed [with breast cancer], you should automatically think about genetic testing," said Lillie Shockney, a registered nurse and the administrative director of the Johns Hopkins Avon Foundation Breast Center in Baltimore. "Their probability of having a gene is high. Breast cancer can be passed down through the generations on the father's side just as equally as it can on the mother's side."

The genes that cause breast cancer - BRCA 1 and BRCA 2 - are the same for both men and women, but those with the BRCA 2 gene have "a higher risk not only for breast and ovarian cancer in the females in that family but also for prostate cancer in the male relatives," said Dr. Julia Smith, director of the Lynne Cohen Breast Cancer Preventive Care Program at the New York University Cancer Institute and Bellevue Hospital in New York City. "All women who come to our program are asked about male relatives, and those with either breast, prostate or melanoma [skin cancer] are screened with genetic testing."

Getting Help

"I noticed a visible lump on my left breast around the nipple," said Crate. "It was very apparent."

Still, a diagnosis of breast cancer was quite the shock.

"I hadn't really thought about what it could be, certainly not breast cancer or anything serious."

He underwent a modified mastectomy in which the nipple, skin and breast tissue were removed, as well as several lymph nodes in his armpit to determine if the cancer had spread. The lymph nodes were free of cancer, indicating it hadn't spread.

Following surgery, he received a mammogram every six months for two years to make sure there were no new tumors. He now follows up with his surgeon every three to five years. He's remained cancer-free since the surgery.

The Father-Daughter Link

In an odd twist of fate, Crate's 40-year-old daughter, Carolyn Delaney of Philadelphia, was recently told she had a lump in her breast during her annual exam with her gynecologist.

She knew from her father's experience that this was something she needed to act on right away.

Within just a few weeks she discovered she, too, had breast cancer. An MRI showed two tumors in her breast. It was her turn for a total mastectomy. She doesn't yet know the exact type of cancer she has or what further treatment she'll need.

The Warning Signs

"A man may notice some changes in his breast tissue," Weiss said. "He might notice a rash, a lump, an area of thickness, an area that is puckered or dimpled, a bulge underneath the surface of the skin, or the nipple may be pulled to one side or pulled in and retracted. Sometimes there can even be a bloody discharge from the nipple. If these changes persist, it's really important to bring them to your doctor's attention."

Because male breast cancer is so uncommon, regular screening is not recommended as it is for women.

"Thankfully, it is very uncommon and screening for an uncommon disease is not really worthwhile," said Dr. Stephen Edge of the Roswell Park Cancer Institute in Buffalo. "There are other health problems that really take priority in men, such as screening for prostate cancer, colon cancer and hypertension. Men need to be sure to see their doctors regularly and get all the recommended screenings."

But men should always speak up if they notice anything out of the ordinary, health experts say.

"Men are reluctant to tell anyone they have a lump in their breast," said Shockney. "It requires acknowledging that they have breasts."

Read more about male breast cancer at http://www.breastcancer.org/male_bc_intro.html