Download Understanding breast cancer in men

A practical guide to understanding cancer
‘My Macmillan nurse, Julie, was
fantastic. She was there from when
I was diagnosed. I could always go
to her with any problems I had.’
Herbie, diagnosed with breast cancer in 2012
About this booklet  1
About this booklet
This booklet is about breast cancer in men.
We hope it answers your questions and helps you
deal with some of the feelings you may have.
Breast cancer in men is rare. About 350 men in the UK are
diagnosed with breast cancer each year.
We can’t advise you about the best treatment for you.
This information can only come from your doctor, who knows
your full medical history. There is a page for you to fill in any
questions for your doctor or nurse (page 125).
If you’d like to discuss this information, call the Macmillan Support
Line free on 0808 808 00 00, Monday–Friday, 9am–8pm.
If you’re hard of hearing, you can use textphone 0808 808 0121,
or Text Relay. For non-English speakers, interpreters are available.
Or you can visit our website at macmillan.org.uk
Men with breast cancer can share their experiences and get
support online. There are some useful addresses and websites
at the end of this booklet (pages 121–124).
2 Understanding breast cancer in men
We have included some comments from men affected by breast
cancer, which you might find helpful. Quotes are from the website
healthtalkonline.org and the Macmillan online community
(macmillan.org.uk/community). Some names may have
been changed. Some quotes are from Herbie, who is on the cover
of this booklet. He has chosen to share his story with us.
If you find this booklet helpful, you could pass it on to your family
and friends. They may want information to help them support you.
We also have a website called The Source which has comments
and advice from people who have had cancer or been affected
in some way (source.macmillan.org.uk). Family and friends can
find valuable information to help them know what to say or do
when someone they care about has cancer.
Contents 3
Contents
The breasts and breast cancer in men
5
Diagnosing breast cancer in men 19
Treating breast cancer in men
37
After your treatment
83
Your feelings and relationships
95
Work and financial support
107
Further information
115
The breasts
and breast
cancer in men
What is cancer?
6
Men’s breasts
8
The lymphatic system
11
Symptoms of breast cancer in men
12
Risk factors for breast cancer in men
14
6 Understanding breast cancer in men
What is cancer?
Cancer starts in cells in our body. Cells are tiny building blocks
that make up the organs and tissues of our bodies. They divide to
make new cells in a controlled way. This is how our bodies grow,
heal and repair. Cells receive signals from the body telling them
when to divide and grow and when to stop growing. When a cell
is no longer needed or can’t be repaired, it gets a signal to stop
working and die.
Cancer develops when the normal workings of a cell go wrong
and the cell becomes abnormal. The abnormal cell keeps dividing
making more and more abnormal cells. These eventually form a
lump (tumour). Not all lumps are cancerous. Doctors can tell if a
lump is cancerous by removing a small sample of tissue or cells
from it. This is called a biopsy. The doctors examine the sample
under a microscope to look for cancer cells.
Normal cells
Cells forming a tumour
The breasts and breast cancer in men 7
A lump that is not cancerous (benign) may grow but cannot
spread to anywhere else in the body. It usually only causes
problems if it puts pressure on nearby organs.
A lump that is cancer (malignant) can grow into nearby tissue.
Sometimes, cancer cells spread from where the cancer first started
(the primary site) to other parts of the body. They can travel
through the blood or lymphatic system (see page 11). When the
cells reach another part of the body, they may begin to grow
and form another tumour. This is called a secondary cancer
or a metastasis.
8 Understanding breast cancer in men
Men’s breasts
Many people don’t know that men can get breast cancer because
they aren’t aware that men have breasts. But men have a small
amount of breast tissue behind their nipples, where breast cancer
can develop.
Cross-section of the male breast
Muscle
Rib
Breast tissue
Nipple
The breasts and breast cancer in men 9
Until puberty, breast tissue in boys and girls is the same.
Both have a small amount of breast tissue behind the nipple
and areola (the darker area of skin around the nipple). This is
made up of a few tiny tubes (ducts) surrounded by fatty tissue,
connective tissue, blood vessels and lymphatic vessels.
At puberty, both girls and boys begin to produce the hormone
oestrogen. In girls, this leads to breast tissue developing. In some
boys oestrogen also causes breast swelling but this is usually
temporary and their breast tissue doesn’t develop. At puberty,
boys begin to make more of the hormone testosterone which acts
against the effects of oestrogen.
Sometimes as men get older, or as a side effect of certain
drugs, the balance between these hormones changes. This can
cause breast tissue to swell, which is called gynaecomastia. It is
not linked with breast cancer, but if you are worried about any
changes you can talk to your GP.
The breasts and breast cancer in men 11
The lymphatic system
In both men and women, breast tissue is connected to the
lymphatic system through a network of lymphatic vessels and
lymph nodes. The lymphatic system helps to protect us from
infection and disease. Lymph nodes are found in the armpit,
beside the breastbone and behind the collarbones.
Sometimes, cancer can spread through the lymphatic system.
If the cancer cells spread outside the breast tissue, they are most
likely to go to lymph nodes in the armpit.
Lymph nodes near the breast
Lymph
nodes
behind the
collarbone
Lymph
nodes in
the armpit
Lymph
vessels
Lymph
nodes
near the
breastbone
12 Understanding breast cancer in men
Symptoms of breast cancer
in men
In most men, the first symptom they usually notice is a painless
lump under the nipple or areola.
Other symptoms may include:
•• a nipple that is turned in (inverted)
•• swelling of the breast tissue
•• a rash around the nipple
•• discharge or bleeding from the nipple
•• a swelling or lump in the armpit
•• an ulcer on the skin of the breast.
You'll know how your chest area normally looks and feels.
If you notice any change, you should see your GP straight away.
If there is breast cancer, treatment will be more effective if it is
diagnosed early.
‘I was in the shower when I found
a lump and I thought it was a boil or
a cyst. It was on my right breast near
the nipple and it was the size of a pea.
Two weeks later it was painful so I went
to the doctor.’
Herbie
14 Understanding breast cancer in men
Risk factors for breast cancer
in men
The exact cause of breast cancer is unknown. But certain things,
called risk factors, can increase a man’s chances of developing it.
However, because breast cancer in men is rare, most men who
have these risk factors will never develop breast cancer.
Age
The risk of breast cancer in men increases with age. It’s most
common in men over 60 years old. Breast cancer in young men
is rare.
Family history of breast cancer
Men who have close relatives with breast cancer may have
an increased risk of developing breast cancer. Close relatives,
sometimes called your first degree relatives, are parents, children,
sisters and brothers. About 1 in 5 men (20%) with breast cancer
have a close relative who has also had breast cancer.
The increased risk may be due to inherited faulty genes.
Our genes store the biological information we inherit from our
parents. The genes most commonly linked to an increased risk of
breast cancer in families are BRCA1 and BRCA2. Men in families
with the BRCA2 gene are more likely to develop breast cancer
than men in BRCA1 families. It’s thought that the BRCA2 gene
may cause up to 1 in 10 (10%) of breast cancers in men.
The breasts and breast cancer in men 15
We have a booklet called Cancer genetics – how
cancer sometimes runs in families, which has more
information about genetic risk.
If you’re concerned about breast cancer in your family, you can
ask your GP or breast specialist to refer you to a family history
clinic or a genetics clinic.
Online risk assessment
We have an interactive online tool called OPERA (Online Personal
Education and Risk Assessment), which gives you personalised
information about inherited breast cancer risk. OPERA is based
on guidance from the National Institute for Health and Care
Excellence (NICE) on familial breast and ovarian cancer. It asks
you a number of questions about your personal and family
history of breast and ovarian cancer. It then gives you a personal
assessment based on your answers.
‘I was diagnosed with breast cancer and
had my breast cancer removed about
two or three years ago. I wasn’t totally
surprised – my mother had it and died
from it. And my sister was diagnosed
with it a year ago, so there seems to be
some kind of genetic link.’
Stephen
16 Understanding breast cancer in men
You can access OPERA at macmillan.org.uk/opera If anyone
else in your family is worried about their risk, they may also want
to use OPERA.
The program also gives details of websites, helpful information
and further support. OPERA isn’t intended to replace professional
genetic counselling services. If you’re concerned about your
genetic risk, you should still consult your GP. You may want to take
a copy of your personal assessment with you when you see them.
Klinefelter syndrome
This is a rare syndrome which affects only men. Normally, males
are born with one X chromosome and one Y chromosome
(XY), while females have two X chromosomes (XX). Men with
Klinefelter syndrome have one Y chromosome and two or more
X chromosomes (XXY or XXXY).
Symptoms of Klinefelter syndrome may include being taller
than average, having increased breast tissue (gynaecomastia),
lower levels of testosterone, smaller testicles and infertility.
Men with Klinefelter syndrome have a higher risk of breast cancer.
For most men, the lifetime risk of developing breast cancer is
about 1 in 1000, but for men with Klinefelter syndrome it’s closer
to 1 in 25.
Radiation
Being exposed to radiation may increase a man’s risk of breast
cancer. Men who have had repeated doses of radiotherapy to
their chest area at a young age may also be at increased risk.
The breasts and breast cancer in men 17
High oestrogen levels
Men may be at risk of developing breast cancer if they have
higher levels of oestrogen than normal. This can be caused by
long-term damage to the liver, such as liver cirrhosis. This can
be caused by heavy drinking over a long period of time.
Oestrogen levels can also be affected by being very overweight.
Increased levels of oestrogen can affect the growth of breast
cancer cells.
Testicular effects
Conditions that can affect or damage the testicles may also
increase the risk of breast cancer. These include:
•• having undescended testicles
•• having surgery to remove one or both testicles
•• having mumps as an adult.
Some occupations
Men who work in hot environments, such as blast furnaces,
steel works and rolling mills, may have a slightly increased
risk. This is probably related to heat damage to the testicles.
Some studies have also linked long-term exposure to petrol and
exhaust fumes with breast cancer in men.
Diagnosing
breast cancer
in men
How breast cancer is diagnosed
20
Further tests 25
Types of breast cancer
28
Staging, grading and receptors for breast cancer
31
20 Understanding breast cancer in men
How breast cancer
is diagnosed
You will usually start by seeing your GP, who will examine you and
refer you to a breast clinic to see a specialist. You should receive
an appointment for the breast clinic within two weeks.
At the breast clinic
At a breast clinic, you’ll see a specialist breast doctor. You may
also see a specialist breast nurse or advanced nurse practitioner.
They usually ask you if you’ve had any other breast problems,
or if anyone in your family has had breast cancer.
The doctor will examine your chest area and the lymph nodes
in your armpits and around your neck. After this, they’ll explain
which tests you need.
Breast ultrasound
An ultrasound uses sound waves to build up a picture of the
breast tissue. It can show if a lump is solid (made of cells) or a
fluid-filled cyst. It can also show whether a solid lump is regular
or irregular in shape.
To have an ultrasound, you’ll be asked to take off your top and
lie down on a couch with your arm above your head. The person
doing the scan puts gel on your breast tissue and moves a small
hand-held device over the area. A picture of the breast tissue
shows up on a screen. An ultrasound only takes a few minutes
and is painless.
Diagnosing breast cancer in men 21
Ultrasound of the lymph nodes
You may have an ultrasound of the lymph nodes in the armpit.
If any of the nodes feel swollen or look abnormal on the
ultrasound, the doctor will take a biopsy or needle aspirate
(see below).
Mammogram
A mammogram is a low-dose x-ray of the breast tissue. To have a
mammogram, you’ll need to take your top off. The radiographer
positions you so that your chest is against the x-ray machine.
Your breast tissue is then gently but firmly compressed with a
clear, flat plastic plate. The breast tissue needs to be squashed
to keep it still and to get a clear picture. You may find this
uncomfortable or painful for a short time. You’ll need to stay still
for a few seconds while the picture is taken.
Breast biopsy
This is when the doctor removes a small piece of tissue or cells
from the lump or abnormal area. A pathologist (a doctor who
specialises in analysing cells) will then examine the tissue or cells
under a microscope to look for cancer cells.
