Sharmin Akter, the wife of Shawkat Hossain, is a cancer survivor. Back in 2017, she was diagnosed with third-stage breast cancer. As a result, she had her breast removed in order to survive.
"I've met countless cancer specialists home and abroad since my wife was diagnosed with breast cancer," said Shawkat Hossain, "Cancer doesn't frighten me anymore, but I was in momentary shock when you asked about male breast cancer. Does it really exist?"
It does exist. And Shawkat's confusion is telling about the state of male breast cancer awareness in Bangladesh.
Breast cancer is most often found in women, but men can get breast cancer too. A study by the Centre for Disease Control and Prevention says, about one out of every 100 breast cancer patients diagnosed in the United States is a man.
Surprisingly, in Bangladesh, the frequency is a little higher. In the year 2018, 28 cases of breast cancer were found in men out of 1,644 total breast cancer cases. So, according to data, 1.7 percent of all breast cancers are found in men. (Source: National Institute of Cancer Research and Hospital).
"There are instances where male patients came to me with breast abnormalities, and after diagnosis, when I told them that it is in fact breast cancer, they could not believe their ears.
This is the state of the awareness level of this particular cancer in our country," said Dr Md Habibullah Talukdar Ruskin, Associate Professor and Head of Cancer Epidemiology, National Institute of Cancer Research and Hospital, Dhaka.
Rushkin further added that many male patients find male breast cancer embarrassing because breast cancer is socially known as a disease of females.
"Some men refrain from seeking help and medical support because they feel less masculine. Whenever I participate in workshops or seminars on generic breast cancer, many male counterparts don't even feel the necessity of attending as they assume these are solely for women.
The awareness level in the country is very alarming," he added.
He also added that men are less likely to have breast cancer as they have a lower number of breast tissues and ducts. Cells in any part of the body might be cancerous, and men's breast tissue is no different.
What we know about male breast cancer
When breast cells grow uncontrollably, they can be viewed on an x-ray or felt as a lump. However, all the lumps are not cancerous. A malignant tumour is the one that can spread to other parts of the body, which is known as metastasis.
It is not clear what the exact causes of male breast cancer are, but there are certain factors that may increase the risk, such as age, family history of breast cancer, high oestrogen levels, radiation etc.
Additionally, the chance of breast cancer in men increases with age. Male breast cancer occurs most frequently in men over 60, although younger men may also get it.
Moreover, family history of breast cancer in first-degree relatives is associated with an increased risk of breast cancer among men. The two inherited genes, BRCA1 and BRCA2, give rise to most hereditary breast cancer.
And high oestrogen hormone levels can stimulate the development of breast cancer. Men naturally have small amounts of oestrogen in their bodies, but long-term liver damage, obesity, marijuana use, thyroid disease, and some genetic conditions may result in higher levels of oestrogen and subsequently lead to cancer.
Radiation also plays a part. Men whose chests are exposed to radiation over prolonged periods may be more likely to develop breast cancer.
"In most cases, male patients come with swollen breasts or a lump in the breasts or underarm areas. And 95 percent of the time, it is just hormonal imbalance or benign tumour," said Dr Jesmen Nahar Runi, General, Breast and Colorectal Surgeon, Consultant, Dhaka Medical College Hospital.
However, other symptoms include ulceration on the breast or nipple, tender or inverted nipple (pulled inwards), rashes on or around the nipple and oozing discharge from the nipple, sometimes with blood as well.
"Symptoms are easy to detect as men have a small breast area. As a result, men are diagnosed in much earlier stages than women," added Dr Runi from her observation.
Breast cancer in men is treated the same way as breast cancer in women. Treatment aims to remove the cancer and prevent it from recurring or spreading to other parts of the body.
Some widely used treatment methods are surgery, radiotherapy, chemotherapy, hormone therapy, immunotherapy, targeted cancer drug therapy, etc.
The doctor decides the most appropriate treatment or combination of treatments based on the type and size of the breast cancer, how far it has spread, and so on.