European Stars and Stripes (Newspaper) - January 23, 1990, Darmstadt, Hesse                                Male Mastectomy by Malcolm Ritter associated press ome of Alvin by Roelfs co workers thought he was kidding when he told them the diagnosis even some nurses did t believe him bucket a 51-year-old computer specialist from Bellevue. Neb., had breast cancer and last june he had a Mastectomy. As a Man you be got to be careful when you Tell people you be had a Mastectomy he said recently they think Vasectomy " Only about 900 men a year Are diagnosed with breast cancer in the United Stales and some 300 die of it annually compared to about 142.000 diagnoses and 43.000 deaths in women experts say it is Loo rare in men to justify widespread screening a is urged for women and that few doctors Check Lor it while doing physicals. Burkell now 52. Had never heard of breast cancer in men when he noticed a Lump near his right nipple beneath the surrounding Areola an internist sent him to a surgeon for a Biopsy in which a piece of tissue is removed for microscopic inspection even before the diagnosis. Burkett had started checking around for information about male breast cancer and found Little available by the time the lab reported the Lump was cancerous he said. I sort of suspected  he spent two Days in the Hospital after a modified Mastectomy tests at the Lime and since have shown no evidence of any remaining disease in fact the prognosis for men As a group is worse than for women experts say one reason is that men lend to be diagnosed in later stages because few men or medical personnel Are watching for it in earlier stages. In addition because men have so much less breast tissue than women it is easier for cancer to spread to adjacent tissue said Robert Crichlow. Professor and chairman of surgery at Dartmouth Hitchcock medical Center in Harover . Why is breast cancer so rare in men it does t appear to be simply that men have so much less breast tissue As the risk is not related to breast size in women said Arthur Holleb a retired american cancer society official who has studied breast cancer in men instead the key seems to be that a Man s breast is not the target for hormones that a woman s breast is the changes hormones induce in a woman s breast May make cancer More Likely than in a Man s. He said any Lump in a Man s breast is reason to consult a doctor especially if it is under the nipple said William Donegan professor of surgery at the medical College of Wisconsin in Milwaukee most breast cancer diagnoses in men Are made around Ages 60 to 65, but men a their 20s can develop the disease As Well. Donegan noted that Many teen age boys get harmless breast lumps that tend to disappear in a year or two. Breast cancer is very rare in teen age boys doctors treat breast cancer in men just As they do in women with surgery and sometimes follow up chemotherapy or radiation treatment a Mastectomy removes the nipple and leaves a scar Donegan said. Burkell s goal now he says is to spread the word that men can get breast cancer too. It that makes men examine their breasts and consult a doctor Early about suspicious lumps he said maybe it will save some lives. Id your health assessing the breast cancer risk by Sally Squires Washington Post hat Are a woman s Odds of developing breast cancer the Best answer doctors have been Able to offer arc Broad Brush estimates that often seemed to have Little specific Rei Vance to the individual woman now a team of researchers at the National cancer Institute has developed a formula that can calculate a woman s risk of developing breast cancer within the next 10 to 30 years based on her medical history the new Way of estimating individual risk is drawn trom the breast cancer detection demonstration project a study of More than 5.000 women a report of the new measure was published in the dec 20 Issue of the journal of the National cancer Institute this is a major Advance in understanding the susceptibility to breast cancer said Daniel g. Miller director of the preventive Medicine Institute at the Strang clinic in new York City. It gives us reliable predictive information about the likelihood of an individual woman developing breast cancer Over a designated time  until now. Doctors could Tell a woman whose Mother had suffered from breast cancer that she too was at increased risk of developing the disease. But they had no Way to calculate what her Odds were of actually developing a tumor. Nor was there any Way to take into account a woman s other risk factors such As at what age she began menstruating which might increase or decrease her chances of developing breast cancer there have been a lot of individual studies of breast cancer risk factors said John Mulvihill. Chief of the clinical genetics Section at Sci and a co author of the study but we now have the first approach of combining risk factors and seeing what summary effect they have on an individual s  do that researchers rely on an equation that takes into account four factors from a woman s medical history age when menstruation began the number of negative breast biopsies she has had her age at the birth of her first live born child and whether her