There are different ways of taking a biopsy. Your doctor or nurse
will explain the type you will have. For a few days after a biopsy
your breast may feel sore and bruised. Taking painkillers will help
with this. Any bruising should go away in a couple of weeks.
Needle (core) biopsy
This is the most commonly used biopsy. The doctor uses a needle
to take a small piece of tissue from the lump or abnormal area.
Before taking the biopsy, they inject some local anaesthetic into
the area to numb it. You may feel a little pain or pressure for a
short time during the biopsy. Several samples can be taken at the
same time.
22 Understanding breast cancer in men
Fine needle aspiration (FNA)
This test may be used instead of a core biopsy to take samples
from lymph nodes (see page 11). It’s a quick and simple
procedure carried out in the x-ray or ultrasound department.
The doctor uses a very fine needle to remove a sample of cells
into a syringe.
Excision biopsy
Occasionally, the surgeon makes a cut in the skin over the tissue
and removes the lump or abnormal area. This is usually done
under a general anaesthetic. Usually you have stitches that
dissolve and don’t need to be removed.
‘I was feeling the lump every morning
when I was in the shower but it never
occurred to me that I had cancer. It was
only when it hurt that I realised it might
be something a bit more serious. But I
still didn’t think it was cancer until I saw
the GP.’
Mike
Diagnosing breast cancer in men 23
Waiting for test results
Waiting for test results can be a difficult time. It may take from a
few days to a couple of weeks for the results of your tests to be
ready. You may find it helpful to talk with your partner, your family
or a close friend. Your specialist nurse or one of the organisations
listed on pages 121–124 can provide support. You can also talk
things over with us on 0808 808 00 00.
Diagnosing breast cancer in men 25
Further tests
If the biopsy results show there are breast cancer cells, you may
need more tests before you can start your treatment. You may
have blood taken to check your general health and to see how
well your kidneys and liver are working. You may have an x-ray
of your chest to check your lungs and heart.
Some men may have other tests to check if the cancer has spread
to other parts of the body.
Bone scan
This test shows up abnormal areas of bone. You have a small
amount of a mildly radioactive substance injected into a vein.
You wait for 2–3 hours after the injection before you have
the scan, which may take an hour. Abnormal bone absorbs
more radioactivity than normal bone and shows up on the
scan pictures.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which builds up a
three‑dimensional picture of the inside of the body. The scan
takes 10–30 minutes and is painless. It uses a small amount of
radiation, which is very unlikely to harm you and will not harm
anyone you come into contact with. You will be asked not to eat
or drink for at least four hours before the scan.
26 Understanding breast cancer in men
You may be given a drink or injection of a dye (called a contrast
medium), which allows particular areas to be seen more
clearly. This may make you feel hot all over for a few minutes.
It’s important to let your doctor know if you are allergic to iodine
or have asthma, because you could have a reaction to the
injection. You’ll probably be able to go home as soon as the scan
is over.
MRI (magnetic resonance imaging) scan
This test uses magnetism to build up a detailed picture of areas
of your body. The scanner is a powerful magnet so you may be
asked to complete and sign a checklist to make sure it’s safe
for you. The checklist asks about any metal implants you may
have, for example such as a pacemaker, surgical clips or bone
pins. You should also tell your doctor if you’ve ever worked with
metal or in the metal industry as very tiny fragments of metal can
sometimes lodge in the body. If you do have any metal in your
body, it’s likely that you won’t be able to have an MRI scan. In this
situation, another type of scan can be used.
Before the scan, you’ll be asked to remove any metal belongings
including jewellery. You will have an injection of dye into a vein in
the arm, which doesn’t usually cause discomfort. This is called a
contrast medium and can help the images from the scan to show
up more clearly.
During the test, you’ll lie very still on a couch inside a long
cylinder (tube) for about 30 minutes. It’s painless but can be
slightly uncomfortable, and some people feel a bit claustrophobic.
It’s also noisy, but you’ll be given earplugs or headphones.
You can hear, and speak to, the person operating the scanner.
Diagnosing breast cancer in men 27
Liver ultrasound
This scan is done to check the liver. The person doing the scan
spreads a gel on to your tummy and moves a small handheld
device, which produces sound waves, over the liver area.
The sound waves are converted into a picture by a computer.
If you need support
If you are diagnosed with cancer, it can come as a shock, even if
your doctors have prepared you for this possibility. There’s lots
of support available. You can call the Macmillan Support Line
free on 0808 808 00 00 (Mon–Fri, 9am–8pm). Or you can visit
macmillan.org.uk, or contact one of the organisations listed
on pages 121–124.
28 Understanding breast cancer in men
Types of breast cancer
There are different types of breast cancer. Knowing the type of
cancer you have helps the doctors plan your individual treatment.
Ductal carcinoma in situ (DCIS)
This is the earliest form of breast cancer. In DCIS, cancer cells
are in the ducts of the breast, but not in any other breast tissue.
A pathologist will look at a sample of the cells under a microscope
to see what grade they are (see page 34). High-grade DCIS may
become invasive (spread outside the ducts) and is treated as a
breast cancer. Other grades (intermediate and low) are different
and doctors are unsure if these will become invasive, so will still
treat them. DCIS is much less common in men than in women;
less than 1 in 10 (10%) of breast cancers in men are DCIS.
We have more information about DCIS, which we can send you.
Invasive breast cancer
Most breast cancers in men are invasive. This means the
cancer cells have spread outside the lining of the ducts and into
surrounding breast tissue. There are different types of invasive
breast cancer:
•• Invasive ductal breast cancer – Most invasive breast cancers
in men are this type (80–90%).
•• Invasive lobular breast cancer – This cancer is rare in men
because there are few, if any, lobules in men’s breasts.
Diagnosing breast cancer in men 29
Other rare types of breast cancer include:
•• inflammatory breast cancer
•• medullary breast cancer
•• tubular breast cancer
•• malignant phyllodes tumour.
For more information about any of these types of breast cancer,
call the Macmillan Support Line on 0808 808 00 00.
‘I still didn’t think it was cancer. I knew men could
get breast cancer, but it never occurred to me for
one moment that I’d got it.’
Mike
‘When the doctor told me I had
breast cancer, I said: ‘I can’t have
breast cancer. I’m a man.’ It took
a bit of explaining to the kids.’ Herbie
Diagnosing breast cancer in men 31
Staging, grading and
receptors for breast cancer
Your breast specialist needs certain information about the cancer
to help plan the best treatment for you. This includes the stage of
the cancer, its grade and whether it has receptors for hormones,
proteins or both. Your specialist doctor and nurse will talk this over
with you.
Staging
The stage of a cancer describes its size and if it has spread from
where it started. This information affects the decisions you and
your doctor make about your treatment. They may not know the
exact stage of the cancer until after surgery.
TNM staging
The TNM staging system gives the complete stage of the cancer:
•• T describes the size of the tumour.
•• N describes whether the cancer has spread to the lymph nodes
and which nodes are involved. For example, N0 is no lymph
nodes affected while N1 means there are cancer cells in the
lymph nodes.
•• M describes if the cancer has spread to another part of the
body. For example, M0 means the cancer has not spread
(metastasised) to other parts of the body.
32 Understanding breast cancer in men
The number stage
Breast cancer can also be divided into number stages.
Stage 0 – This describes non-invasive breast cancers. Ductal
carcinoma in situ (DCIS) is sometimes described as stage 0.
The following four stages are known as invasive breast cancer:
Stage 1 is divided into two stages:
•• Stage 1A – The cancer (lump) is 2cm or smaller and has not
spread outside the breast tissue.
•• Stage 1B – The cancer is not found in the breast tissue (or is
less than 2cm) and there are a few cancer cells in the lymph
nodes under the arm.
Stage 2 is divided into two stages:
•• Stage 2A – The cancer is not found in the breast tissue or
is smaller than 2cm and has spread to lymph nodes OR is
bigger than 2cm (but under 5cm) and hasn’t spread to the
lymph nodes.
•• Stage 2B – The cancer is bigger than 2cm but not bigger than
5cm and has spread to the lymph nodes in the armpit OR is
bigger than 5cm but has not spread to the lymph nodes.
Stage 1 and 2 breast cancer is often called early breast cancer.
Diagnosing breast cancer in men 33
Stage 3 is divided into three stages:
•• Stage 3A The cancer is not found in the breast or is any
size and has spread to 4–9 lymph nodes in the armpit OR
the cancer is bigger than 5cm and has spread to a few
lymph nodes.
•• Stage 3B – The cancer has spread to tissue near the breast and
may be attached to muscle or skin (causing ulcers). There are
usually cancer cells in the lymph nodes.
•• Stage 3C – The cancer has spread to 10 or more lymph nodes
in the armpit, below the breastbone, near the neck or under
the collarbone.
Sometimes stage 3 breast cancer is called locally advanced
breast cancer. Cancer that has spread to the skin may be
inflammatory breast cancer.
Stage 4 The cancer has spread to other parts of the body such as
the bones, liver or lungs. This is called secondary or metastatic
breast cancer.
34 Understanding breast cancer in men
Grading
The grade of a cancer gives an idea of how quickly it might grow.
The grade is based on what the cancer cells look like under the
microscope compared with normal cells. Knowing the grade helps
your doctor to decide if you need further treatment after surgery.
Grade 1 or low-grade
The cancer cells look similar to normal cells (are
well‑differentiated) and usually grow slowly. The cancer cells
are less likely to spread.
Grade 2 or moderate- or intermediate-grade
The cancer cells look more abnormal and grow slightly faster
than grade 1 cells.
Grade 3 or high-grade
The cancer cells look very different from normal cells
(are poorly differentiated) and may grow more quickly than
grade 1 or 2 cells.
Receptors
Some breast cancer cells have receptors that hormones or
proteins can attach to. This can stimulate the cancer cells to grow.
A pathologist will do tests on the cancer cells to find out if
receptors are present and what type they are. This information
helps you and your doctor to decide on the most effective
treatment for you.
Diagnosing breast cancer in men 35
Hormone receptors
Hormones exist naturally in the body. They help to control how
cells grow and what they do in the body. All men have small
amounts of the hormones oestrogen and progesterone in their
bodies. Hormones, particularly oestrogen, can encourage some
breast cancer cells to grow.
About 20% of oestrogen is made by the testicles. The remaining
80% is made from male sex hormones (androgens).
Breast cancers with receptors for the hormone oestrogen are
called oestrogen receptor-positive or ER-positive breast cancer.
The term ER is used because the American spelling of oestrogen
is estrogen. Some hospitals also check if cells are progesterone
receptor (PR) positive.
About 90% of breast cancers in men are ER-positive. These
cancers respond well to hormonal treatments (see pages 70–73).
Oestrogen receptor-negative or ER-negative breast cancer doesn’t
have oestrogen receptors.
Protein receptors
Some breast cancers have receptors for the protein HER2 (human
epidermal growth factor 2), which can encourage breast cancer
cells to grow. These cancers are called HER2-positive breast
cancers. They may be treated with a drug called trastuzumab
(Herceptin®) (see pages 75–77).
Cancers that have no hormone (oestrogen or progesterone)
or protein receptors are called triple-negative breast cancer.
Treating
breast cancer
in men
Treatment overview
38
How treatment is planned
40
Surgery43
Radiotherapy 55
Chemotherapy 61
Hormonal therapy 70
Targeted therapy 75
Research – clinical trials
79
38 Understanding breast cancer in men
Treatment overview
Treatments for men with breast cancer are similar to those used
for breast cancer in women. The treatment you have will depend
on the stage of breast cancer that you have.
Your doctor and specialist nurse will explain the treatments
they think are best for your situation.
Early and locally advanced breast cancer
For most men, the main treatment for early breast cancer is
surgery to remove it. As most men have only a small amount of
breast tissue, the operation usually involves taking away all of the
breast tissue and the nipple on the affected side. Rarely, only the
lump and some surrounding tissue is removed.
Men who have larger cancers may have chemotherapy or
hormonal therapy before surgery to shrink the tumour. This is
known as neo-adjuvant therapy.
