Dr. Erika Kube| Special to The Columbus Dispatch USA TODAY NETWORK
Doug came to the emergency department in the middle of the night complaining of chest pain. He was in his 60s and had a history of diabetes and high blood pressure.
He was vague in describing his symptoms and said his pain had been going on for a couple of days, but seemed worse at night. He came to the hospitalbecause he couldnt sleep.
He rated the pain as a mild 3 out of 10 burning pain that crossed the front of his chest. He didn'thave any shortness of breath or nausea, and he hadn'ttaken anything for his symptoms.
Dougs EKG was normal, andI asked him to tell me about his symptoms. In my head I was running down the list of causes of chest pain, trying to figure out what was going on with him.Chest pain is alwaysconcerning, especially given Dougs risk factors for heart disease, but he didnt have the classic symptoms of a heart attack. I ordered lab tests and a chest X-ray and gave him medication for acid reflux to see if that would help.
I asked him if there was anything else going on with him or his health, and he initially said no, but called me back to the room a few minutes later to tell me that he had noticed a lump on his chest. He had been meaning to see his family doctor about it, but never got around to it. I asked Doug if I could pull down his gown to look at the area, and I immediately noticed his right breast had a mass the size of a walnut and the nipplewas distorted. I examined his armpit and felt a few small swollen lymph nodes, which heightened my concern.
Doug could see the concern in my eyes as I was examining him, and hestarted to look worried. I asked him about his family history, and he said that his parents and siblings had diabetes and high blood pressure, like he did. I asked specifically about cancer, and he said that almost all the women in his family had had breast cancer. His eyes grew wider as he realized why I was asking the questions I was asking. I told him we would await theresults of the tests already taken and then further discuss how to work up his breast mass.
As I was leaving the room, he asked me if it was even possible for a man to have breast cancer.
Dougs labs came back normal; his chest X-ray didnt show any specific abnormalities. He was feeling better after he received the medications.I was glad his chest pain symptoms seemed to be mostly related to acid reflux, but I was worried about the mass and wanted to admit him to the hospital. I reviewed his results with him, and he agreed to stay in the hospital to get some answers. He was very quiet and kept shaking his head in disbelief.
Doug was admitted to the hospital and underwent a biopsy of his breast mass.
Unfortunately, this confirmed that Doug had a form of breast cancer, and it had spread to his lymph nodes.He met with a breast surgeon and oncologist while in the hospital. They recommended he undergo surgical removal of the mass followed by chemotherapy and radiation.
While breast cancer is not common in men, approximately 1 in 100 diagnosed breast cancers in the United States are in men.Because it is less common and not screened for like breast cancer in women, it is often more advanced when it is finally diagnosed.
The types of breast cancers seen in men are the same as found in women. Risk factorsinclude advanced age, family history of breast cancer, genetic mutations, use of hormonal therapies like estrogen that can be used to treat prostate cancer, obesityand liver disease.
Like women, breast cancer treatment in men depends on the size of the tumor and whether it has spread outside of the breast. Treatment can include surgery, chemotherapy, radiation therapy and hormonal therapies.
Doug hadsurgery to remove the breast tumor before he left the hospital. Chemotherapy was scheduled to start a few weeks later, and radiation would start once his surgical wounds had healed. The oncologist recommended genetic testing for Doug and his family members, as there are certain inherited gene mutations that can increase cancer risk.
There are two genes, known as BRCA1 and BRCA2 (breast cancer 1 and breast cancer 2 genes), that are the most commonly affected in hereditary breast and ovarian cancer.
Approximately 3% of breast cancers and 10% of ovarian cancers result in inherited mutations in the BRCA1 and BRCA2 genes. These genes normally protect you from getting certain cancers, but when mutated, they can increase your risk of developing cancer.
Dougs oncologist was hopeful Doug would continue to do well with his cancer treatments and have many healthy years ahead. Dougs children met with a genetic counselor after hehad gone through genetic testing, and they made specific cancer screening recommendations for Dougs family in hopes of preventing or finding cancer at an earlier and more treatable stage.
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