Men with breast cancer more likely to be undertreated and not survive

The T-shirts read "Fight like a girl." But while October’s Breast Cancer Awareness Month brings messages of strength and familiar pink ribbons, a fight rages on for the disease's lesser-known victims: men.

Though breast cancer strikes men much less often than women, a new study in the Journal of the American Medical Association [JAMA] reveals that three to five years after a breast cancer diagnosis, men are less likely to be alive.

Dr. Monica Morrow, a surgical oncologist with Memorial Sloan Kettering who specializes in breast cancers, agrees breast cancer in men accounts for quite a small amount of cases, yet they are typically caught when they’re more advanced, and more often fatal.

In an interview with ABC News, Morrow said that “Although later stage of diagnosis and undertreatment explain a large amount of difference in outcomes, they don’t explain them all, so all of the molecular research in women, we need to do those in men.” Dr. Morrow was not involved in the JAMA study.

The numbers haven’t made a strong case for studying breast cancer in men. Male victims account for less than one percent of all breast cancer cases, leaving a significant void in interest, and in funding, for research. According to the Centers for Disease Control and Prevention, about 245,000 women are diagnosed each year, compared to 2,200 men. About 460 men die each year, compared to 41,000 women.

The disease has gotten attention sporadically, but most recently in a number of cases among 9/11 responders and survivors.

And although the loudest cries for funding in breast cancer’s growing community seem to be those of women, they’re playing a critical part in helping men be heard. A New Jersey woman whose life was touched by male breast cancer happened upon the story of Bret Miller, a Kansas City man diagnosed at 24 years old. Together, they founded the Male Breast Cancer Coalition in 2013.

There’s an active coalition website, covered with half-pink, half-blue ribbons and pictures from their many fundraising events, along with Miller’s recount of his journey through breast cancer. His diagnosis ultimately resulted in a mastectomy and chemotherapy. In the website’s article, he calls it “terrible experience,” admitting he “never thought it was possible for a man to get a woman’s disease.”

Dr. Morrow recognizes that men are also getting fewer conventional treatments than women. They are less likely to get treatment “in terms of radiation use, chemotherapy use -- the things we know save lives in breast cancer,” she added.

The Vanderbilt researchers who performed the JAMA study seem to support this impression, noting one of the biggest contributors to lower survival times in men other than gender was undertreatment, though it wasn’t clear why.

A separate study in the Journal of Radiology suggests screening tests like mammography and ultrasound recommended for women may be also beneficial in detecting male breast cancers, but only in those who are considered ‘high-risk.’ Men who have a close family history of breast cancer, are of Ashkenazi descent, or have a known genetic mutation might benefit from screening, the study proposed.

Genetic testing in men has also been an unpopular subject, given a woman’s lifetime risk of breast cancer with the infamously cancer-causing BRCA gene is more than four times that of men. Because of this, there are no concrete guidelines on testing, or taking preventative action, in affected men.

Morrow told ABC News that due to lack of supportive research, screening average-risk men, with even a manual breast exam, “doesn’t make any sense.” She adds that the key for catching treatable breast cancer is to have any breast lump, no matter the size, evaluated promptly. This may include a simple physical exam by a trusted healthcare provider, a mammogram, or even needle biopsy.

General public awareness that men can, in fact, get breast cancer could be key in early detection and improving survival rates.

The Male Breast Cancer Coalition is sending a similar message with their tagline, putting it quite simply: ‘Men have breasts too.’

Dr. Kendrick is a family physician with the ABC News Medical Unit.