By Elizabeth McQuillan
The little pink ribbon is a familiar symbol to us all now, a good exercise in public relations that has served to effectively raise the profile and awareness of breast cancer. Charity "pink runs" are organised to raise funds for the research charities, with participants proudly wearing embellished pink bras and costumes. The delicate pink ribbon is worn on lapels, emblazoned on T-shirts, posted on Facebook and unites women against the curse of cancer.
A positive thing indeed, but the symbolism may be a little off the mark and less than representative. Both men and women have nipples and breast tissue. This is composed mainly of lobules (milk-producing glands in women), ducts and stroma – fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels and lymphatic vessels.
At puberty, under the influence of hormones, the breast tissue in females becomes more developed and specialised, but the basic tissue remains the same in both men and women. The breast ducts can undergo cancerous changes, and the incidence of breast cancer in men is much rarer simply due to the duct cells being less developed, having not been constantly bombarded with growth-promoting female hormones.
However, many men with breast cancer suffer avoidable isolation and embarrassment and may delay going to the doctor because of the widespread belief that only women get the disease. A new section on breast cancer in men at healthtalkonline.org has shown that this commonly held view is a major challenge for many of the 300 men who are diagnosed with breast cancer each year in the UK.
What’s more, this myth is compounded by hospital and GP leaflets and the annual Pink Ribbon October fund-raising campaign, according to some of the 33 men whose video and audio interviews appear on the new section.
"The pinking of breast cancer has become the universal sign of support for breast cancer research in October, and that’s very understandable," said lead researcher Professor Kate Hunt, of the Medical Research Council’s social and public health sciences unit in Glasgow.
"But these interviews strongly suggest we need some blue in those pink bows to remind everyone – clinicians as well as the general public – that men get breast cancer too."
Breast cancer is worrying and challenging for those unfortunate enough to have to do battle with the disease, but the experience is made harder when met with ignorance and misinformation. Male respondents vividly describe having to manage other people’s responses including disbelief, embarrassment – or, in a few cases – "snide remarks", with one man finding it necessary to point out that "I’m no less of a man because I’ve had breast cancer".
Another man describes having to open his shirt on a bus to convince a friend that he really did have a mastectomy scar. "I would probably say about 95 per cent of the people I spoke to were really surprised to find that, as a man, I had got breast cancer," he says.
This experience is not restricted to the public domain, with the clinical environment often failing male patients. Many men describe feelings of isolation and embarrassment as a result of being on the receiving end of health care geared entirely towards women – including "sticking out like a sore thumb" in a ward full of women having chemotherapy, and being within "a very female environment”.
Clinics predominantly filled with women often offer pink hospital gowns and reading material composed entirely of women's glossy magazines, and are doing their male patients a great disservice. Male patients reported getting strange looks and being automatically addressed as "Mrs" when their name was called out in a busy waiting area.
One man, a 50-year-old lorry driver, describes how he became a recluse after treatment, finding it hard to talk about his experiences even to close family. "How hard is it," he asks, "to put 'men and women diagnosed with breast cancer' [in patient leaflets]? Just add that three letter word … and a small flash of pale blue [on the pink ribbons] they’re selling for a pound a time. Women get a lot of support when they get breast cancer … I would have loved some of that support … and a recognition that men need counselling too."
According to Macmillan Cancer Support, in most men breast cancer is first noticed as a painless lump under the nipple or areola.
Other signs may include:
● a nipple turning in (inversion/inverted nipple)
● changes in the size or shape of the breast
● a rash affecting the nipple
● discharge or bleeding from the nipple
● a swelling or lump in the armpit
● an ulcer on the skin of the breast.
Breast cancer in men is rare, but it does happen – so men should have no hesitation in contacting their GP if they notice any changes to their nipple or breast.
Think Pink has done wonderful things to raise funds and awareness of breast cancer in Scotland, with recipe books, Christmas cards and fundraising events helping the cause. Perhaps next October there could be a little bit of blue in there, to highlight the fact that it's not exclusively a female concern.
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