Many men will then have other treatments after surgery
(adjuvant therapy) to reduce the risk of the cancer coming
back (recurring). These treatments may include radiotherapy,
chemotherapy, hormonal therapy or targeted therapy with
trastuzumab (Herceptin®).
You may have radiotherapy to the chest wall. This is to get rid of
any cancer cells that may have been left behind after surgery.
Some men may also have radiotherapy to the lymph nodes in the
armpit or the lower part of the neck.
Treating breast cancer in men 39
If the cancer is large, has spread to the lymph nodes or is
high‑grade (see page 34), you may be given chemotherapy after
your operation. Men who have triple-negative breast cancer are
also usually treated with chemotherapy.
If the cancer is ER-positive, you’ll be given hormonal treatment for
a number of years. This will start after chemotherapy if you are
having it.
If you have HER2-positive breast cancer, you may have treatment
with trastuzumab (Herceptin) and chemotherapy.
Secondary breast cancer
If the cancer has spread beyond the breast and lymph nodes
in the armpit to another part of the body, it is called secondary
breast cancer. The most common places for breast cancer to
spread to are the bone, liver, lungs or occasionally the brain.
Treatment for secondary breast cancer is different for each
person. It will depend on the type of breast cancer and where
it has spread to. The main treatments are hormonal therapy,
chemotherapy and targeted therapy, although surgery and
radiotherapy may be helpful in some situations.
The aim of treatment for secondary breast cancer is usually to
help control it, reduce the symptoms and improve your quality
of life. Before you have any treatment, your cancer specialist
and breast care nurse will talk it over with you and answer
your questions.
40 Understanding breast cancer in men
How treatment is planned
A team of specialists will meet to discuss and decide on the
best treatment for you. This multidisciplinary team (MDT)
will include:
•• a surgeon who specialises in breast surgery
•• oncologists (cancer specialists) who specialise in chemotherapy,
radiotherapy, hormonal therapy and targeted therapy
•• a specialist breast care nurse who gives information
and support
•• a radiologist who analyses x-rays and scans
•• a pathologist who advises on the type and extent of
the cancer.
It may also include other healthcare professionals, such as a
physiotherapist, a research nurse, psychologist, plastic surgeon,
social worker or counsellor.
The MDT will look at a number of factors to help decide which
treatments are likely to work best for you. These include:
•• the stage and grade of the cancer
•• whether the cancer cells have hormone receptors
or HER2 receptors
•• your general health.
After the MDT meeting, your cancer specialist or nurse will talk
to you about the best treatment for your situation.
Treating breast cancer in men 41
Consent
Before you have any treatment your doctor will explain its
aims. They will ask you to sign a form saying that you give
your permission (consent) for the hospital staff to give you the
treatment. No medical treatment can be given without your
consent. Before you are asked to sign the form, you should
be given full information about:
•• the type and extent of the treatment
•• its advantages and disadvantages
•• any significant risks or side effects
•• any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know
straight away, so they can explain again. Some cancer treatments
are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the
treatment is explained, to help you remember the discussion.
You may also find it useful to write a list of questions before
your appointment.
You can always ask for more time if you feel that you can’t make
a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff
can explain what may happen if you don’t have it. It’s essential
to tell a doctor or the nurse in charge, so they can record your
decision in your medical notes. You don’t have to give a reason
for not wanting treatment, but it can help to let the staff know
your concerns so they can give you the best advice.
42 Understanding breast cancer in men
Second opinion
Your multidisciplinary team (MDT) uses national treatment
guidelines to decide the most suitable treatment for you. Even so,
you may want another medical opinion. If you feel it will be
helpful, you can ask either your specialist or GP to refer you to
another specialist for a second opinion.
Getting a second opinion may delay the start of your treatment,
so you and your doctor need to be confident that it will give you
useful information.
If you do go for a second opinion, it may be a good idea to take
a relative or friend with you, and have a list of questions ready,
so that you can make sure your concerns are covered during
the discussion.
Treating breast cancer in men 43
Surgery
Most men only have a small amount of breast tissue, so the most
common operation involves taking away all of the breast tissue
and the nipple. This is called a mastectomy. You will usually have
some or all of the lymph nodes removed from the armpit during
this operation.
Occasionally the surgeon may be able to remove only the area
of the cancer with some surrounding normal-looking tissue.
This operation is called a wide local excision and for some men
it may mean that they keep their nipple.
‘I had a mastectomy and my lymph
nodes tested. I didn’t have a
reconstruction. I was left with a six-inch
scar across my chest.’
Herbie
44 Understanding breast cancer in men
After this operation, the pathologist examines the tissue that’s
been removed to see if there is an area of normal cells around
the cancer. This is called a clear margin. If there are still cancer
cells at the edge of the removed breast tissue, you’ll need to have
a mastectomy.
Before your operation, your surgeon will talk to you about the type
of operation that is recommended for you.
‘I have a scar across my chest but I don’t worry
about it. My chest hair has grown over it so I’m not
very self conscious.’
Herbie
46 Understanding breast cancer in men
Surgery to the lymph nodes
Your surgeon may remove some or all of the lymph nodes in your
armpit. There are different types of lymph node surgery.
Sentinel lymph node biopsy (SLNB)
This may be done if you have a small cancer and the ultrasound
of your armpit is normal. SLNB isn’t suitable for everyone – your
surgeon will explain if it’s an option for you.
A sentinel lymph node biopsy is a way of checking the smallest
possible number of lymph nodes (usually 1–3) in the armpit to
see if they contain cancer cells. The sentinel nodes are the first
ones that lymph fluid drains to from the breast, so they are the
most likely to contain any cancer cells. If the sentinel nodes don’t
contain cancer cells, you won’t need surgery to remove more
lymph nodes.
Removing only the sentinel lymph nodes lessens the risk of side
effects that can sometimes occur after lymph node surgery.
These include swelling of the arm known as lymphoedema and
stiffness of the arm (see page 53).
How an SLNB is done
The doctor or a technician will inject a tiny amount of radioactive
liquid, which is harmless, into your breast, usually around the
nipple. You have this done on the day of surgery or sometimes the
day before.
During the operation, the surgeon may inject a blue dye into your
breast, which stains the lymph nodes blue. The sentinel lymph
nodes absorb the radioactivity or become blue first.
Treating breast cancer in men 47
The surgeon uses a small handheld instrument to find the lymph
nodes that have picked up the radioactivity. They only remove the
blue or radioactive nodes (sentinel nodes). These are tested to see
if they contain cancer cells.
If any of the nodes contain cancer cells, you may have further
surgery to remove all the lymph nodes (axillary lymph node
dissection). Some men may have radiotherapy to the lymph nodes
instead of surgery.
Removing all the lymph nodes
In some cases, the surgeon will want to remove all the lymph
nodes in the armpit. This is called an axillary lymph node
dissection (ALND) or clearance. It removes any nodes that
contain cancer cells. You usually won’t need radiotherapy to the
area afterwards.
An ALND is usually done when:
•• the ultrasound of the lymph nodes is abnormal, and
•• a biopsy of the lymph nodes is positive, or
•• the sentinel node biopsy shows there are cancer cells
in the nodes.
There’s an increased risk of developing swelling of the arm
called lymphoedema after an ALND. You can read more about
lymphoedema and taking care of your arm on pages 85–86.
48 Understanding breast cancer in men
Before your operation
Before your operation, you may be seen at a pre-assessment
clinic. This gives you a chance to ask questions and talk over any
concerns about the operation. You may have tests to check your
general health. These can include blood tests, a chest x-ray or a
recording of your heart (ECG).
Your surgeon or breast care nurse will talk to you about how
your chest will look after your surgery. They may show you
photographs of other men who have had breast surgery or put
you in touch with someone who has been through it. Or you can
contact a support group or Breast Cancer Care (see page 121).
You will usually come into hospital on the day of your
operation. You’ll meet the doctor who gives you the anaesthetic
(anaesthetist). The nurses may give you elastic stockings
(TED stockings) to wear during and after the operation to
help prevent blood clots.
After your operation
You’ll be encouraged to start moving around as soon as possible
after your operation.
Your wound
You’ll have a dressing covering your wound, which may be left
undisturbed for the first couple of days. The nurses will let you
know how to look after it before you go home.
How long your wound takes to heal depends on the operation
you had. If you only had a small area of tissue removed, it will
usually heal quickly. If you don’t have stitches that dissolve,
you will probably have your stitches removed about 7–10 days
after your operation.
Treating breast cancer in men 49
Wound infection
This can be a complication of surgery. Signs of infection can
include warmth, redness, swelling around the wound or discharge
coming from it. You may also feel unwell with a fever. Tell your
nurse or doctor if you get any of these symptoms, even after you
go home.
Pain
You’ll probably have some pain around the wound and in your
armpit if you had lymph nodes removed. This may last a few
days. The nurses will give you painkillers to take regularly until
it settles down. After a mastectomy, you may need to take them
for a week or two. Let your doctor or nurse know if the painkillers
aren’t helping. They can prescribe stronger ones for you to try.
Drains
You may have a long, thin plastic drainage tube coming from
your wound. This is attached to a bottle that fluid from the wound
drains into. It’s usually left in for 24 hours or until it stops draining,
which may take a few days. You can go home with the drain.
A district nurse or practice nurse may check it and remove it when
you’re at home. Or you may come back to have it removed at
the hospital.
Fluid collecting around the wound (seroma)
Fluid can build up in the area around the wound. This is called
a seroma. It usually goes away within a few weeks. Sometimes
your nurse or doctor may drain it off with a needle and syringe.
Stiff shoulder or arm
After a mastectomy or having lymph nodes removed,
your shoulder or arm may feel stiff or sore.
50 Understanding breast cancer in men
It’s important to do the arm exercises that your physiotherapist
or nurse shows you. This will help improve the movement in
your shoulder or arm and reduce the risk of long-term problems.
You should start the exercises the day after your operation and
gradually build up what you can do.
Breast Cancer Care (see page 121) have a leaflet about
these exercises.
Numbness and tingling in the upper arm
You may have numbness and tingling if nerves have been injured
during the operation. This is more likely if you had all the lymph
nodes in the armpit removed. It may slowly improve over several
months but is sometimes permanent.
How your chest looks
It is common to have swelling and bruising after your operation.
This should improve after a few weeks, but let your nurse know if
it doesn’t. If you had a SLNB, the dye may make your skin in that
area look blue for a while, but this is normal.
After breast surgery there will be a scar across your chest in line
with where your nipple used to be. There may also be a dent
where the breast tissue has been removed.
To begin with, your scar may be red if you have white skin,
or darker if you have dark skin. It may also be firm and slightly
raised. Over time, it will flatten and fade. Everyone’s skin heals
differently. If you have dark skin or fair, freckled skin, scars can
take longer to settle and may be more noticeable for longer.
For some men this won’t be a problem at all. But, it can affect
your confidence and how you feel about yourself as a man. If you
are worried about changes in your appearance, talk to your
breast care nurse or surgeon.
Treating breast cancer in men 51
You may worry that your partner will be put off by your scars or a
change in how your body looks. If you’re feeling self-conscious
about how you look, talking with your partner or specialist nurse
can help you feel more confident.
Reconstruction of the breast area is not commonly carried out for
men as implants don’t give the right shape for men. But it may
be possible to improve the appearance of the chest area with
surgery. Your surgeon or breast care nurse can also discuss with
you ways of recreating the appearance of a nipple.
Going home
Most men will go home on the day of their surgery or the day
after. When you get home, take things easy for a while. How you
feel depends on the operation you’ve had. It’s common to feel
very tired, so try to have plenty of rest and eat well. Although you
might feel you have recovered physically, you may continue to feel
emotionally tired.
You may need to avoid lifting or carrying anything heavy for a
few weeks. It’s important to carry on with the exercises you were
shown in hospital. Try to do a bit more each day and rest in
between so that you build up the amount that you do gradually.
Some insurance policies give specific time limits for not driving
after surgery – so check this with your insurance company.
Don’t drive unless you feel in full control of the car.
