RENEE MONTAGNE, HOST:
First though, this look at breast cancer in men. It's rare. Only about 1 percent of all breast cancer patients are men. Still, that means every year, about 2,600 men are diagnosed with the disease. NPR's Patti Neighmond reports.
PATTI NEIGHMOND, BYLINE: At 46 years old, Oliver Bogler's reaction to a suspicious lump in his chest seems typical for a man.
OLIVER BOGLER: I ignored it for three, four months, maybe a little bit longer.
NEIGHMOND: Ignored it, even though he's a cancer biologist. He figured the lump was a benign swelling of breast tissue.
BOGLER: It took me a while to grow up and go see my primary care doctor, who then quickly referred me. And I had a biopsy and was diagnosed with invasive breast cancer fairly quickly.
NEIGHMOND: This sent Bogler on a personal journey he would make public in a blog called Entering A World Of Pink.
BOGLER: I called it Entering The World Of Pink because that's kind of how it feels when you're a man who's diagnosed with breast cancer.
MONTAGNE: At the MD Anderson Cancer Center in Houston, oncologist Sharon Giordano specializes in men with breast cancer. She says by the time patients like Bogler finally get diagnosed, the disease is more advanced than it is for most women.
SHARON GIORDANO: I've had many patients tell me that they had no idea that they were at risk for breast cancer or even could get breast cancer. Men don't typically think about themselves as having breasts and so really don't have even an awareness that all men have some residual breast tissue.
NEIGHMOND: And like women, men can inherit a gene, BRCA, that puts them at greater risk. Once men are diagnosed, the treatment's pretty much the same as it is for women - surgery to remove the cancer, followed by chemotherapy, radiation and hormone suppressing medication, like Tamoxifen. That's what happened with Oliver Bogler, with one big difference. Most women have lumpectomies followed by radiation. For men, the tumors are commonly right behind the nipple, which means a mastectomy. That's what Bogler had. And most men don't have reconstruction - probably, says Giordano, because they don't even know it's an option.
GIORDANO: When brought up, I think a lot of male patients are interested in having nipple reconstruction to the chest wall so that if they're - you know, if they're swimming, if they're out playing basketball and have their shirt off, that the surgical changes aren't quite so obvious. And they don't have to constantly answer questions about it.
NEIGHMOND: And during diagnosis and treatment, men can experience something of a gender misfit. Because breast cancer is so much more common among women, breast centers are often decorated in pink - lots of pink.
GIORDANO: I had a patient who told me that he had gone in for a breast biopsy. And this particular patient had a great sense of humor and was laughing about it. But what was given to him, which was the supply for everybody, was a pink, floral icepack. And the instructions were to place inside your bra.
NEIGHMOND: This misfit goes way beyond the medical office. When Edward Smith (ph) was diagnosed about four years ago, he did what lots of people do. He went online looking for sites to give him emotional support.
EDWARD SMITH: The first couple that I looked at, when I identified myself as a male, people kind of pulled back a little bit. They weren't outright nasty or anything. But you could just feel that they were pulling back in terms of the conversation that was going on at the time.
NEIGHMOND: Eventually, Smith found a site that was welcoming, which was important, he says, because while his family was important, colleagues at work just seemed confused.
SMITH: They were just stupefied. They just weren't sure that they were really hearing the right thing because most people have never encountered a male that's had breast cancer.
NEIGHMOND: The lack of awareness about men and breast cancer, even among some doctors, says oncologist Giordano, means less money for needed research to figure out how breast cancer in men differs from women, especially when it comes to life-saving treatment.
GIORDANO: To me, the most pressing question is, you know, what is the best hormonal treatment for a man with breast cancer? Should we be giving them Tamoxifen like we give to women? Or are there other treatments that might be more effective in men? And we just don't know the answer to that.
NEIGHMOND: Giordano's now doing research to try to find out some answers, investigating the effectiveness of hormone treatments for men with breast cancer. Patti Neighmond, NPR News.