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October, the Breast Cancer Awareness Month, is also the time of reality check for males in the sultanate

By Hubert Vaz

Breast Cancer Awareness Month, marked every October internationally, has been helping draw attention and support for awareness, early detection, treatment and palliative care of this disease.

This observance especially holds significance in Oman where four per cent of breast cancer cases concern males.

The World Health Organization (WHO) states that there are about 1.38mn new cases and 458,000 deaths from breast cancer each year and that it is by far the most common cancer among women worldwide, both in developed and developing countries.

Dr Rajashree Narayan Kutty, a cancer specialist surgeon in Oman, pointed out that men, too, can get breast cancer even though it is rare.

“The incidence of male breast cancer is about one per cent in the US, but in Oman it is four per cent as at least four new cases are reported every year,” she said, pointing out that, like female breast cancer, no single cause has been identified for this.

The risk factors that have been identified for male breast cancer include family history, exposure to estrogen by food or medicines, chronic liver disease, obesity, Klenifelter’s syndrome, testicular disease as well as genetic mutations, she said, adding that the commonest breast lumps that develop in men, especially young males, are gynecomastia where there may be a lump or increase in size of the male breast, which can be due to an imbalance of estrogen/testosterone.

Males could also be identified with fat lumps – lipomas, cysts with fluid inside but most of the swellings are not cancer – they are benign and harmless but surely need examination by a doctor.

The simple tests include a thorough history and examination by a physician and an ultrasound scan.

Treatment modalities include surgery – mastectomy, chemotherapy, radiation-therapy, hormone therapy and targeted therapy while the five-year survival rate for male breast cancer depends on the stage of diagnosis and treatment, Dr Kutty said.

She added, “The need of the hour is leading a healthy lifestyle, avoiding junk food and fizzy drinks, managing stress and exercising regularly.”

WHO states that there is not sufficient knowledge on the causes of breast cancer,  therefore, early detection remains the cornerstone in controling this disease. When breast cancer is detected early, and if adequate diagnosis and treatment are available, there is a good chance that it can be cured, it states.

According to Dr Rory McGoldrick, plastic and reconstructive surgeon – Aesthetics, King’s College Hospital London – Dubai, when following the diagnosis and treatment, it is also important to consider options with regards to breast reconstruction.

“One of the most important things is to ask the doctor who will be treating you what their planned treatment is, as well as your post-cancer options,” he said. The cancer treatment plan can involve surgically removing a lump or more than that. Also, you should know whether there is any additional treatment other than surgery, such as chemotherapy or radiotherapy. Once you have these answers, it guides your decision-making with regards to the post-cancer journey, which is the reconstruction of one’s breast, Dr McGoldrick said.

Breast reconstruction options

Breast reconstruction options depend on what is missing.

If there is just a small part of breast missing after a lump-ectomy, then no reconstruction may be required. But after a full mastectomy, reconstruction is needed, Dr McGoldrick states.

The two options involve reconstruction of breasts using part of one’s body or using a breast implant.

Silicone implants

The simplest form of breast reconstruction is the use of silicone implants. However, some patients don’t really want to have a breast implant because it is a foreign object which could lead to chances of complications.

Fat transfer

With ‘fat transfer’, patients undergo liposuction and then that fat is processed in a special way and injected in and around the breast tissue and/or the implant.

Free Tissue Transfer

Utilising own body parts is the best reconstruction option in terms of reduced complications because you don’t need an implant. This is done by performing abdominoplasty.

Reconstruction time

In the Middle East, often breast reconstruction is not offered immediately. How-ever, doing it on the same day has advantages, including less psychological trauma.