Making choices about treatment for breast cancer in men

Because breast cancer in men is rare (about 390 men each year are diagnosed –less than 1% of all breast cancers diagnosed each year in the UK (Cancer Research UK July 2014)), most medical information about the best ways to treat breast cancer is based on clinical trials of treatment for women with breast cancer.

Surgery is usually the first form of treatment a man with breast cancer will have. Men generally have much less breast tissue than women and so it is usually necessary to remove all of their breast tissue and the nipple on the affected side (a mastectomy). When a woman is diagnosed with breast cancer it is sometimes possible for her to have a lumpectomy rather than a mastectomy but this is not usually possible for men.

Sometimes the chest muscle is also removed during surgery if this has been affected or if the lump was very close to the muscle. The surgeon will usually remove at least one of the lymph nodes to check whether there are any signs of the cancer there.

After surgery, a man may be offered other treatments, including radiotherapy, chemotherapy and hormone treatment, depending on the characteristics of his particular cancer. Men may also be offered the option of reconstruction following surgery (see Reconstruction).

The small amount of breast tissue that men generally have can mean that surgical options are more limited for men than they are for women. Most of the men we interviewed accepted that their treatment choices were limited and they went along with what was recommended by their doctor. The relatively small numbers of men who are diagnosed with breast cancer means that it is more unusual for men to be included in any randomised trials of new treatment options.

Steve felt that the surgeon explained that he would need a mastectomy very professionally and…

Age at interview 58

Gender Male

Age at diagnosis 58

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RG was told he would need a mastectomy and chemotherapy. He felt that his decision to accept this…

Age at interview 64

Gender Male

Age at diagnosis 62

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Tom felt that there werent really too many options about his treatment. He wanted the doctors to…

Age at interview 54

Gender Male

Age at diagnosis 50

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Bernard did not feel that there were many choices to be made about his treatment, but he was…

Age at interview 59

Gender Male

Age at diagnosis 56

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A few men reflected that leaving decisions about their treatment to the doctor had been the right thing to do because the treatment had been effective.
Some men did feel frustrated by the lack of choice, even though they accepted the treatments that were recommended to them.

Alan was told he needed a mastectomy, chemotherapy and radiotherapy, but he did query his need…

Age at interview 73

Gender Male

Age at diagnosis 71

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David heard female patients talking about the choices they had been offered and the treatment…

Age at interview 57

Gender Male

Age at diagnosis 52

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Some of the men had been given options when their treatment was discussed. This could be about the type of surgery they had or whether to have chemotherapy, radiotherapy or hormone treatment. Occasionally men chose not to have some of the treatment offered to them, or they sought information about alternatives.

The surgeon went through a range of options with Stuart, including whether he would like to have…

Age at interview 40

Gender Male

Age at diagnosis 36

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Eddie chose not to have chemotherapy on the basis of the information he was given, but he felt…

Age at interview 70

Gender Male

Age at diagnosis 69

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Occasionally men chose not to have some of the treatment offered to them, or they sought information about alternatives.

Roy accepted the advice to have a bilateral mastectomy but refused to have chemotherapy because…

Age at interview 67

Gender Male

Age at diagnosis 65

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Robert had looked for information about alternatives to taking tamoxifen and he asked his doctor…

Age at interview 58

Gender Male

Age at diagnosis 54

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Being given a choice about treatments can also make people feel responsible if things go wrong, which can be burdensome.

Robert B said patients are expected to make treatment choices now. He felt overwhelmed by…

Age at interview 70

Gender Male

Age at diagnosis 70

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