Seventy-three-year-old country singer Paul Ott Carruth has sung about heartache and loss, the death of patriotism and dwindling natural resources.
But recently, he battled a bigger foe, one that few men ever confront: breast cancer.
Doctors diagnosed Carruth with breast cancer earlier this year after finding a lump in his left breast. He had his left breast tissue removed, along with a three-quarter-inch tumor. Fortunately, the cancer had not spread to his lymph nodes.
His doctors predict that he'll make a full recovery, and he has already returned to hosting his outdoor-themed radio program, "Listen to the Eagle."
And Carruth's experience may help increase awareness that breast cancer affects men too, albeit rarely.
"Men have breast tissue, so they certainly can get breast cancer," says Dr. Carol Scott-Conner, a professor in the department of surgery at the University of Iowa Hospitals and Clinics, who has treated several men with breast cancer.
Male breast cancer comprises only 1 percent of all breast cancer cases — not a surprising figure, since men's bodies contain only about 1 percent of the breast tissue that women's do. In 2007, Scott-Conner estimates there will be about 2,000 men diagnosed with breast cancer, compared with 178,000 women identified with the disease.
"There is a pattern," she says, adding that Carruth fits it. "Mostly, we see male breast cancer in older men, and typically, it presents as a lump."
How a Man Copes With a Womanly Cancer
Considered "country royalty" in Mississippi for years, Carruth's family has found fame in many places. His first wife was a former Miss Louisiana, one of his sons was a professional football player with the Green Bay Packers, and his daughter, Carla, was nearly crowned Miss Mississippi.
But cancer has touched his family with an equal measure of tragedy. Carruth lost his wife to ovarian cancer in 1983. His daughter had a double mastectomy as a precautionary measure after finding a lump in 2005.
And when Carruth had his genes tested, he was found to be a carrier of both BRCA1 and BRCA2, the genes that increase the risk of contracting breast and ovarian cancer.
Dr. Beverly Moy, a medical oncologist at the Massachusetts General Hospital Cancer Center, says even though these genes increase risk, they do not necessarily mean a man will get breast cancer.
"It's hard to say, but about 5 percent of men who carry BRCA1 develop breast cancer, and about 5 to 10 percent of men who carry BRCA2 will develop it."
Moy adds that men are more likely to wait when they have a lump, which can lead to a more difficult treatment.
"Often, men have a more advanced stage of cancer, because they wait until longer to get a lump checked out," Moy says, adding that men should look out for a lump, any distortion in the nipple or any nipple discharge.
Male breast cancer tends to affect African-American men more often than white men, though the reasons for this are not entirely known.
Despite having such a rare cancer among men, Carruth joins a few other famous men who have struggled with breast cancer, including actor Richard Roundtree (best known for his starring role in the movie "Shaft") and Edward Brooke, a former U.S. senator from Massachusetts.
Treatment for Men: Similar, Yet Different
Treatment is largely the same for men, consisting of mastectomy — removal of the breast tissue — followed by radiation or chemotherapy, depending if the cancer has spread to other parts of the body.
Whether slightly different strategies would work better for men is still a matter of some debate, however.
"We just haven't been able to do many studies on men's treatment," says Scott-Conner, "because there aren't enough of them out there to study."
Additionally, according to Scott-Conner, there can be further hardships for men diagnosed with breast cancer.
"Men have a difficult time with it," she says. "It can be isolating for them, because many men don't even know that breast cancer is even something that is possible for them to have."
Moy agrees. "It can be hard for men to go into a clinic; in many places, the breast cancer treatment takes place in a women's cancer center.
"We all have to do a better job to focus on all our patients."