52 Understanding breast cancer in men
Before you leave hospital, you’ll be given an appointment
to attend the outpatient clinic to see the surgeon and breast
care nurse. At the clinic they will check that the wound is
healing properly. They’ll also tell you the stage of the cancer
(see pages 31–33). Your doctors will discuss with you any further
treatment that you may need.
This is a good time for you to ask questions or talk to them about
any problems you have. There is space on page 125 for you
to write these down.
Late effects of surgery
Some men may have problems with the effects of surgery for
some months or longer after their operation. Tell your breast
care nurse if you have any of these or if there’s anything you are
worried about.
Cording
This is an uncomfortable feeling like a tight cord running from
the armpit to your hand. This is called cording. It can happen
weeks or months after surgery and usually gets better over a few
months. You may need physiotherapy and massage to improve it.
Pain and changes in sensation
Rarely some men have numbness, tingling or pain in the
upper arm, because the nerves have been affected by surgery.
Your doctor can prescribe low doses of antidepressant drugs and
anticonvulsants (drugs to stop fits) to improve these symptoms.
They help to reduce the pain caused by nerve damage.
Treating breast cancer in men 53
Changes to your arm/shoulder movement
Arm and shoulder movement and strength usually improve after
surgery. Doing your exercises helps reduce the risk of long-term
problems. If you have problems, ask your doctor for a referral
to a physiotherapist. If moving your shoulder or arm is painful,
your doctor can prescribe you some painkillers.
Lymphoedema
Surgery or radiotherapy to the lymph nodes in the armpit can
sometimes lead to a swelling of the arm called lymphoedema.
If you notice any swelling, speak to your breast care nurse or
doctor. The earlier the treatment for lymphoedema begins,
the more effective it can be.
There is information on how to help reduce your risk of getting
lymphoedema on pages 85–86.
Our booklet Managing the late effects of breast
cancer treatment has more information.
Treating breast cancer in men 55
Radiotherapy
Radiotherapy uses high-energy rays to destroy cancer
cells, while doing as little harm as possible to normal cells.
You may be given it to reduce the risk of the cancer coming
back in the chest area and in the nearby lymph nodes.
You usually start radiotherapy 4–6 weeks after surgery
unless you have chemotherapy.
Radiotherapy after surgery
Some men may need radiotherapy after mastectomy. Your cancer
doctor may advise you to have radiotherapy after mastectomy if:
•• the cancer was large
•• the cancer was high-grade
•• several lymph nodes contain cancer cells
•• there were cancer cells close to the edge of the removed
breast tissue.
If you had a wide local excision (see pages 43–44) you will usually
need radiotherapy to the area where the cancer was removed.
Radiotherapy to lymph nodes
If some of the lymph nodes from your armpit contain cancer cells,
you may have radiotherapy to the rest of the nodes. If you had all
the lymph nodes in your armpit removed, you usually won’t need
to have radiotherapy to this area.
56 Understanding breast cancer in men
How it is given
You’ll usually have a course of radiotherapy lasting three weeks.
You have the treatment in the hospital radiotherapy department
as a series of short, daily sessions. Each treatment takes
10–15 minutes and they are usually given from Monday–Friday,
with a rest at the weekend. Your doctor will talk to you about the
treatment and possible side effects.
External radiotherapy doesn’t make you radioactive and
it’s safe for you to be around other people, including children,
after your treatment.
Planning radiotherapy
Radiotherapy has to be carefully planned to make sure it’s
as effective as possible. A doctor, called a clinical oncologist,
will plan your treatment. On your first visit to the radiotherapy
department you will have a CT scan or lie under a machine
called a simulator, which takes x-rays of the area to be treated.
You usually have markings drawn on your skin to show the exact
place where the radiographer (who gives the treatment) directs the
rays. Usually permanent markings (tattoos) the size of a pinpoint
are made. These are only done with your permission. It can feel
a little uncomfortable while they’re being made, but it makes sure
treatment is given to the right area.
Positioning
You’ll need to be able to position your arm so that the
radiotherapy machine can give the treatment effectively.
A physiotherapist can show you some exercises to do to make
this easier if your muscles and shoulder feel stiff or painful.
Treating breast cancer in men 57
Treatment sessions
At the start of each session the radiographer will position you
carefully on the couch and make sure you are comfortable.
During your treatment you’ll be alone in the room, but you can
talk to the radiographer who will watch you from the next room.
Radiotherapy is not painful, but you will have to lie still for a few
minutes during the treatment.
We can send you a booklet with more information about
radiotherapy. We also have a video about having radiotherapy
at macmillan.org.uk/radiotherapy
58 Understanding breast cancer in men
Side effects of radiotherapy
You may develop side effects over the course of your treatment.
These usually disappear gradually over a few weeks or months
after treatment finishes. Your doctor, nurse or radiographer will
discuss this with you so you know what to expect. Let them know
about any side effects you have during or after treatment, as there
are often things that can be done to help.
Skin irritation
You may develop redness, dryness and itching of the skin in the
treatment area. If you have dark skin it may get darker or have a
blue or black tinge. Your doctor can prescribe creams to soothe
your skin if it becomes sore and flaky. Usually, any skin reaction
settles down 2–4 weeks after radiotherapy. You’ll be given advice
on how to look after your skin, such as:
•• Don’t use perfumed soaps, deodorants/antiperspirants or any
creams (unless prescribed by your cancer specialist).
•• Have showers rather than baths but turn away from the spray
to protect your chest. If you do have a bath, avoid soaking the
affected area for too long.
•• Pat the area dry gently with a soft towel – don’t rub.
•• Wear loose clothing as this may be more comfortable and less
likely to irritate your skin.
•• Avoid exposing the treated area to sunshine for at least a
year after treatment finishes. Use suncream with a high sun
protection factor (SPF) of at least 30, to protect your skin
if it’s exposed.
Treating breast cancer in men 59
Hair loss
If you have hair on your chest, you will lose it from the treatment
area during radiotherapy. It will grow back after treatment is over.
Tiredness
You’re likely to feel tired during treatment, and this may continue
for a month or two after it finishes. Pace yourself and save energy
for the things you have to do, and that you enjoy. Get plenty of
rest but balance this with some physical activity, such as short
walks, which will give you more energy.
There’s also a video of Denton’s experience of fatigue
at macmillan.org.uk/fatigue
Our booklet Coping with fatigue has more
helpful tips.
Aches and swelling
You may notice a dull ache or shooting pains in the treated
area lasting for a few seconds or minutes. Sometimes the area
becomes swollen. These effects usually improve quickly after
treatment finishes.
60 Understanding breast cancer in men
Late effects
Radiotherapy to the breast may cause side effects that occur
months or longer after radiotherapy. If you’re worried about
a particular side effect, talk to your cancer specialist.
You may notice red ‘spidery’ marks (telangiectasia) appearing
on your chest. This is caused by radiotherapy damage to the small
blood vessels in the skin, but it’s harmless.
It’s rare for radiotherapy to cause any heart problems and only
if you had treatment to your left side. Problems with the ribs in the
treated area or with the lungs are also rare. Let your doctor know
if you notice any problems with your breathing or have any pain
in that area.
Radiotherapy for secondary breast cancer
Radiotherapy can be used to treat secondary cancer that is in
the bone or skin. It can help to shrink the cancer and relieve
symptoms such as pain. This is called palliative radiotherapy.
You may only need one or two doses of radiotherapy to treat
secondary breast cancer. This type of radiotherapy causes very
few side effects.
Treating breast cancer in men 61
Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy
cancer cells. Cytotoxic means toxic to cells. These drugs disrupt the
way cancer cells grow and divide but they also affect normal cells.
When you have chemotherapy
Some men have chemotherapy before surgery to shrink a large
cancer (neo-adjuvant treatment). Or your cancer specialist
may recommend you have chemotherapy after surgery to reduce
the risk of breast cancer coming back. This is called adjuvant
treatment. Your doctor or nurse will explain the benefits of this
to you and the likely side effects.
You are usually offered chemotherapy after surgery if the cancer:
•• is large
•• is high-grade
•• has spread to the lymph nodes
•• is HER2-positive
•• is triple-negative.
Chemotherapy can also be used to control breast cancer that has
come back (recurrent cancer) or spread to another part of the
body (secondary breast cancer).
Cancer research trials look at how to improve the effectiveness of
chemotherapy and other therapies. Your cancer specialist may ask
you to take part in a research trial that compares different types
of treatment (see pages 79–81).
62 Understanding breast cancer in men
How you have chemotherapy
You usually have chemotherapy in the chemotherapy day unit.
The nurse will usually give you drugs into a vein (intravenously)
but you may have some as tablets.
The nurse gives you chemotherapy drugs into a vein by injection
or as a drip (infusion). You usually have them through a small
tube (cannula) in your hand or arm. Sometimes you have them
through a soft, plastic line called a central line or a PICC line.
These go into a large vein in your chest or your upper arm.
You can also have the drugs given into a tube that has a rubber
disc (port) under the skin on your upper chest.
You can read more about lines and ports in our
booklet Understanding chemotherapy.
You will have several sessions of chemotherapy. Each session
takes a few hours. After the session, you will have a rest
period. This allows your body to recover from the side effects.
The chemotherapy session and the rest period is called a cycle
of treatment.
The length of a cycle depends on the chemotherapy drugs
you’re taking, but most cycles are 1–3 weeks long. Your doctor
or nurse will explain more about this. Most, but not all, courses of
chemotherapy are six cycles.
Treating breast cancer in men 63
The drugs used
If you are having adjuvant chemotherapy, you will have a
combination of different chemotherapy drugs. Some commonly
used combinations include:
•• FEC – fluorouracil (5FU), epirubicin and cyclophosphamide
•• FEC-T – FEC followed by docetaxel (Taxotere®)
•• AC or EC – doxorubicin (Adriamycin®) and cyclophosphamide
or epirubicin and cyclophosphamide
•• CMF – cyclophosphamide, methotrexate and fluorouracil (5FU)
•• E-CMF – epirubicin and CMF.
Adjuvant chemotherapy usually includes an anthracycline drug,
such as epirubicin or doxorubicin. If there is more risk of the
cancer coming back, docetaxel (Taxotere) is also usually included.
Your doctor may offer you a choice of chemotherapy treatments.
Secondary breast cancer
For secondary breast cancer, the drugs you have will depend on
the chemotherapy drugs you’ve previously had. You often have
a single drug but sometimes a combination of drugs are used.
Drugs that may be used to treat secondary breast cancer include:
•• docetaxel
•• paclitaxel
•• vinorelbine (Navelbine®)
•• capecitabine (Xeloda®).
Our booklet Understanding chemotherapy has more
information about chemotherapy treatment and its side
effects. We can send you information about individual drugs
and combinations.
Treating breast cancer in men 65
Side effects of chemotherapy
Chemotherapy drugs may cause unpleasant side effects, but these
can usually be well controlled with medicines and will usually go
away once treatment has finished. Not all drugs cause the same
side effects and some people may have very few. You can talk
to your doctor or nurse about what to expect from the treatment
that’s planned for you. The main side effects are described here,
as well as some ways to reduce or control them.
We can send you further information about many of the side
effects mentioned here.
Risk of infection
Chemotherapy can reduce the number of white blood cells,
which help fight infection. If the number of your white blood cells
is low, you’ll be more prone to infections. A low white blood cell
count is called neutropenia.
Always contact the hospital immediately on the 24-hour contact
number you’ve been given and speak to a nurse or doctor if:
•• your temperature goes over 37.5°C (99.5°F) or over
38°C (100.4°F), depending on the advice given by your
chemotherapy team
•• you suddenly feel unwell, even with a normal temperature
•• you feel shivery and shaky
•• you have any symptoms of an infection such as a cold,
sore throat, cough, passing urine frequently (urine infection),
diarrhoea.
66 Understanding breast cancer in men
If necessary, you’ll be given antibiotics to treat any infection.
You’ll have a blood test before each cycle of chemotherapy to
make sure your white blood cells have recovered. Occasionally
your treatment may need to be delayed if the number of your
white blood cells is still low.