Mother or Sisters have had breast cancer. For example take a 40-year-old woman who began menstruating at age 12. This same woman has already had one breast Biopsy the extraction of a tiny bit of tissue for diagnostic examination that proved benign. She is childless and neither her Mother nor her Sisters have Ever had breast cancer. Based on this medical history the researchers calculate that her Chance of developing breast cancer in the next 30 years would be 101 percent about the same risk As the average american woman faces. But for another 40-year-old woman the Odds could be quite different. This woman began menstruating before age 12 and has had one breast Biopsy that also proved benign she had her first child before age 20, which helps to reduce her risk of breast cancer but both her Mother and her sister have had the disease which greatly increases her risk this woman s chances of developing breast cancer within the next 30 years Are 39 8 percent or about four times higher than the general population. This is the kind of person that really has an unusual risk said Mitchell h. Gail head of the epidemiological methods Section at the Sci and a co author of the paper this is a person who requires intensive  by offering women a much More precise idea of their actual risk researchers and physicians Hope to increase their use of mammography and monthly breast sell exams As Well As regular Check ups by physicians. In addition some women May be advised to lose weight lower their fat consumption and give up alcohol Allol which have been linked in some studies to breast cancer women with a family history of breast cancer tend to overestimate their chances of getting breast  said the Strang clinic s Miller. They often develop tremendous anxiety about their risk and sometimes he said Don t take appropriate Steps to limit their risk. They need a reliable estimate so that they can act in a rational manner he said it will help them comply with the recommendation Lor Early detection " doctors could then target certain women Lor More frequent physical exams weight loss Low fat diets and. In extreme cases preventive mastectomies one criticism of the study noted in an editorial accompanying the publication was that it failed to take into account alcohol consumption and oestrogen replacement therapy both have been shown in this study and some others to increase the risk of breast cancer. The new risk measure tells the average woman her likelihood of developing breast cancer said Linda Williams Pickle director of the Bio statistical unit at Georgetown University s Vincent t. Lombard cancer research Center but for women who Are at High risk these will be  but the new Model by encouraging breast screening and boosting research in prevention represents a major step toward achieving breast cancer  note Pickle and her colleague Karen a Johnson also of Georgetown in the editorial the information could also help doctors make treatment decisions such As whether to prescribe oestrogen replacement therapy to a particular woman. And it a ill help researchers design better studies of breast cancer prevention. If you want to prevent breast cancer you have to know what the incidence is Likely to to in a population that you Are studying so that you can determine if a treatment you Are using is having an effect or not said Miller this measure will allow us to do  by offering women a much More precise idea of their actual risk researchers and physicians Hope to increase their use of mammography and monthly breast self exams As Well As regular Check ups by physicians. The key to More effective treatment of breast cancer remains earlier detection by self examination for possible lumps and even More effectively by regular mammograms after age 40. But preliminary results of a study of 75 women at High risk of breast cancer found that the majority were not adept at doing self exams. The women were tested by Michael Stefanek co director of the breast surveillance service at Johns Hopkins medical institutions in Baltimore in three areas their general knowledge about How to do a self exam their ability to find lumps on models of a breast and their proficiency at doing a self exam. Despite knowing that they were at High risk for breast cancer women on average in the study performed cursory exams that covered just half of each breast they often missed altogether the upper right quadrant of each breast the area where 50 percent of breast tutors Are Lound. In detecting lumps on breast models the women also scored poorly. Each Model contained live lumps stage one breast cancer the most curable variety involves detecting lumps less than 2 centimetres a Little less than an Inch in diameter. Yet Only two of 75 women in the study were Able to find All five lumps of this size in the Model breast. Even when researchers asked women to identify slightly larger lumps Only 10 of 75 women could correctly do so. There s been some question about the value of breast self exams in increasing survival from breast cancer said Stefanek. Part of the problem with sell exams May be that women Don t understand How to do them Well. Page 16 the stars and stripes tuesday january 23,1990