~ 060909 A Guy's Breast Cancer and Hot Flashes: Treatment's Side Effects Unknown for Little-Studied Ailment in Men

The Baltimore Sun, Maryland

Jun. 8--The case was fairly routine: The patient felt a lump smaller than a pea, had a mammogram, got a diagnosis of breast cancer and quickly underwent a mastectomy.

What was different is this patient was a man -- Mike Nelsen, a 49-year-old high-level sales executive who never saw himself at risk."I remember distinctly sitting in a conference room when my cell phone rang," Nelsen said recently. It was his doctor, so Nelsen walked out into the hall to hear the news. "I guess I don't get shocked by a lot but I didn't even think men could have breast cancer. I'd never heard of it before. He said, 'There's 180,000 women and 2,000 men -- and you're one of them.' "

The diagnosis put Nelson into an overlooked and understudied group. While decades of research into breast cancer in women has led to more effective treatments and improved outcomes for patients, comparatively little attention has been paid to the disease as it strikes men.

The common lack of awareness about male breast cancer can be lethal. Diagnosed at the same stage of cancer, men and women of the same age do equally well. But the disease tends to be caught later in men, giving it time to grow and spread and wreak havoc in the body.

"Men are different than women. They think it's not really a lump. It'll go away. I'll ignore it," said Dr. Michael J. Schultz, Nelsen's oncologist at the Breast Center at St. Joseph Medical Center in Towson. "Women are conditioned: If it's a lump, I've got to take care of it."

Men "just can't believe it -- I'm not a woman [they say]. How can I have this? It's sort of a challenge to their masculinity but any cell type in the body can develop a mutation and develop into a cancer cell. It's all around us."

Schultz said that while male breast cancer is something to be aware of -- men do have breast tissue -- it certainly should not be added to the list as yet another thing to worry about. The diagnosis is a rare one.

Still, efforts are under way to learn more about male breast cancer, which kills fewer than 500 men each year in the United States. Up until now, the data has been limited and collected over so many years as to not be valuable. An international consortium is currently in the process of collecting 1,000 tissue samples from male breast tumors from 100 medical institutions across the globe in hopes of learning more.

"The whole trend in cancer treatment in general and breast cancer in particular is trying to individualize therapy for the individual patient's cancer -- targeted therapy," said Dr. Monica Morrow, chief of the breast service at Memorial Sloan-Kettering Cancer Center in New York. And little is known about how to do that for men. "There is something fundamentally different about the hormonal environment in men."

Dr. Sharon H. Giordano, an oncologist at the University of Texas M.D. Anderson Cancer Center in Houston, said a clinical trial was opened to study a hormonal breast cancer treatment in men. But without enough cases of the disease to enroll enough men in the trial, the trial was canceled.

Mike Nelsen, a healthy, vigorous guy, felt the lump underneath his right nipple last fall as he lay on his stomach in bed. "It felt tender," he recalled. "I thought, 'That doesn't seem right.' "

Nelsen procrastinated a bit about going to the doctor. He didn't have one. Within a month, though, he had an appointment. It was a good choice, he figured, when, a few days before his scheduled visit, he took off his T-shirt and found a wisp of blood on it.

His doctor sent him to Schultz, who ordered a mammogram and diagnosed the cancer. On Dec. 17, Mike Nelsen had a mastectomy. Schultz removed the breast tissue on Nelsen's right side and 14 of his lymph nodes. His nipple is gone, but he has decided against reconstructive surgery: "I'm not a surfer dude."

Nelsen spends a lot of time on the road, selling spices for McCormick & Co. in Hunt Valley, where he is director of sales. So he was back at it in no time, flying across the country still fixed with drains used to draw lymphatic fluid from his wound. There was work to be done.

He started chemotherapy in early February and was told that seven days later he would likely feel the worst. But he had a meeting in Chicago and then plans to entertain clients in Breckenridge, Colo. He just figured he wouldn't ski as hard as usual. He ended up in intensive care in a Chicago hospital for days, the chemo had so damaged his large intestine.

It would be his last round of chemotherapy. He was concerned he wasn't doing enough to keep the cancer from coming back, but genetic testing of his tumor indicated it was unlikely to return.

"I could get hit by a bus just as easily as I could die from cancer, based on this report," he said, his Midwestern accent giving away his Chicago roots.

Now, he is taking tamoxifen, a drug that interferes with the estrogen that fed his breast tumor. Tamoxifen is used to shrink existing tumors and to prevent them from coming back. He will be on the drug for the next five years. It does have side effects.

"How I got a women's disease from the start I don't know," Nelsen said. But because of the tamoxifen, "I get flushed from time to time. As my female friends say, 'Now you know what it's like to have hot flashes.' "

While there is data that tamoxifen can shrink tumors in men with breast cancer, Giordano said little is known about whether it has prevention properties in men, or what the side effects -- which include blood clots, increased risk of uterine cancer and vaginal dryness in women -- are in men.

Nelsen doesn't know for sure if he inherited his disease. But knows his mother had breast cancer while in her 40s, melanoma in her 50s and died of ovarian cancer at 63. And that an aunt had ovarian cancer, too. His daughter, 23-year-old Megan, plans to start getting routine mammograms when she is 25, much earlier than the average for women.

For now, Nelsen spends his good days at work -- and they are mostly good days. He plays golf. He works in the yard at his Parkton home. He plays with Mikayla, the 2-year-old he and his wife adopted from Guatemala. And he will throw out the ceremonial first pitch at the June 14 Orioles game as part of an annual Cancer Survivors Day sponsored by St. Joseph.

It is not Nelsen's way to fret about his health. He's worrying more these days about whether he'll get the ball over the plate than if there is more cancer is in his future.

"I try to take everything in stride. You run into issues your whole life. Instead of feeling sorry for yourself, you just have to go on. I don't know how else to do it," he said.

"I'm not very good at sitting still."
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