Breast cancer can also occur in men

On a relatively warm winter’s day on February 23, 2023, Mark Clausen of Dennis got in the car for what he thought would be a routine doctor’s appointment.

“I had an appointment with my primary care physician in Norwood because I didn’t have a PCP on Cape yet and I had some issues with pain in my shoulder that I wanted to address,” said Clausen. “It was a beautiful day to be outside, with temperatures in the mid-50s.”

What Clausen believed would be a routine exam turned into something he never expected.

His doctor noticed that his left chest looked inflamed and a little swollen.

“My doctor asked me if I had been hit by someone or something and when I responded no, he told me he wanted to order a mammogram and an ultrasound while I was at his office,” said Clausen. “I was alarmed and annoyed because I had planned to go golfing right after my visit with him. I wasn’t sick, I wasn’t feeling badly, I thought I was healthy!”

Following the mammogram and an ultrasound, a radiologist came into the room and told him that he had breast cancer and would need to schedule a biopsy.

“In disbelief, I asked her three times if she was sure and she said ‘yes,’” said Clausen.

As Clausen drove the 80 miles from Norwood to his Dennis home, he wondered how he was going to tell his wife Joanna. She had also been diagnosed with breast cancer just three months prior and was scheduled for surgery. He also mused about the fact that for 34 years, he and Joanna had held an annual golf tournament, named MARJO (‘Mark and Joanna’), which raised over $625,000 to help cancer patients, and, incredulously, now he and his wife were patients at the very same time.

“I waited 20 minutes after I got home to talk with her,” said Clausen. “It was very hard telling her and then deciding how we were going to share the news with our children.”

He had already met Naomi Kalliath, DO, breast surgeon with Cape Cod Healthcare Breast Surgery in Falmouth and Hyannis, and Edward Wyluda, DO, medical oncologist at Davenport-Mugar Cancer Center when Joanna was diagnosed and decided he wanted to be treated by them as well.

Surgery and Treatment

With challenges and a series of setbacks, including Joanna suffering a heart attack in April 2023, Mark’s surgery was delayed several weeks in order for him to care for her. Mark’s surgery was re-scheduled for May 2023.

“My surgery was scheduled for May 6th and I was very nervous,” said Clausen. “The staff held my hand trying to keep me calm. The surgery presented a couple of surprises because in addition to removing the left chest mass, Dr. Kalliath found abnormal nodes and so she had to make an additional cut into my armpit and remove 19 lymph nodes. Sixteen of the 19 were cancerous and I was re-diagnosed from stage I to stage III cancer because the breast cancer had spread.”

In addition to Drs. Kalliath and Wyluda, Clausen met with Jeffery Martin, MD, a radiation oncologist at the Davenport-Mugar Cancer Center to discuss radiation treatment. Given Clausen’s cancer type HER2 negative, estrogen and progesterone positive, Dr. Martin recommended a 25-day cycle of radiation which Clausen completed in January 2024.

Men Do Get Breast Cancer

“Out of every 100 breast cancers, one is male,” said Dr. Kalliath. “It is not nearly as common as female breast cancer.”

According to the Breast Cancer Research Foundation, approximately one in 726 men will develop breast cancer in their lifetime in contrast to one in eight women in the U.S.

By the time a palpable breast lump is found in a man, it is often at a later stage, Dr. Kalliath said. Women are often diagnosed before they feel a lump because they have screening mammograms, which men do not. Stage for stage, men and women have the same prognosis, she said.

“Mark had a very unusual presentation because he had some shoulder pain and his primary care found the lump in his breast during examination,” said Dr. Kalliath. “He had a very common male breast cancer that is fed by classically female hormones which are estrogen and progesterone. Most breast cancers in men are hormone-driven like his and are usually invasive ductal carcinoma, which is also the most common type in women.”

Risk Factor for Men

The following are some of the risks for male breast cancer, according to the American Cancer Society:

• Aging: The risk of breast cancer goes up with age. Men are about 72 years old, on average, when diagnosed.
• Men with a BRCA2 gene have an increased risk. BRCA1 risk is lower.
• Klinefelter syndrome: Men with this syndrome are more likely to get breast cancer, with 20-60 times the risk of men in the general population.
• Heavy drinking of alcoholic beverages.
• Excess body weight: Fat cells convert male hormones (androgens) into female hormones (estrogen) causing higher levels of estrogens.
• Testicular conditions: An undescended testicle, mumps as an adult or having an orchiectomy may increase risk.

Early Detection

“I recommend everyone (men and women) do a self-breast exam every month or every couple of months,” said Dr. Kalliath. “Check for asymmetrical lumps and/or nipple discharge, which would be abnormal, especially in men. I think men doing a self-check is very important.”

The Journey Continues

Clausen continues to take oral chemotherapy medications and is experiencing side effects that make him feel unwell some days. He also has many follow-up exams and tests, including physical therapy for treatment of edema in his upper left chest wall, osteoporosis, and neuropathy in his feet.

“I am trying to stay busy, strong and resilient,” said Clausen.

He continues in his role as the Cape Wellness Collaborative president and chairman of the board raising awareness about cancer and the services the organization provides. He is looking forward to the start of a new program being offered for men impacted by cancer at the Cape Wellness Center. The Men’s Cancer Support Group-You’re Not Alone will begin on November 3rd from 5:30-6:30 PM and will meet the first Monday of every month.

While he has days that are trying and can get him down, he relies on his faith and the support of family and friends to get him through. He is looking forward to the tapering of his oral chemotherapy in six months with the hopes of having fewer side effects and feeling better.

“Whenever I feel down or at my lowest, I am reminded of what my mother called, vitamin F,” said Clausen. “Vitamin F is faith, family, and friends. I have deep faith that will push me through. I have a wonderful wife and a village of family and friends helping me and I put my trust in Cape Cod Healthcare.”