After chemotherapy, your nurse may give you injections of a drug
called G-CSF under the skin. This encourages the production of
white blood cells and reduces the risk of infection.
We have information about G-CSF that you may find helpful.
Bruising and bleeding
Chemotherapy can reduce the number of platelets in your blood.
Platelets are cells that help the blood to clot. Tell your doctor if you
have any unexplained bruising or bleeding, such as nosebleeds,
bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
Chemotherapy can reduce the number of red blood cells. A low
red blood cell count is called anaemia, which can make you feel
tired or short of breath. Tell your doctor or nurse if you have
these symptoms.
Feeling sick (nausea)
Some chemotherapy drugs can make you feel sick (nauseated)
or even be sick (vomit). Your cancer specialist will prescribe
anti‑sickness (anti-emetic) drugs to prevent this. Let your doctor or
nurse know if they don’t work for you as there are different drugs
you can try.
We can send you more information about nausea and vomiting.
Treating breast cancer in men 67
Tiredness (fatigue)
You’re likely to become tired and have to take things more slowly.
Try to pace yourself and save your energy for things that you want
to do or that need doing. Balance rest with some physical activity.
Even just going for a short walk will help increase your energy.
Our booklet Coping with fatigue has more
helpful tips.
Hair loss
Some chemotherapy drugs may cause hair loss. Some people
may have complete hair loss including eyelashes and eyebrows.
Others may only have some hair loss or thinning. It depends on
what chemotherapy drugs you are having. Your doctor or nurse
can tell you more about what to expect. If you do have hair loss,
your hair should return to how it was within about 3–6 months
of the end of treatment. It may grow back straighter, curlier, finer,
or a slightly different colour than it was before. Your nurse can
give you advice about coping with hair loss and how to look after
your scalp.
‘I was dreading the word chemotherapy
and thinking what was going happen.
I thought I was going to be really ill.
Then coming through it and out the
other side, you look back and you think
well, actually, for me it wasn’t too bad.’
Stuart
68 Understanding breast cancer in men
Sore mouth
Your mouth may become sore or dry, or you may notice small
ulcers during treatment. Drinking plenty of fluids, and cleaning
your teeth regularly and gently with a soft toothbrush, can help to
reduce the risk of this happening. Tell your nurse or doctor if you
have any of these problems, as they can prescribe mouthwashes
and medicine to prevent or clear mouth infections.
Taste changes
You may notice that food tastes different. Some people describe
having a metallic taste in their mouths. Normal taste usually
comes back after treatment finishes. A dietitian or specialist nurse
at your hospital can give you advice about ways of coping with
this side effect.
Bowel changes
Chemotherapy can cause constipation or diarrhoea. Constipation
can usually be helped by drinking plenty of fluids, eating more
fibre in your diet and doing some gentle exercise. You may need
to take medicine to help (laxatives). Your doctor can prescribe
these or you can buy them at a pharmacy. Diarrhoea can usually
be easily controlled with medicine but tell your doctor if it’s
severe or continues. It’s important to drink plenty of fluids if you
have diarrhoea.
Numbness or tingling in hands or feet
Some chemotherapy drugs can affect the nerves in your hands or
feet. This can cause tingling or numbness, a sensation of pins and
needles or muscle weakness (peripheral neuropathy).
It’s important to let your doctor or nurse know if this happens.
They may need to change the chemotherapy drug if it gets
worse. Usually, peripheral neuropathy gradually gets better when
chemotherapy is over, but sometimes it’s permanent. We can send
you more information about peripheral neuropathy.
Treating breast cancer in men 69
Contraception
Your doctor will advise you not to father a child while having
chemotherapy as the drugs can affect your sperm. It’s important
to use effective contraception during your treatment and for at
least a few months afterwards. You can discuss this with your
doctor or nurse.
Sex
You’re usually advised to use condoms if you have sex within
48 hours of chemotherapy. This is to protect your partner in case
the drugs are present in semen.
Fertility
Some chemotherapy drugs can affect your ability to father a child.
If chemotherapy is likely to make you infertile and you want to
have children, it may be possible to store sperm before treatment
begins. If your fertility is a concern, it’s important to talk to your
doctor about this before your treatment starts.
We have a leaflet called Cancer treatment and
fertility – information for men, which you may
find helpful.
70 Understanding breast cancer in men
Hormonal therapy
Hormones help to control how cells grow and what they do in the
body. The hormone oestrogen encourages some breast cancers
to grow.
Hormonal therapies reduce the levels of oestrogen in the body,
or prevent it from attaching to the cancer cells. They only work for
men with oestrogen-receptor (ER) positive cancers (see page 35),
which is about nine out of every ten men diagnosed with breast
cancer. Hormonal therapy is one of the main treatments for breast
cancer in men.
The most commonly used hormonal therapy is tamoxifen,
but other therapies may be used. Hormonal therapy is usually
given for at least five years to reduce the risk of breast cancer
coming back.
You can also have hormonal therapy to treat breast cancer
that comes back in the same area (recurrent cancer) or has
spread to another part of the body (secondary breast cancer).
If this happens, your doctor will offer you a different treatment
to tamoxifen. You have it for as long as it’s working to control
the cancer.
Treating breast cancer in men 71
Types of hormonal therapy
Tamoxifen
Tamoxifen is an anti-oestrogen drug. It prevents oestrogen
attaching to breast cancer cells and encouraging them to grow.
You take it daily as a tablet, usually for five years. We have more
information about tamoxifen that we can send you.
‘I’m in remission but I still feel like I’m
recovering. I’m taking Tamoxifen for
another two years. The side effects are
a bit odd for me – having hot flushes
and things like that is quite strange
as a man.’
Herbie
Aromatase inhibitors
Aromatase inhibitors (AIs), such as letrozole, anastrozole and
exemestane, also reduce oestrogen levels. You take them daily
as a tablet. These drugs reduce oestrogen levels in men by
stopping male hormones (androgens) being made into oestrogen.
You usually have an AI if you cannot take tamoxifen, or if the
cancer has come back or is no longer being helped by tamoxifen.
Some of the oestrogen in a man’s body is produced directly by the
testicles, not by androgens. Because of this, your doctor may give
you another drug called goserelin (Zoladex®) along with your AI.
72 Understanding breast cancer in men
Goserelin (Zoladex®)
The testicles are stimulated to make the hormones oestrogen
and testosterone by signals received from the pituitary gland
in the brain. Goserelin blocks these messages and stops the
testicles making oestrogen and testosterone. Goserelin is given
as a slow‑release implant that is injected just under the skin once
every 1–3 months.
Fulvestrant (Faslodex®)
This is a newer type of anti-oestrogen that is given as an injection.
It may occasionally be used if you have already had other
hormonal therapies.
We have information about these hormonal therapy drugs that
we can send you.
Side effects of hormonal therapy
People often cope well with hormonal therapies but the side
effects can vary from person to person. Tell your doctor or nurse
if you have problems. There are usually things that can be done
to manage difficult side effects.
Often side effects improve over the first 3–6 months. But, if they
continue to be a problem, your doctor may prescribe a different
hormonal drug.
Lower sex drive and erection difficulties
Some men are less interested in sex or have problems with
erections. If this happens, it may continue for as long as you have
the treatment. Many men say this is one of the most difficult side
effects to deal with.
Treating breast cancer in men 73
Try not to feel embarrassed about talking to your doctor or nurse
about any difficulties with sex. They are used to talking about
these side effects and giving advice. There are treatments that
they can prescribe to help you get an erection.
Our booklet Sexuality and cancer in men has
more information.
Hot flushes and sweats
These can be quite common, but many men find that the hot
flushes wear off after a period of time. There are a number of
ways to help reduce or control hot flushes and sweats. Some men
find it helps to cut down on tea, coffee, nicotine and alcohol.
Headaches
Headaches can usually be relieved with mild painkillers.
Feeling sick
Sometimes hormonal therapies can make you feel sick. If your
hormonal therapy is taken as a tablet, you may find taking it with
food can help.
Mood swings
You may feel irritable or low in mood (depressed) when taking
hormonal therapies. There are treatments your doctor can
prescribe to help with this.
Sore joints
Some people may have sore joints, but this is usually mild and
will stop when the treatment is finished.
Treating breast cancer in men 75
Targeted therapy
Targeted therapies (sometimes called biological therapies) are
drugs that work differently from chemotherapy. The main targeted
therapy used in breast cancer is trastuzumab (usually called
Herceptin®). It is only given to men with HER2-positive breast
cancer (see page 35).
Trastuzumab attaches to HER2 receptors on the surface of breast
cancer cells and stops them dividing and growing. It also helps the
body’s own immune cells to destroy the cancer cells.
You usually have it to reduce the risk of breast cancer coming
back. But it can also be given to help control secondary
breast cancer.
So far research into trastuzumab has only been done in women
with breast cancer. This means the benefits of trastuzumab in
men are not fully clear.
We have more information about trastuzumab.
How trastuzumab is given
You usually have trastuzumab every three weeks for a year.
It’s given in the chemotherapy day unit or outpatient department.
You have it with chemotherapy or on its own. The nurse gives you
trastuzumab as a drip (infusion), into a vein (intravenously) or as
an injection under the skin (subcutaneously).
76 Understanding breast cancer in men
When it’s given as a drip, you have it slowly the first time
(over about an hour and a half) so the nurses can check you
for signs of a reaction. After this you can have it over about
30 minutes.
It only takes a few minutes to have it as an injection under the
skin. But you still have to wait for an hour and a half so the nurses
can check you for any reaction.
If you have trastuzumab to treat secondary breast cancer,
you have it as long as it is controlling the cancer.
Treating breast cancer in men 77
Side effects of trastuzumab
The side effects of trastuzumab are usually mild. You may get
some side effects during the infusion or injection or up to four
hours after, particularly with the first dose. These include flu-like
symptoms, such as a headache, high temperature (fever) and
chills, or feeling sick. They generally get better within a few hours
of the drip finishing.
Another possible side effect is an allergic reaction, but this is
rare. The nurses will check for signs of a reaction. If it happens,
they can treat it quickly with drugs. You may get other side
effects after treatment. These include diarrhoea, headaches
and feeling sick.
Effects on the heart
Trastuzumab may lead to changes in the way your heart works.
Usually, any effect is mild and reversible. You’ll have tests to check
your heart before and during treatment to make sure the drug
isn’t causing any damage. You may be given heart medicines
to prevent heart problems or to treat any that develop.
Treating breast cancer in men 79
Research – clinical trials
Cancer research trials are carried out to try to find new and better
treatments for cancer. Trials that are carried out on patients are
known as clinical trials. These may be carried out to:
•• test new treatments, such as new chemotherapy drugs
or targeted therapies
•• look at new combinations of existing treatments, or change
the way they are given to make them more effective or reduce
side effects
•• compare the effectiveness of drugs used to control symptoms
•• find out how cancer treatments work
•• find out which treatments are the most cost-effective.
Trials are the only reliable way to find out if a different type of
surgery, chemotherapy, hormone therapy, radiotherapy, or other
treatment is better than what is already available.
Taking part in a trial
You may be asked to take part in a treatment research trial.
There can be many benefits in doing this. Trials help to improve
knowledge about cancer and develop new treatments. You will
be carefully monitored during and after the study.
Usually, several hospitals around the country take part in these
trials. It’s important to bear in mind that some treatments that
look promising at first can later be found to not to be as good
as existing treatments or to have side effects that outweigh
the benefits.
80 Understanding breast cancer in men
If you decide not to take part in a trial, your decision will be
respected and you don’t have to give a reason. However, it can
help to let the staff know your concerns so that they can give you
the best advice. There will be no change in the way that you’re
treated by the hospital staff, and you’ll be offered the standard
treatment for your situation.
Clinical trials are described in more detail in our
booklet Understanding cancer research trials
(clinical trials).
Blood and tumour samples
Blood and tumour samples may be taken to help make the right
diagnosis. You may be asked for your permission to use some of
your samples for research into cancer. If you take part in a trial
you may also give other samples, which may be frozen and stored
for future use when new research techniques become available.
