Aug 23, 2011 6:59 PM
If you've never met a guy with breast cancer - and odds are good that you haven't - Terry Mautner is happy to be your first.
"I've worn it as kind of a badge of courage, or whatever you want to call it. I like to engage people in conversation about it because they find it so unusual or interesting," he says. In fact, while talking to WebMD by phone, the Indianapolis man notices that he's wearing his "I'm a survivor" T-shirt, which he picked up at a breast cancer fundraising event.
And no, it's not pink. "It's gray," he says with a laugh.
Mautner's story is a reminder that for the most part, "women's diseases" don't really exist. Men can't get ovarian or other female reproductive cancers, of course. But though you can call them "pecs" all you want, men do have breasts. And guys have bones, so we can get osteoporosis. And we can have depression, irritable bowel syndrome, and lupus and other autoimmune diseases, even though these more often strike women.
Men can face special challenges when we develop a disease more common in women. We may be slower to notice symptoms. We may have more trouble coping. We may feel frustrated over having any disease, let alone one that society regards as a "women's problem."
If one of these ailments does find you, here's how to confront it like a man... er, a fighter.
Decades ago, Mautner had a benign cyst removed from his left breast, so he was used to finding lumps. When he felt another lump in 2000, he ignored it for a month. His wife urged him to get it checked. He saw his doctor on a Friday and had a mastectomy three days later.
Men's breast cancers are often found at a more advanced stage, says George Sledge, MD, a breast cancer expert at the Indiana University Melvin and Bren Simon Cancer Center in Indianapolis, who treated Mautner after his cancer returned in 2005. After all, almost no men have regular mammograms or check themselves for breast lumps. The National Cancer Institute says there is no information on the benefits or risks of breast cancer screening in men.
Overall, men's outcomes aren't worse than women's, as long as they catch the tumor early enough. Men have estrogen in their systems, too, and most men's breast cancers contain receptors for the hormone, which allow it to influence the tumor.
As a result, guys tend to respond well to drugs that keep estrogen from encouraging breast cancer growth, Sledge tells WebMD. Many other treatments - surgery, radiation, and chemotherapy - are similar in men and women.
And guys may get a warning that they're at risk if the disease shows up in their family. Men who carry a BRCA2 gene mutation have about an 8% chance of getting breast cancer, though this is much less than the 40% or higher chance seen in women, Sledge says. Men with a BRCA1 gene mutation are also at higher risk of breast cancer.
However, after their diagnosis, guys don't find a community of peers waiting to welcome them, as women might. When men head to the golf club or gym, odds are better that "they could commiserate about prostate cancer or their heart attack, but there just isn't a large number of guys with breast cancer who can talk to each other," Sledge says.
For centuries, doctors have known that autoimmune diseases are more common in women, says Fotios Koumpouras, MD, a lupus specialist at the West Penn Allegheny Health System in Pittsburgh. The difference might be due to the way estrogen levels affect the immune system in women and men.
Among young people, lupus affects females especially heavily, he says. In our 50s and beyond, women still account for most cases, but men start to catch up. His older patients tend to be more concerned that they've developed a disease that pops up more in women. "I have 19-year-old men with lupus who don't care, per se," Koumpouras says. "The 55-year-old men may be a bit more traditional. You can sometimes feel there's a bit of reticence or embarrassment on their part over the diagnosis," he says.
Men tend to have more serious cases of the disease than women, Koumpouras says, and it's often especially severe in young men. However, men typically respond as well to treatments - which are mostly the same for men and women -- and the risk of death from the disease is similar.
If a man responds with disbelief when he learns he has osteoporosis, it's understandable, says Pamela Taxel, MD, of the University of Connecticut Health Center. Even doctors don't always have the disease on their radar screens with male patients, says Taxel, who is interested in men's bone health. And "if our knowledge of osteoporosis in women is in its middle-age years, in men it's still in its preteen years," Taxel says.
Guys can get this problem when their natural supply of bone-building testosterone dwindles with age. That's one reason. Decreasing estrogen levels might play a role, too, she tells WebMD.
In about half of cases, a doctor can find the reason for a man's bone loss. Steroid drugs such as cortisone and prednisone, which are used for treating some chronic diseases, can put men at risk. So can testosterone-reducing drugs used for prostate cancer. Smoking and too much alcohol can also set the stage.
Men with osteoporosis may need to take testosterone to treat the problem if their own levels are low (and prostate cancer isn't a concern). And they can take many of the bone-building drugs that are FDA-approved for men and women, Taxel says.
In general, "We know that men use less effective coping strategies when confronted with disease," no matter what the problem is, says Will Courtenay, PhD, a psychologist who focuses on men's health and is the author of Dying to Be Men.
"Many men feel like their bodies should work like a well-oiled machine. When anything goes wrong with it, they can feel like less of a man," he says. A guy who feels like he's in line with a group of women waiting for treatment might feel even more out of sorts.
Here's how to cope better if you come down with one of these ailments -- or any chronic health problem.
Mautner, 59, who works at a pharmaceutical company by day and as a wedding DJ in his spare time, has never been ashamed of the scar on his hairy chest. Now cancer-free for five years, he welcomes the chance to share his story to educate people. "I'm not embarrassed about it. It's just something that happened to me, and it's not what I'm all about."