Breast Cancer in Men

Female nurse examining senior man with stethoscope at home

When 54-year-old Realtor Vern Oakum first noticed a pebble-size lump near his left armpit, he disregarded it. “But it never went away,” says Oakum.

Over six months, the lump grew to golf-ball size and was sore when he lay on his side. “I was a typical man,” he admits. “I procrastinated about going to the doctor.”

Finally, just before Thanksgiving 2014, he saw his primary care physician, who was equally perplexed. Ultrasounds and mammograms of the mass were inconclusive.

Given Oakum’s family history of cancer, including a mother with breast cancer, grandmother with stomach cancer and various male relatives with prostate cancer, his doctor referred him to Liz Thu Ha Lee, M.D., FACS, breast surgeon affiliated with Memorial Hermann.

“In 30-40 seconds of probing the left breast with ultrasound, she pinpointed the lump,” Oakum says.

As the son and spouse of female breast cancer survivors, he says, “I had a good idea what I was getting into – especially when Dr. Lee opened her office early the next day to do a biopsy.”

How Does Breast Cancer Treatment Differ For Men?

With less than 1 percent of breast cancer striking men, he joined a rare group: 2,600 American men diagnosed yearly with the disease.

Still, “I was just stunned,” he says. “Once I heard ‘breast cancer,’ nothing Dr. Lee told me registered. I started thinking about my mortality, finances and family and friends.”

Fortunately, Oakum’s slow-growing cancer was caught early at Stage 2B, between 2-5 centimeters, but it had spread to a lymph node. Dr. Lee quickly assembled a treatment team, including oncology hematologist Ronjay Rakkhit, M.D., and Katy radiation oncologist Tse-Kuan Yu, M.D.

Due to lymph involvement, the team first treated him with chemotherapy, a chemical cocktail to shrink or slow the tumor’s growth. Surgery, hormonal blockade and radiation followed.

According to Drs. Lee and Rakkhit, radiation and chemotherapy are the same for men or women. What differs are the types of surgery and hormonal drugs used post-surgery to cut risks of recurrence.

Before his surgery on June 29, 2015, Oakum underwent six months of chemotherapy, starting the Friday after Thanksgiving. “I could not taste food other than egg-drop soup,” he says.

Worse than losing 20 pounds and his hair, Oakum experienced extreme exhaustion. Walking two steps was challenging. “It felt like someone had removed my batteries.”

Lumpectomies are rare for men. “Because men’s breasts are so small, it’s hard to get sufficiently wide margins around the tumor,” Dr. Lee says.

Oakum and his team chose to remove both breasts and all 21 lymph nodes in the arm pit and chest. “Prophylactic mastectomies have not been proven medically to raise survival rates,” Dr. Lee says, “but it gives some patients more peace of mind.”

Reducing the Chance of Cancer Returning

Rather than aromatase inhibitor drugs to lower estrogen levels, typically given to female patients to cut recurrence, Oakum received tamoxifen, another drug that thwarts growth of hormone receptor-positive tumors such as his. “Aromatase inhibitors are not shown to be successful in men,” Dr. Rakkhit says.

Having a disease identified with women meant the literature was geared to female breast cancer and “the only survivors I could talk to were women,” Oakum says. “But Drs. Lee and Rakkhit and their teams made sure I understood exactly what I’d experience. They answered questions before I asked. They were absolutely fabulous.”

Post-surgery Oakum had radiation five-times weekly using high-energy particles to destroy cancer cells. “My skin gradually began to burn,” he says of the six-week treatment. “By the end, it was peeling under my arm and on the side of my chest. It felt like it would never end. I spent a year in hell, but learned to take it one day at a time.”

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Rehabilitation to Regain Strength and Flexibility

Due to scarred and stiff tissues from surgery and radiation, Oakum had limited mobility in his left arm. He also faced lymphedema, the lifetime risk of tenderness and swelling due to damage to the lymphatic drainage during radiation and lymph node removal. Dr. Lee referred him to TIRR Memorial Hermann for cancer rehabilitation before receiving radiation.

“Cancer rehabilitation, or prehabilitation, starts at the time of diagnosis,” says Emilia Dewi, OTR/L, OTD, CLT, Occupational Therapist III and clinical coordinator at TIRR Memorial Hermann. “Evidence suggests it can improve healthcare outcomes and reduce healthcare costs. The sooner patients learn home exercises, the sooner they recover.”

TIRR therapists helped Oakum restore his range of motion, flexibility and strength and taught him how to treat and prevent fluid buildup with massage, exercise and compression garments.

“Physical and occupational therapy is vital,’’ Dr. Lee says. “It improves patients’ mobility and recovery time and shows what exercises prevent lymphedema and stiffness in joints that can occur after surgery and radiation.”

Unlike chemo and radiation, the twice-weekly one-hour sessions at TIRR Memorial Hermann over two months “wasn’t something I dreaded,” Oakum says. “It was a learning experience each time.”

Getting Back in the Swing of Things

Although he’s not back to running 2.5 miles daily as before his diagnosis, he has full range of motion and is back at work.

“He has a higher than 80 percent chance of being cured,” Dr. Rakkhit says.

Oakum sees Dr. Lee annually and Dr. Rakkhit every three months. He returns to TIRR Memorial Hermann for six-month follow-ups.

“While it sucked having breast cancer,” Oakum says, “having a team getting me back on my feet made all the difference in the world.”

Learn more about Memorial Hermann’s cancer network and rehabilitation services.

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Tashika Varma