Your name will be removed from the samples so you can’t
be identified.
The research may be carried out at the hospital where you are
treated, or at another one. This type of research takes a long time,
and results may not be available for many years. The samples
will be used to increase knowledge about the causes of cancer
and its treatment, which will hopefully improve the outlook for
future patients.
Treating breast cancer in men 81
Current research
Because breast cancer in men is very rare, it’s difficult to run large
clinical trials that can collect lots of information and study the
effects of treatments. A lot of the information about breast cancer
in men is based on research carried out in women with breast
cancer. Because of this, a group of international specialists have
formed the Male Breast Cancer Study. This group plans to pool
current information on risks, causes and treatments as well as to
gather tumour samples. This means they will be able to plan more
trials in the future.
After your
treatment
Follow-up84
Sexuality87
Well-being and recovery
88
Getting help and support
92
84 Understanding breast cancer in men
Follow-up
After treatment, you may have regular check-ups. Your
appointments may be every few months at first, but eventually
they may be once a year.
Appointments are a good time to talk to your doctor or nurse
about any concerns you have. If you notice any new symptoms,
you can contact your doctor or nurse between your appointments
for advice.
Sometimes, instead of routine appointments, some men are given
information by their breast care nurse on what to look out for.
They are asked to contact their cancer specialist or nurse if there’s
anything they’re worried about. Some men may attend follow up
at a nurse-led clinic and only see their cancer doctor if something
needs to be checked further.
You may also need to see your specialist or GP if you’re having
ongoing treatment with hormonal therapy, or if you have any
treatment side effects that haven’t gone away.
Many men find they get anxious for a while before the
appointments. This is natural. It can help to get support
from family, friends or one of the organisations listed on
pages 121–124. You can also contact the Macmillan Support
Line on 0808 808 00 00.
After your treatment 85
Be aware of changes
The treated side of your chest will look and feel different
depending on the treatment you’ve had. It’s a good idea to
be aware of what’s now normal for you.
Your breast care nurse can tell you what you should expect
and what to look out for. It’s also important to be aware of
what to look out for in your untreated breast.
If you notice anything unusual between appointments,
contact your cancer specialist or breast care nurse straight away.
‘Men check other parts of their anatomy,
but they don’t check their breasts. If
they have a problem, seepage around
the nipple, or a hard nipple, or little
painful areas around the nipple, or
other parts of the breast, they should
go to their GP. I don’t see where the
stigma is. Get it checked out. It’s such
an easy procedure.’
Steve
Lymphoedema
Lymphoedema is a swelling of the arm that sometimes happens
after surgery or radiotherapy to the lymph nodes in the armpit.
It can develop months or years after treatment. It’s more likely
if you’ve had all or a large number of lymph nodes removed.
Having radiotherapy to the armpit as well as surgery also
increases lymphoedema risk.
86 Understanding breast cancer in men
If you notice any swelling in your arm, hand or chest, always get
it checked by your doctor or nurse. The earlier lymphoedema
is diagnosed the easier it is to manage and treat successfully.
Reducing your risk of lymphoedema
There are things you can do to help reduce your chances of
developing lymphoedema. It’s important to protect your arm and
hand, and to look after the skin in that area. Here are some tips:
•• Keep your skin clean and moisturise every day with unperfumed
cream or oil to keep it in good condition.
•• Wash small grazes and cuts straight away, put on antiseptic
cream and cover if necessary.
•• See your GP straight away if you get signs of infection around
a cut, for example, if it becomes red, hot or swollen.
•• Avoid needles (blood tests, injections, drips or acupuncture)
and having your blood pressure taken in the affected arm.
•• Wear gloves and long sleeves when doing any household tasks,
DIY, gardening or when handling animals.
•• Use nail clippers to cut your nails. Don’t push back or cut
the cuticles.
•• Avoid high temperatures – don’t use saunas or hot tubs.
•• Cover up in the sun and use a suncream with a high sun
protection factor (SPF) of at least 30.
Our booklet Understanding lymphoedema has
more information. There is also information and
several videos about lymphoedema at macmillan.org.
uk/lymphoedema
After your treatment 87
Sexuality
Breast cancer, its treatments and side effects may affect your
sex life and your feelings about yourself as a man. Loss of sex
drive (libido) and erection difficulties (impotence) can occur.
Difficulties often improve after treatment, although for some men
it may take longer or continue.
You may feel insecure and worry about your current or future
relationships. If you have a partner, it’s important to let them
know if you don’t feel interested in sex. It can help to talk openly
with them about your feelings. Cuddles, kisses and massages can
show how much you care for someone, even if you don’t have sex.
If you have problems getting or maintaining an erection, there are
different options that can help you.
Let your doctor or nurse know if any difficulties with your sex life
don’t improve. They may be able to reassure you or offer further
help and support. If you feel uncomfortable talking to your doctor
or nurse, you can call us on 0808 808 00 00.
Some people may find it helpful to talk to a sex therapist. You can
contact a therapist through the College of Sexual and Relationship
Therapists (see page 122).
Our booklet Sexuality and cancer has more
information and tips that may help you.
88 Understanding breast cancer in men
Well-being and recovery
After treatment, some men choose to make some positive lifestyle
changes. This doesn’t mean you didn’t lead a healthy lifestyle
before but you might now want to focus more on your well-being.
Eat well and keep to a healthy weight
After treatment, it’s not unusual to find that you have put on
weight. This can happen with chemotherapy and hormonal
therapy. When you are ready, you can ask your GP if your weight
is within the normal range for your height.
There’s some evidence that keeping to a healthy weight reduces
the risk of some other cancers, heart problems and other illnesses
such as diabetes. Try to:
•• only eat as much food as you need
•• eat a balanced diet with lots of fruit and vegetables
•• eat less saturated fat and sugar
•• become more physically active.
Our booklets Managing your weight after cancer
treatment and Healthy eating and cancer both
have some helpful tips.
90 Understanding breast cancer in men
Get physically active
Being physically active helps to keep your weight healthy and
can reduce stress and tiredness. It also helps to keep your bones
strong and your heart healthy.
We have a booklet called Physical activity and cancer
treatment, which has more information. You can also watch
videos about the benefits of physical activity, including stories from
people with cancer, at macmillan.org.uk/physicalactivity
Look after your bones
Aromatase inhibitors (see page 71) can cause bone thinning
(osteoporosis) in women, but it’s not clear if this happens to the
same extent in men. Zoladex may cause bone thinning when
it’s given over a longer period of time.
It’s a good idea to look after your bones. Keeping physically
active, eating a healthy diet with enough calcium and vitamin D,
and not smoking helps to keep your bones healthy.
Our booklet about Bone health has more information.
Look after your heart
Some treatments for breast cancer may increase the risk of
getting heart problems later in life. Look after yourself by keeping
physically active, eating healthily, not smoking and sticking
to sensible drinking guidelines.
We have more information about heart health after
cancer treatment.
After your treatment 91
Stop smoking
If you smoke, giving up is one of the healthiest decisions you can
make. Smoking increases your risk of bone thinning (osteoporosis)
and is a major risk factor for smoking-related cancers and
heart disease.
Our booklet Giving up smoking has more
information and tips to help you stop.
Stick to sensible drinking
Stick to sensible drinking guidelines which recommend that men
drink fewer than 3 units of alcohol a day, or fewer than 21 units
a week. Try to have a few alcohol-free days each week.
There is more information about recommended
drinking guidelines in our booklet Healthy eating
and cancer.
92 Understanding breast cancer in men
Getting help and support
Different people can help you during and after treatment.
Practical help
If you need help at home during or after treatment, a nurse or
hospital social worker may be able to arrange this. If you have
children, the social worker may arrange some help with childcare.
We have information on childcare that we can send you.
A social worker or benefits adviser (see pages 123–124) can tell
you about benefits you may be able to claim and help with other
costs. If you need help with a wound or wound drain, the district
nurses can visit you at home to help with this.
Emotional help
It’s common to have different and sometimes difficult feelings
after cancer treatment (see pages 96–101). But as you recover
and get back to your everyday life, these usually get easier to
deal with. Talking to family and friends often helps. If you think
you may be depressed, or feel helpless or anxious a lot of the
time, talk to your cancer specialist or nurse. They can refer you
to a psychologist or counsellor who specialises in the emotional
problems of people with cancer. Our cancer support specialists on
0808 808 00 00 can tell you more about counselling and let you
know about services in your area.
After your treatment 93
Complementary therapies
Some men find that using some complementary therapies help
them to relax or cope with treatment side effects. Some hospitals
or support groups may offer therapies such as relaxation
or aromatherapy.
Our booklet Cancer and complementary therapies
has more information.
Support groups
Self-help or support groups offer a chance to talk to other people
who understand what you’re going through. You can call us or
visit our website for information about support groups in the UK.
Online support
Many people get support on the internet. There are online support
groups, social networking sites, forums, chat rooms and blogs
for people affected by cancer. You can use these to share your
experience and to ask questions, or get and give advice based
on your breast cancer experience.
Our online community (macmillan.org.uk/community) is a
social networking site where you can talk to people in our chat
rooms, write blogs, make friends and join support groups.
Your
feelings and
relationships
Your feelings
What you can do
96
101
Relationships102
If you are a relative or friend
104
Talking to children
105
96 Understanding breast cancer in men
Your feelings
It’s common to feel overwhelmed by different feelings when
you’re told that you have cancer. We talk about some of these
here. Partners, family and friends may also have some of the
same feelings.
You might have different reactions to the ones we describe
here. There is no right or wrong way to feel. You’ll cope with
things in your own way. Because breast cancer may be thought
of as ‘a woman’s condition’, men with breast cancer can feel
embarrassed about their diagnosis. You may have to deal with
a lack of awareness about the cancer and sometimes some
unhelpful reactions from others. Talking to people close to you
or other people affected by cancer can often help.
Shock and disbelief
You may find it hard to believe it when your doctor tells you that
you have cancer. It’s common to feel shocked and numb. You may
not be able to take in much information and find that you keep
asking the same questions again and again.
At first, you might find it hard to talk to family and friends about
the cancer. This usually gets easier as the shock wears off and it
becomes more real to you. You may find you can’t think or talk
about anything but the cancer. This is because your mind is trying
to process what you’re going through.
Your feelings and relationships 97
Fear and anxiety
People can be very anxious or frightened about whether treatment
will work and what will happen in the future. This uncertainty can
be one of the hardest things to cope with.
It can help to try to focus on what you can control. You may
want to find out more about the cancer, its treatment and how to
manage side effects. It can also help to talk about your feelings
and to take time to do things that are important to you and that
you enjoy.
Doctors often know roughly how many people can benefit from
a type of treatment. But they can’t be sure what will happen to an
individual person. Although they may not be able to answer your
questions fully, they can usually talk through any problems with
you and give you some guidance.
Avoidance
Some people cope by not wanting to know very much about the
cancer and by not talking about it. If you feel like this, let your
family and friends know that you don’t want to talk about it right
now. You can also tell your doctor if there are things you don’t
want to know or talk about yet.
Occasionally, this avoidance can be extreme. Some people may
not believe that they have cancer. This is sometimes called being
in denial. It may stop them making decisions about treatment.
If this happens, it’s very important for them to get help from
their doctor.
98 Understanding breast cancer in men
Sometimes, avoidance is the other way around. Family and
friends may seem to avoid you and the fact that you have cancer.
They may not want to talk about it or they might change the
subject. This is usually because they are also finding the cancer
difficult to cope with, and they may need support too. Try to let
them know how this makes you feel and that talking openly with
them about your illness will help you.
Anger
You may feel angry about your illness and sometimes resent other
people for being well. These are normal reactions, especially
when you feel frightened, stressed, out of control or unwell.
You may get angry with the people close to you. Let them know
that you are angry at your illness and not at them. Finding ways
to help you relax and reduce stress can help with anger. This can
include talking about or writing down how you feel, gentle
exercise, breathing or relaxation therapy, yoga or meditation.
