breast cancer. For many, this is still one thing above all: a women’s disease. Men can also get sick. It is estimated that there are 770 each year. How dangerous is breast cancer in men, Mr. Jurmeister? In principle, just as dangerous as in women. However, if you look at the data from the Robert Koch Institute, you will see that the 5-year survival rate is worse for men than for women. That’s not entirely clear.
What do you mean? There is one type of breast cancer that is more aggressive and carries a poorer prognosis. This is what is known as triple negative breast cancer. It occurs in about 10 to 15 percent of women with breast cancer and less than 5 percent of men. Based on this, the survival rate for women should actually be worse than that for men in the statistics.
However, it is exactly the other way around. Why? It can be assumed that several factors play a role here. One is that nobody expects breast cancer in men and it is discovered too late – or at least later than in women.
There are regular check-ups for women. What about the early detection of breast cancer in men? There are no early detection measures for men. Basically, hardly any doctor pays attention to breast cancer in men, maybe a dermatologist. It is simply not looked for systematically and as a result it is often only discovered late. We all know how important early detection is for treatment success. Another point is that when women fall ill, they are simply better cared for than men.
Men get worse medical care than women? What are you up to? For example, there is a disease management program for women. This is a program where patients are taken by the hand, so to speak, and guided through the treatments. This program is available for several chronic diseases. This program is also available for women with breast cancer, but unfortunately not for men. An evaluation by the Institute for Quality Assurance and Transparency in Health Care (IQTIG) also found that essential quality factors that play a role in the treatment of breast cancer are less well observed in men and they are more often not treated in accordance with the guidelines.
So you’re saying that our healthcare system in Germany isn’t prepared for men with breast cancer? It’s not sufficiently prepared. The disease management program, for example, was designed from the outset for women only. There is no other disease that excludes a gender from a certain health care system, only breast cancer. This may also be a reason why survival rates for males are not as good as for females.
Actually it’s rather the other way around. Medicine is still mostly thought of in terms of men, to the detriment of women. That is correct. This problem exists, but it has now also been recognized and is being addressed. Unfortunately, I’ve already had to find out on this topic that something like, well, you men can see how we women are doing, subliminally. But that cannot be a reason to tolerate unequal treatment in the other direction.
What would have to change in order to improve the supply situation for men? First of all, access for men to the breast centers would have to be made easier. It would also be important for the breast cancer disease management program to also be accessible to men in order to end gender-based inequality.
When it comes to breast cancer, women first go to the gynecologist. Who do men go to? Well, men don’t have a dedicated doctor. They’re often told to see a urologist, but that advice is a bit strange. The urologist has absolutely nothing to do with this disease. He takes care of the male genital organs and the urological diseases. I don’t know of any cases where the breast was looked at during urological check-ups.
According to estimates by the Robert Koch Institute, around 66,800 women are diagnosed with breast cancer every year. For women, it is the most common type of cancer. Young people are also increasingly affected. The German Cancer Society speaks of over 18,000 women dying of breast cancer every year. Men can also develop breast cancer, with them there are around 770 new cases each year. The breast cancer month of October draws attention to the situation of patients.
Couldn’t men just go to a gynecologist? It is often very difficult for a man to get into a gynecological practice. They are often not accepted by established gynecologists because they do not want men to sit in their practice. Many gynecologists still think, although this is hardly the case today, that they cannot bill for the examination.
And what options are there for men? There are breast centers specifically for breast diseases. If a man wants to have an appointment there, it can also happen that a referral from the gynecologist is requested and that from the family doctor is not sufficient. Then the search for a gynecological practice starts all over again. But sometimes everything works smoothly, depending on the local supply structures.
Is breast cancer treated so differently in women and men that this explains the chaos? The principle of treatment is largely the same. There are differences when it comes to topics such as breast augmentation. In the male, it is perhaps less relevant that the breast is restored. However, men do not have as much opportunity to hide their illness in public. After all, they don’t wear a top in the swimming pool, for example, and the external change is noticeable. As a rule, the nipple is removed, which makes the upper body strikingly asymmetrical.
It is said again and again that one reason why breast cancer is discovered later in men is that they wait too long before they go to the doctor. What do you say about that? I’m always annoyed by a YouTube video in which a well-known professor once said that men are just a bit bashful and therefore don’t go to the gynecologist. But that’s only one side. Of course, a man does not like going to the gynecologist. The other side, however, is that the supply structures for men are not established. In addition, it is very individual whether men take care of their health or not. But to simply claim that men don’t like going to the gynecologist and that’s why the survival rate isn’t that good is certainly a one-sided view. However, it should also be noted that the supply structures have improved significantly in recent years!
Are men perhaps still not sufficiently sensitized when it comes to breast cancer? This, too, has improved significantly in recent years. In the meantime, public education about the disease has played a greater role, but this is still in need of improvement. Nevertheless, many still see breast cancer as a women’s disease and think: I’m a normal, established man. I can’t possibly get breast cancer. Many people still have the image in their heads that a man can only get breast cancer if he also has real breasts. Any man can get breast cancer! Unfortunately, many still do not understand this. There is also a marathon runner in our network who is extremely slim and has no visible breasts. However, he got breast cancer.
The estrogen level, i.e. the amount of the so-called female sex hormone, can promote breast cancer …… every man always produces estrogen, also for example in the testicles. This is completely normal. Estrogen levels in men are roughly the same as in women after menopause. Estrogen plays a role in the development of breast cancer in both sexes. In most cases, an essential part of therapy is anti-estrogen treatment. However, the hereditary burden plays a much greater role. If men have inherited the so-called BRCA2 gene, the probability of developing breast cancer increases by almost 100 times and is in the range of women in the general population.
And then the grown man suddenly gets breast cancer – and masculinity gets a crack? There are many men who have a problem with it. I’ve experienced this most with men who have a more traditional understanding of roles. It is more problematic for them if they believe that a breast cancer diagnosis is a sign of lack of masculinity. In my experience, modern men for whom gender roles are less important do not have such a problem with the diagnosis.
