Disease: Male breast cancer
Retired mechanic Mr Lo, 82, first found a small lump in his chest almost a decade ago. Then 73 and still working, he felt a small painless bump barely the size of a green bean near his left nipple while taking his nightly bath. When the nodule did not go away after 10 days or so, he felt uneasy and decided to see a doctor, who gave him some anti-inflammatory medication.
After a week of faithfully applying the medicine, the tiny bump remained. Lo returned to the doctor, who recommended that he see a specialist.
Lo was eventually diagnosed with breast cancer. The condition is often thought of as a women's disease but it can affect men, too, because men also have breast tissue concentrated behind the nipple. However, in men, this tissues does not produce milk. At puberty, a rise in female hormones in girls stimulates the breast tissue to grow and develop milk glands. Male hormones suppress that process.
Hong Kong Cancer Registry statistics show that, in the past decade, an average of 16 men have been diagnosed with breast cancer each year compared with an average of 2,351 women. The incidence rate among Hong Kong men is 0.3 to 0.5 per 100,000; in predominantly Caucasian populations it's one per 100,000.
Kwong analysed data from the past decade and found Hong Kong men tend to be older when diagnosed compared to women - 64.5 years for men versus 52.7 years for women - which is consistent with international trends. In the US, it's 63 years for men and 54 for women, according to an Associated Press report.
She says that although not proven, doctors theorise that men tend to be stricken with breast cancer later in life because as they get older their testosterone levels decrease and oestrogen levels become comparatively higher. Oestrogen exposure is linked to the development of breast cancer.
Dr Polly Cheung Suk-yee, founder of the Hong Kong Breast Cancer Foundation (HKBCF), says there may also be many oestrogenising factors in the environment, such as chemicals in food, that might come into play.
Kwong found that 7.6 per cent of sufferers in Hong Kong were likely to be diagnosed with breast cancer at a younger age (under 40) compared to 2.3 per cent of Caucasians. This parallels the trend among women, but no one yet knows why.
All cases of breast cancer in men are self-detected, says Kwong. Four in five discover the disease because they notice a breast lump. The rest have more severe symptoms like bloody nipple discharge.
About half of all Hong Kong men and women have tumours that are smaller than 2cm (stage I or IIa) at the point of discovery - a statistic Kwong is unhappy about because more women should be catching the disease early as most effort has been directed at them to get screened regularly.
Men have little breast and fatty tissue in the chest area and so lumps are more easily spotted, which helps early detection. That said, 9 per cent of Hong Kong male breast cancer patients are diagnosed at the final stage 4, nearly double that among women. In general, however, a local study by Kwong showed that men survive breast cancer better - one in five male patients died within five years of diagnosis compared with three in five females.
Male breast cancer patients face slightly different challenges. According to Doris Cheung Chun-ho, a counselling nurse and head of support services at the Hong Kong Breast Cancer Foundation, some men might have trouble accepting the diagnosis of what is commonly thought of as a women's disease. As such, they may not seek help even when they have trouble coping with the disease.
Polly Cheung estimates that only 5 per cent of male patients seek support services. She adds that the number of male breast cancer patients in Hong Kong is small and awareness about the disease is low. There is no critical mass to form support groups like in the US.
A patient once told Doris Cheung that it would have helped him to speak with other patients. But since breast cancer support groups were women-oriented, he did not feel comfortable joining them. She recalls another case of a man with a lump in his breast who chose to forego a follow-up test using the medical insurance provided by his employer because he did not want his colleagues to know about it.
However, in Polly Cheung's experience, many male patients have tremendous support from their wives. A mastectomy, which removes the breast tissue, nipple and areola, leaves the form of the male chest somewhat intact - men are also less likely to have marital problems post-surgery.
Men do not associate their sexuality with their breasts the way women do, so they cope better on some fronts, says Polly Cheung. However, the absence of the nipple and areola might make some men feel self-conscious.
Kwong is studying the psychological impact of breast cancer on male patients.
Lo considers himself lucky that the cancer was detected early. The fact that it developed in his breast did not concern him as much as the fact that he had cancer. Years previously, he lost his daughter to lung cancer.
With support from his wife and two sons, Lo underwent treatment and beat the cancer. However, genetic testing revealed that he carried a mutation in the BRCA gene - 14.2 per cent of male breast cancer patients do, according to Kwong's research - which markedly raises one's risk for breast cancer.
In men, the gene mutation also raises the risk for prostate cancer. Kwong says that while 3 per cent to 5 per cent of male breast cancer patients may have prostate cancer, the risk jumps to 14.2 per cent when one is a BRCA mutation carrier. One in seven BRCA carriers also develop multiple cancers.
Lo was diagnosed with prostate cancer around the time the gene test results arrived. Four years later, the cancer spread to his bones. Given that BRCA mutations are hereditary, Lo's two sons also underwent testing. Neither had the gene mutation.
Despite his multiple health challenges, Lo remains sanguine. "When something like [cancer] happens, it has already happened," he says. "Happy or sad, you still have to live, so you might as well be happy and positive. I know what it is like to watch a loved one go through this. Be happy, so you won't affect your family."