Guilt and blame
Some people feel guilty or blame themselves or others for the
cancer. You may try to find reasons for why it has happened to
you. Most of the time, it’s impossible to know exactly what has
caused a person’s cancer. Over time, several different factors may
act together to cause a cancer. Doctors don’t fully understand all
of these factors yet. Instead, try to focus on looking after yourself
and getting the help and support you need.
Your feelings and relationships 99
Feeling alone
Some people feel alone because they don’t have enough support.
Family and friends may live far away, have other commitments or
feel uncomfortable because of their own fears about cancer. Try to
let your family and friends know how you feel and how they could
support you more.
If you need more support, you can call the Macmillan Support
Line free on 0808 808 00 00 and talk to one of our cancer
support specialists. Our website can help you find out about local
support groups – visit macmillan.org.uk/supportgroups
You can also talk to other people going through the same thing
on our online community at macmillan.org.uk/community
It’s normal to have times when you want to be left alone to sort
out your feelings. But if you find you’re avoiding people a lot of
the time, then try to talk to your doctor or nurse.
‘I heard about this peer support thing – and what a
relief it was. I talked to a guy who’d gone through
exactly the same things that I’d gone through, who had
had a mastectomy and who’d had chemotherapy and
who could answer all my questions.’
David
100 Understanding breast cancer in men
If you need more help
These feelings can be very difficult to cope with and sometimes
people need more help. This happens to lots of people and
doesn’t mean you’re not coping.
If you feel anxious, panicky or sad a lot of the time, or think you
may be depressed, talk to your doctor or nurse. They can refer
you to a doctor or counsellor who can help. They may also
prescribe medicine to help with anxiety or an antidepressant drug.
Our booklet How are you feeling? The emotional
effects of cancer discusses the feelings you may
have in more detail, and has suggestions for coping
with them.
‘My Macmillan nurse, Lorraine, has been with
me ever since my diagnosis. They asked if I
needed counselling, but she’s always ready
to listen to me so I don’t feel I need it. I can
talk to her about anything. When I had
surgery to remove the lump, she came in
with me. She is fantastic, marvellous.’
Lance
Your feelings and relationships 101
What you can do
One of the hardest things to cope with can be the feeling that
the cancer and its treatment have taken over your life. This is a
common feeling, but there are lots of things you can do.
There may be days when you feel too tired to even think about
what could help. You’ll have good and bad days, but if you’re
overwhelmed by these feelings, let your doctor or nurse know.
It may be that you have depression, and this is treatable so they
should be able to help.
Finding ways to cope
You may find it helps to try to carry on with life as normally as
possible, by staying in contact with friends and keeping up your
usual activities. Or you may want to decide on new priorities
in your life. This could mean spending more time with family,
going on the holiday you’ve dreamed about or taking up a new
hobby. Just thinking about these things and making plans can
help you realise that you still have choices.
Some people want to improve their general health by eating
a more healthy diet, by getting fitter or by finding a relaxing
complementary therapy.
Understanding about the cancer and its treatment helps many
people cope. It means they can discuss plans for treatment,
tests and check-ups with their doctors and nurses. Being involved
in these choices can help give you back control of your life.
102 Understanding breast cancer in men
Relationships
Your cancer experience may have improved your relationships
with people close to you. Support from family and friends may
have helped you cope. But cancer is stressful and can affect your
relationships. Any problems usually improve over time, especially
if you can talk openly about them.
Your partner
Some couples become closer when one partner has cancer.
However, cancer can put a lot of strain on a relationship.
Problems can develop, even between couples who’ve been
together for a long time. If a relationship was already difficult,
the stress of a major illness may make things worse.
Even couples who are close may not always know how their
partner is feeling. Talking openly about your feelings and listening
to each other can help you understand each other.
Our booklets Cancer, you and your partner and Sexuality
and cancer have more information that may help.
Family and friends
Your family and friends may not always understand if you aren’t
feeling positive. They may not know how much your treatment is
affecting your life. Talking about how you feel will help them give
you the support you need.
Our booklet Talking about your cancer has more useful tips.
Your feelings and relationships 103
If you are a relative or friend
Some people find it hard to talk about cancer or share their
feelings. You might think it’s best to pretend everything is fine,
and carry on as normal. You might not want to worry the person
with cancer, or you might feel you’re letting them down if you
admit to being afraid. Unfortunately, denying strong emotions
can make it even harder to talk, and may lead to the person with
cancer feeling very isolated.
Partners, relatives and friends can help by listening carefully to
what the person with cancer wants to say. It may be best not to
rush into talking about the illness. Often it’s enough just to listen
and let the person with cancer talk when they are ready.
You may find some of the courses on our Learn Zone website
helpful. There are courses to help with listening and talking,
to help friends and family support their loved ones affected by
cancer. Visit macmillan.org.uk/learnzone to find out more.
Our booklet Lost for words – how to talk to
someone with cancer has more suggestions if you
have a friend or relative with cancer.
If you’re looking after a family member or friend with cancer,
you may find our booklet Looking after someone with cancer
helpful. It’s based on carers’ experiences and has lots of practical
tips and information.
We have more information about supporting someone with
cancer at macmillan.org.uk/carers
Your feelings and relationships 105
Talking to children
Deciding what to tell children about your cancer is difficult.
An open, honest approach is usually best. Even very young
children can sense when something is wrong, and their fears
can sometimes be worse than the reality.
How much you tell children will depend on their age and how
mature they are. It may be best to start by giving only small
amounts of information, and gradually tell them more to build
up a picture of your illness.
Teenagers
Teenagers can have an especially hard time. At a stage when
they want more freedom, they may be asked to take on new
responsibilities and they may feel over-burdened. It’s important
that they can go on with their normal lives as much as possible
and still get the support they need.
If they find it hard to talk to you, you could encourage them to talk
to someone close who can support and listen to them, such as
a grandparent, family friend, teacher or counsellor. They may
also find it useful to look at the website riprap.org.uk which
has been developed especially for teenagers who have a parent
with cancer.
Work and
financial
support
Work108
Financial help and benefits
110
108 Understanding breast cancer in men
Work
You may need to take time off work during your treatment and
for a while afterwards. It can be hard to judge the best time to go
back to work, and this will depend mainly on the type of work you
do and how much your income is affected. It’s important to do
what’s right for you.
Getting back into your normal routine can be very helpful,
and you may want to go back to work as soon as possible. It can
be helpful to talk to your employer about the situation – it may be
possible for you to work part-time or job share.
On the other hand, it can take a long time to recover fully from
cancer treatment, and it may be many months before you feel
ready to return to work. It’s important not to take on too much,
too soon. Your consultant, GP or specialist nurse can help you
decide when and if you should go back to work.
Employment rights
The Equality Act 2010 protects anyone who has, or has had,
cancer. Even if a person who had cancer in the past has been
successfully treated and is now cured, they are still covered by the
act. This means their employer must not discriminate against them
for any reason, including their past cancer. The Disability
Discrimination Act protects people in Northern Ireland.
Our booklets Work and cancer, Working while
caring for someone with cancer and
Self‑employment and cancer have more information
that may be helpful. There’s also lots more information
at macmillan.org.uk/work
110 Understanding breast cancer in men
Financial help and benefits
If you are struggling to cope with the financial effects of cancer,
help is available.
If you cannot work because you are ill, you may be able to get
Statutory Sick Pay. Your employer will pay this for up to 28
weeks of sickness. If you qualify for it, they cannot pay you less.
Before your Statutory Sick Pay ends, or if you do not qualify
for it, check whether you can get Employment and Support
Allowance (ESA). This benefit is for people who cannot work
because they are ill or disabled.
There are two different types of ESA:
•• contributory – you can get this if you have made enough
national insurance contributions
•• income-related – you can get this if your income and savings
are below a certain level.
Since October 2013, a new benefit called Universal Credit has
started replacing income-related ESA in England, Scotland and
Wales. This benefit is for people who are looking for work or on
a low income.
Personal Independence Payment (PIP) is a new benefit
for people under 65 who find it difficult to walk or look after
themselves (or both). You must have had these difficulties for at
least three months, and they should be expected to last for the
next nine months. Since April 2013, PIP has started to replace a
similar older benefit called Disability Living Allowance in England,
Scotland and Wales.
Work and financial support 111
Attendance Allowance (AA) is for people aged 65 or over who
find it difficult to look after themselves. You may qualify if you
need help with things like getting out of bed, having a bath or
dressing yourself. You don’t need to have a carer, but you must
have needed care for at least six months.
If you are terminally ill, you can apply for PIP, DLA or AA under
the ‘special rules’. This means your claim will be dealt with quickly
and you will get the benefit you applied for at the highest rate.
112 Understanding breast cancer in men
Help for carers
Carers Allowance is a weekly benefit that helps people who look
after someone with a lot of care needs. If you don’t qualify for
it, you can apply for Carer’s Credit. This helps you to build up
qualifying years for a State Pension.
More information
The benefits system can be hard to understand, so it’s a good
idea to talk to an experienced welfare rights adviser. You can
speak to one by calling the Macmillan Support Line on 0808 808
00 00. We’ve just listed some benefits here, but there may be
others you can get.
You can find out about state benefits and apply for them online at
gov.uk (England, Wales and Scotland) and nidirect.gov.
uk (Northern Ireland). These websites have information about
financial support, your rights, employment and independent living.
You can also get information about these issues from the relevant
Department for Work and Pensions helplines (see page 123)
or Citizens Advice (see page 123). In Northern Ireland, you can
call the Benefit Enquiry Line Northern Ireland on 0800 220 674.
Our booklet Help with the cost of cancer has more detailed
information. You might also find our video at macmillan.org.uk/
gettingfinancialhelp useful.
Work and financial support 113
Insurance
People who have, or have had, cancer may find it hard to get
certain types of insurance, including life and travel insurance.
A financial adviser can help you look at your needs and find the
best deal for you. You can find a financial adviser by contacting
one of the organisations on pages 123–124.
Our booklets Insurance and Getting travel
insurance may also be helpful.
Further
information
About our information
116
Other ways we can help you
118
Other useful organisations
121
Your notes and questions
125
116 Understanding breast cancer in men
About our information
We provide expert, up-to-date information
about cancer. And all our information is free
for everyone.
Order what you need
Other formats
You may want to order more
We also provide information
leaflets or booklets like this one. in different languages and
Visit be.macmillan.org.uk or
formats, including:
call us on 0808 808 00 00.
•• audiobooks
We have booklets on different
cancer types, treatments and
side effects. We also have
information about work,
financial issues, diet, life after
cancer and information for
carers, family and friends.
All of our information is also
available online at macmillan.
org.uk/cancerinformation
There you’ll also find videos
featuring real-life stories
from people affected by
cancer, and information
from health and social
care professionals.
•• Braille
•• British Sign Language
•• Easy Read booklets
•• ebooks
•• large print
•• translations.
Find out more at macmillan.
org.uk/otherformats
If you’d like us to produce
information in a different
format for you, email us at
cancerinformationteam@
macmillan.org.uk or call
us on 0808 808 00 00.
Further information 117
Help us improve
our information
We know that the people
who use our information are
the real experts. That’s why
we always involve them in
our work. If you’ve been
affected by cancer, you can
help us improve our
information.
We give you the chance to
comment on a variety of
information including booklets,
leaflets and fact sheets.
If you’d like to hear more
about becoming a reviewer,
email reviewing@macmillan.
org.uk You can get involved
from home whenever you like,
and we don’t ask for any
special skills – just an interest
in our cancer information.
118 Understanding breast cancer in men
Other ways we can help you
At Macmillan, we know how a cancer
diagnosis can affect everything, and we’re
here to support you. No one should face
cancer alone.
Talk to us
If you or someone you know
is affected by cancer, talking
about how you feel and sharing
your concerns can really help.
Macmillan Support Line
Our free, confidential phone
line is open Monday–Friday,
9am–8pm. Our cancer support
specialists can:
•• help with any medical
questions you have about
your cancer or treatment
•• help you access benefits and
give you financial advice
•• be there to listen if you need
someone to talk to
•• tell you about services that
can help you in your area.
