The case of a 45-year old man from Marion, North Carolina, in the US, whose parents both had breast cancer and, when he suspected he was getting symptoms himself, was turned away by a local public health clinic that offers free breast screening because he is a man, has highlighted the plight of men who may be at risk of the disease: dealing with a system that appears to assume only women get breast cancer.

According to ABC News, Scott Cunningham has been vigilant about his health since both his parents were diagnosed with breast cancer in the 1990s. He says he now has the same symptoms that his father had: lumps under his nipple that feel like “knots”, he feels “different” and tired all the time.

He had not done anything about it for several months because he was uninsured and unemployed after losing his job at a furniture factory.

Eventually, as the symptoms got worse, he decided he would call a local health clinic that offered free mammograms, but when he contacted them they said he was not eligible because he was a man and the clinic only served women.

Cunningham was turned away by the Rutherford-Polk-McDowell Health District’s National Breast and Cervical Cancer Early Detection Program, which is funded by the Centers for Disease Control and Prevention (CDC), and only serves women, aged 40 to 60.

Helen White, a clinical nursing supervisor at the Rutherford-Polk-McDowell Health Department, said it was true that federal breast screening funds are limited to women, but added they would do everything they could to help Cunningham.

She said like any other situation, it would depend on whether he had insurance, Medicaid (the government insurance scheme for people on low income), or was eligible on low income grounds.

“We would refer him to a couple of options, a free clinic in the county, or Health Plus, which is a sliding scale at the hospital — whether he was male or female,” White told ABC News.

Cunningham said he was stunned and confused when they told him they only offered screening to women. He had assumed that while it was once thought to be just a woman’s cancer, it was well known that men can also get it.

White has now been in contact with Cunningham and offered him help to find another clinic.

According to the National Cancer Institute, compared to occurrence in women, male breast cancer is rare: less than 1 per cent of all cases are in men. Last year in the US, there were an estimated 1,910 cases of breast cancer in men, and 440 deaths, compared with 192,370 cases and 40,170 deaths among women with the disease.

The average age for breast cancer diagnosis in men is between 60 and 70, but it can occur at any age.

Risk factors include: exposure to radiation, estrogen, and diseases linked to having excessive amounts of estrogens in the body, such as cirrhosis or Klinefelter syndrome. Family history is thought to be a factor, especially where many female relatives have had the disease, and where it involves the BRCA2 gene mutation.

The NCI says that overall chances of survival is similar to that of women, and the impression that men have a worse prognosis is probably due to the fact they don’t receive an early diagnosis.

Among many reasons given for men receiving a later diagnosis is that they are not sufficiently aware that they could be susceptible to breast cancer.

However, as this case demonstrates, it could be that there is also a need for greater awareness in the public health system so screening and support is as widely available for men as for women.

Last year, Peter Criss, the 63-year old ex drummer and founding member of rock band KISS spoke in public about his breast cancer.

Criss said that thanks to an early diagnosis he was successfully treated for breast cancer in 2008. He urged men to be aware that breast cancer was not an exclusively female disease and if they spot a lump they should not be ashamed and go to the doctor straight away.

In the case of Scott Cunningham and his father, they said they were not put off by the stigma of it being a “female disease”. They said they were not bothered by those stereotypes.

“Some men would hang their heads, but no way, I am a man,” said Cunningham.

Related article:

Medical News Today, Ex Drummer Of Rock Band KISS Speaks In Public About His Breast Cancer, 22 October 2009.

Source: ABC News, MNT Archives, NCI.

Written by: Catharine Paddock, PhD