Last June, Zvi Lebanoni’s life turned upside down when symptoms of unusual back pain turned into shocking news: He was diagnosed with breast cancer. The surprise regarding this diagnosis reveals the general sense of shame men experience due to a lack of awareness and knowledge that they too are susceptible to breast cancer.
Zvi Lebanoni. Photography: Courtesy of Zvi Lebanoni.
A popular British sitcom, “Lovesick,” had an episode aimed at educating the public that that breast cancer is not just a women’s issue. The protagonist of the series fought for his life after being diagnosed with the disease. This lack of awareness also caught Haifaite Zvi Lebanoni (63) off-guard when he was recently diagnosed with breast cancer. Now, Lebanoni has two missions: To fight for his life and to raise public awareness that yes, men also develop breast cancer and should be aware of the signs.
“For several months I had been suffering from back pain, as if I pulled a muscle or something had seized up,” Lebanoni recalled. “Even with painkillers there was no improvement. At one point, the pain even increased. Then, two months ago, I felt a fatty lump in my nipple, but I didn’t take it seriously. I finally went in for a mammogram and the result was benign.”
A back CT scan and biopsies uncovered malignant tumors in Lebanoni’s spine and pelvis. His physician, Dr. Ithai Waldhorn, a resident in the Joseph Fishman Oncology Center at Rambam Health Care Campus (Rambam) in Haifa, Israel now had to determine what kind of cancer they were dealing with. He performed a manual breast exam, similar to the exam a woman might do on her own at home. Within minutes of palpating the area, he noted several lumps, which also turned out to be metastatic cancer.
The BRCA2 gene can also be found in men
There was much more to Lebanoni’s diagnosis than he realized. “We did a genetic investigation and discovered I carry the BRCA2 gene, meaning my cancer is genetic and possibly hereditary,” he explains. “While my partner and I have no children, my extended family members are now aware of their increased risk.”
Dr. Ayelet Shay, director of the Unit of Breast Oncology at Rambam, explains that just like women, men also have risk factors that increase the odds of developing cancer. “The most significant risk factor is a mutation in one of two genes BRCA1 and BRCA2. These genes significantly increase the risk of developing breast cancer, ovarian cancer and cervical cancer in women,” explains Shay.
Indeed, while men generally have less than a one-tenth of a percent chance of developing breast cancer, the risk increases in men: They have a 1-5% lifetime risk if they have BRCA1 mutation and a 5-10% lifetime risk with the BRCA2 mutation.
Diagnosing and treating breast cancer in men
“Every man who is diagnosed with breast cancer reacts the same,” points out Rita Vortman, the head nurse of the Follow-up Clinic for BRCA carriers at Rambam. “Similar questions always arise: How can breast cancer be found in the milk ducts in men? Who even knew men had milk ducts? Why does no one explain this to us and why isn’t it talked about with preventive tests in us, as for women?”
She points out that the general population is poorly informed and unaware of those who can be at risk for breast cancer. “Since the television series aired, there seems to be more awareness surrounding the issue,” she adds. “People are thirsty for information. I have received an increasing number of inquiries from friends, family, and colleagues.”
It is important to note that although breast cancer is the most common cancer in women, in Israel and globally, it is extremely rare in men. Only one in 100 men are diagnosed with breast cancer. In Israel, around 60 men annually are diagnosed.
As in women, it is optimal to catch breast cancer before it has metastasized, while the cure rates are high. “If changes appear in the breast, a lump develops or a discharge from the nipple begins, ask to be examined by your physician or specialist, and if necessary, do a biopsy,” emphasizes Shay. “In most cases, because the male breast is smaller, it is easier to notice the appearance of a lump. Therefore, if there is awareness, it is possible to catch the tumor early on and remove it surgically.”
Shay explains that most cases of breast cancer in men are what is known as hormonal breast cancer. “To date, I have treated only a few cases of breast cancer in men – all of which were hormonal breast cancer,” says Shay. When detected early, the accepted treatment is to remove the tumor surgically, followed by radiation treatments. If the biopsy reveals a high-risk cancer, chemotherapy is added, followed by hormonal therapy in the years following surgery.”
Vortman reiterates, “There is a combination of shame, and lack of awareness and knowledge in male breast cancer. All three are deadly. The lack of awareness surrounding breast cancer in men is a major reason for the delay in diagnosis. The later the diagnosis, the lower the chances of recovery.” She points out that little information geared toward men is available. As a result, men are unaware of the warning signs and are ashamed to contact medical professionals when they discover something suspicious in the breast. In
Vortman’s experience, most cases of male breast cancer involve penetration to nearby tissues and metastasization to other organs. She concludes, “Prevention and early detection saves lives. Pay attention to your body, apply for tests on time, do cancer screening tests, and apply for genetic counseling if there is a history of cancer in the family. Don’t be shy, don’t neglect, and take care of yourself. There is absolutely nothing in the world more precious than our health.”
Today, Lebanoni is being treated with new generation oral biological drugs along with monthly hormone-suppressing injections; both are aimed at treating the tumors and prevent further metastases. He also receives support from Rambam’s Oncology counseling staff. Despite the cancer’s advanced stage, he is responding well and his prognosis is positive.
In light of the fact that there is such a lack of education and understanding surrounding male breast cancer, Lebanoni has taken his diagnosis as a mandate to not only better understand the disease for himself, but to fight for others. With the knowledge he received at Rambam, he has made it his mission to raise awareness for other men who might be at risk.
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