Call us on 0808 808 00 00
or email us via our website,
macmillan.org.uk/talktous
Information centres
Our information and support
centres are based in hospitals,
libraries and mobile centres.
There, you can speak with
someone face to face.
Visit one to get the information
you need, or if you’d like a
private chat, most centres
have a room where you can
speak with someone alone
and in confidence.
Find your nearest centre
at macmillan.org.uk/
informationcentres or call
us on 0808 808 00 00.
Further information 119
Talk to others
Online community
Thousands of people use our
No one knows more about the
online community to make
impact cancer can have on your friends, blog about their
life than those who have been
experiences and join groups
through it themselves. That’s
to meet other people going
why we help to bring people
through the same things.
together in their communities
You can access it any time
and online.
of day or night. Share your
experiences, ask questions,
Support groups
or just read through people’s
Whether you are someone
posts at macmillan.org.uk/
living with cancer or a carer,
community
we can help you find support
The Macmillan
in your local area, so you
healthcare team
can speak face to face with
people who understand.
Our nurses, doctors and
Find out about support groups
other health and social care
in your area by calling us or
professionals give expert care
by visiting macmillan.org.uk/
and support to individuals and
selfhelpandsupport
their families. Call us or ask
your GP, consultant, district
nurse or hospital ward sister
if there are any Macmillan
professionals near you.
‘Everyone is so supportive on the online community,
they know exactly what you’re going through. It can
be fun too. It’s not all just chats about cancer.’
Mal
120 Understanding breast cancer in men
Help with money worries
Having cancer can bring extra
costs such as hospital parking,
travel fares and higher heating
bills. If you’ve been affected in
this way, we can help.
Financial advice
Our financial guidance
team can give you advice
on mortgages, pensions,
insurance, borrowing
and savings.
Help accessing benefits
Our benefits advisers can
offer advice and information
on benefits, tax credits, grants
and loans. They can help you
work out what financial help you
could be entitled to. They can
also help you complete your
forms and apply for benefits.
Macmillan Grants
Macmillan offers one-off
payments to people with
cancer. A grant can be
for anything from heating
bills or extra clothing to a
much-needed break.
Call us on 0808 808 00 00
to speak to a financial guide or
benefits adviser, or to find out
more about Macmillan Grants.
We can also tell you about
benefits advisers in your area.
Visit macmillan.org.uk/
financialsupport to find out
more about how we can help
you with your finances.
Help with work and cancer
Whether you’re an employee,
a carer, an employer or are
self-employed, we can provide
support and information to help
you manage cancer at work.
Visit macmillan.org.uk/work
Macmillan’s My
Organiser app
This free mobile app
can help you manage
your treatment, from
appointment times
and contact details,
to reminders for when
to take your medication.
Search ‘My Organiser’
on the Apple App
Store or Google Play
on your phone.
Further information 121
Other useful organisations
There are lots of other organisations that can give
you information or support.
Breakthrough Breast Cancer
Weston House,
246 High Holborn,
London WC1V 7EX
Tel 08080 100 200
Email
[email protected]
www.breakthrough.org.uk
Aims to discover the causes of
the disease, find methods of
prevention and develop new
treatments. Campaigns for
policies that support breast
cancer research and better
services, and promotes
breast cancer education
and awareness.
Breast Cancer Care
5–13 Great Suffolk Street,
London SE1 0NS
Helpline 0808 800 6000
(Mon–Fri, 9am–5pm,
Sat, 9am–2pm)
Textphone 0808 800 6001
Email
[email protected]
www.breastcancercare.
org.uk
Provides information,
publications, practical
assistance and emotional
support for anyone affected by
breast cancer. Specialist breast
care nurses run the helpline.
The British Heart Foundation
Greater London House,
180 Hampstead Road,
London NW1 7AW
Tel 0300 330 3311
www.bhf.org.uk
Carries out research, provides
information and ensures quality
care and support for everyone
living with heart disease.
122 Understanding breast cancer in men
Counselling and
emotional support
General cancer
support organisations
British Association
for Counselling and
Psychotherapy (BACP)
BACP House,
15 St John’s Business Park,
Lutterworth LE17 4HB
Tel 01455 883 300
Email [email protected]
www.bacp.co.uk
Promotes awareness of
counselling and signposts
people to appropriate services.
You can search for a qualified
counsellor at itsgoodtotalk.
org.uk
Cancer Support Scotland
Calman Centre,
Gartnaval Complex,
75 Shelley Road,
Glasgow G12 0ZE
Tel 0141 211 0122
Email info@
cancersupportscotland.org
www.cancersupport
scotland.org
Offers information and support
to people affected by cancer.
Also runs support groups,
and provides counselling and
complementary therapies.
The College of Sexual and
Relationship Therapists
COSRT, PO Box 13686,
London SW20 9ZH
Tel 020 8543 2707
Email [email protected]
www.cosrt.org.uk
Has a directory of therapists to
help members of the public find
professional support in their
local area.
Irish Cancer Society
43–45 Northumberland Road,
Dublin 4, Ireland
Tel 1800 200 700
(Mon–Thurs, 9am–7pm,
Fri, 9am–5pm)
Email [email protected]
www.cancer.ie
Has a freephone cancer
helpline staffed by nurses
trained in cancer care.
You can also chat to a nurse
online and use the site’s
message board.
Further information 123
Maggie’s Centres
1st Floor, One Waterloo Street,
Glasgow G2 6AY
Tel 0300 123 1801
Email enquiries@
maggiescentres.org
www.maggiescentres.org
Maggie’s Centres provide
information about cancer,
benefits advice, and emotional
or psychological support. Tenovus
Head Office, Gleider House,
Ty Glas Road,
Cardiff CF14 5BD
Tel 0808 808 1010
www.tenovus.org.uk
Provides a range of services
to people with cancer
and their families,
including counselling
and a freephone helpline.
Financial or legal advice
and information
Benefit Enquiry Line
Northern Ireland
Tel 0800 220 674
(Mon–Wed and Fri, 9am–5pm,
Thu, 10am–5pm)
Textphone 0800 243 787
www.nidirect.gov.uk/
money-tax-and-benefits
Provides information and
advice about disability benefits
and carers’ benefits
in Northern Ireland.
Citizens Advice
Provides advice on a variety
of issues including financial,
legal, housing and employment
issues. Details for your local
office can be found in the
phone book or on one of the
following websites:
England and Wales
www.citizensadvice.org.uk
Scotland
www.cas.org.uk
Northern Ireland
www.citizensadvice.co.uk
You can also find advice
online in a variety of languages
at adviceguide.org.uk
124 Understanding breast cancer in men
Department for Work
and Pensions (DWP)
Disability Living Allowance
Helpline 0345 712 3456
Textphone 0345 722 4433
Personal Independence
Payment Helpline
0345 850 3322
Textphone 0345 601 6677
Carer’s Allowance Unit
0345 608 4321
Textphone 0345 604 5312
www.gov.uk/browse/
benefits
Manages state benefits in
England, Scotland and Wales.
You can apply for benefits
and find information online
or through its helplines.
Personal Finance Society –
‘Find an Adviser’ service
42–48 High Road,
South Woodford,
London E18 2JP
Tel 020 8530 0852
www.findanadviser.org
Use the website to find qualified
financial advisers in your area.
Support for carers
Carers UK
20 Great Dover Street,
London SE1 4LX
Tel (England, Scotland,
Wales) 0808 808 7777
Tel (Northern Ireland)
028 9043 9843
(Wed–Thu, 10am–12pm
and 2–4pm)
Email
[email protected]
www.carersuk.org
Offers information and support
to carers across the UK. Can
put people in contact with
support groups for carers in
their area.
Advanced cancer and
end-of-life care
Marie Curie Cancer Care
89 Albert Embankment,
London SE1 7TP
Tel 0800 716 146
(Mon–Fri, 9am–5.30pm)
Email supporter.services@
mariecurie.org.uk
www.mariecurie.org.uk
Marie Curie nurses provide free
end-of-life care to people in
their own homes, or in Marie
Curie hospices, 24 hours a day,
365 days a year.
Your notes
and questions
126 Understanding breast cancer in men
Disclaimer
We make every effort to ensure that the information we provide is accurate and up to date
but it should not be relied upon as a substitute for specialist professional advice tailored to
your situation. So far as is permitted by law, Macmillan does not accept liability in relation
to the use of any information contained in this publication, or third-party information or
websites included or referred to in it. Some photographs are of models.
Thanks
This booklet has been written, revised and edited by Macmillan Cancer Support’s
Cancer Information Development team. It has been approved by our Medical Editor,
Dr Rebecca Roylance, Consultant Medical Oncologist.
With thanks to: Mr Glyn Neades, Consultant Breast Surgeon; Ms Caroline Richardson,
Breast Surgeon; Ms Jennifer Rusby, Consultant Oncoplastic Breast Surgeon;
Dr Matthew Wallis, Consultant Radiologist; and Dr Robin Wilson, Consultant
Radiologist. Thanks also to the people affected by cancer who reviewed this booklet,
and those who shared their stories.
Sources
We’ve listed a sample of the sources used in this publication below. If you’d like further
information about the sources we use, please contact us at bookletfeedback@
macmillan.org.uk
ESMO Guidelines Working Group. Primary breast cancer: ESMO Clinical Practice 2013.
National Institute for Health and Care Excellence (NICE). NICE clinical guideline 80 –
Early and localised breast cancer: diagnosis and treatment 2009.
National Institute for Health and Care Excellence (NICE). NICE Clinical Guideline 81 –
Advanced breast cancer (update): Diagnosis and treatment 2014.
National Institute for Health and Care Excellence (NICE). NICE Quality Standards QS12
– Breast cancer quality standard 2011.
Scottish Intercollegiate Guidelines Network. SIGN 134 – Treatment of primary breast
cancer. A national clinical guideline 2013.
WHO. Classification of tumours of the breast. Lyon: International Agency for Research
on cancer. 2012.
Can you do something to help?
We hope this booklet has been useful to you. It’s just one of our
many publications that are available free to anyone affected by
cancer. They’re produced by our cancer information specialists
who, along with our nurses, benefits advisers, campaigners and
volunteers, are part of the Macmillan team. When people are
facing the toughest fight of their lives, we’re there to support
them every step of the way.
We want to make sure no one has to go through cancer alone,
so we need more people to help us. When the time is right for you,
here are some ways in which you can become a part of our team.
5 ways
you can someone
hElP with
cAncer
Share your cancer experience
Support people living with cancer by telling your story,
online, in the media or face to face.
Campaign for change
We need your help to make sure everyone gets the right support.
Take an action, big or small, for better cancer care.
Help someone in your community
A lift to an appointment. Help with the shopping.
Or just a cup of tea and a chat. Could you lend a hand?
Raise money
Whatever you like doing you can raise money to help.
Take part in one of our events or create your own.
Give money
Big or small, every penny helps.
To make a one-off donation see over.
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More than one in three of us will get cancer.
For most of us it will be the toughest fight we
ever face. And the feelings of isolation and
loneliness that so many people experience
make it even harder. But you don’t have to
go through it alone. The Macmillan team
is with you every step of the way.
We are the nurses and therapists helping you
through treatment. The experts on the end of
the phone. The advisers telling you which benefits
you’re entitled to. The volunteers giving you a hand
with the everyday things. The campaigners improving
cancer care. The community there for you online,
any time. The supporters who make it all possible.
Together, we are all Macmillan Cancer Support.
For cancer support every step of the way,
call Macmillan on 0808 808 00 00
(Mon–Fri, 9am–8pm) or visit macmillan.org.uk
Hard of hearing? Use textphone
0808 808 0121, or Text Relay.
Non-English speaker? Interpreters available.
Braille and large print versions on request.
© Macmillan Cancer Support, June 2015. 3rd edition. MAC11915.
Next planned review 2017. Macmillan Cancer Support, registered charity
in England and Wales (261017), Scotland (SC039907) and the Isle of
Man (604). Printed using sustainable material. Please recycle.