Identifying the Needs of Men With Breast Cancer

By Marissa Fors LCSW, OSW-C

Breast cancer is often perceived as a woman's disease, as most breast cancers that are diagnosed in the U.S. are in women. Diagnoses in men contribute to less than 1% of cases.¹ Although male breast cancer is rare, health care providers must be well-informed of the psychosocial impacts of the disease. An understanding of the physical and emotional effects specific to men is crucial in the development of patient-centered cancer care.

Men with breast cancer often face unique challenges. This diagnosis can be shocking, and may bring about feelings of isolation, shame, and emasculation. A lack of awareness of male breast cancer, along with responses from others, contribute to these emotions. As health care providers, actions can be taken to better understand the experiences of male breast cancer patients and ensure an inclusive and supportive environment.

It is important to identify the factors that reinforce these feelings of distress. Stigma is commonly expressed as one of the most stressful barriers to receiving care and support for men with breast cancer. This stigma can be experienced in many settings, including within the cancer care system and in existing social surroundings. Studies have shown that breast cancer care focuses on female patients, leading men to feel dismissed. Men report being mistakenly called by female names and prefixes in waiting rooms and will most often be the only male breast cancer patient in the room. This brings about feelings of embarrassment and of being an outsider. ² In social settings, men often hesitate to disclose their diagnosis due to fear of how others will react. Many times, close family and friends are the only trusted sources of emotional support, and these chosen few are often equally as shocked by the diagnosis as the patient. Other times, people do not know how to deal with the diagnosis and will retreat from the patient. Men will often feel isolated and have few outlets for support, which leads to social exclusion and ongoing shame.³

There are many studies that demonstrate the emotional impact of mastectomy and treatment side effects. However, body image is often a topic reserved for supporting women. Not enough research is designed to understand the effects of scars and altered appearances in men after this surgery. Men may associate their own bodies with a masculine identity. A diagnosis of breast cancer, in combination with visible scarring to the chest area, may contribute to feelings of emasculation and psychological trauma. Additionally, hair loss is not equally addressed. For men and women alike, hair loss contributes to an identity of being sick. Both may express stress due to this side effect of treatment, but in different ways. For example, men may lose facial hair, a typical masculine trait, while in chemotherapy treatments. This could further exacerbate any feelings of emasculation.² These negative perceptions of body image and personal appearance could cause distress for many patients.⁴

In order to reduce the impact of these stressful events, studies have shown there are solutions to provide a more comprehensive approach in the health care setting. More awareness and equality of cancer care will decrease shock and shame. When breast cancer is not seen as only a woman’s disease, negative outlooks decrease. Publications handed to patients could be gender-neutral or contain aspects for both genders.² Discussions about treatment side effects, the impacts on quality of life and concerns about body image that are specific to men will promote an inclusive environment.⁴ Health care providers play a significant role in the patient’s perception of the disease. Knowledge, attitude, and office atmosphere contribute to better psychological outcomes.³

Stigma, feelings of exclusion, and other stressors will impact overall well-being and functioning. Health care providers who can identify these factors will better be able to provide much-needed emotional support, improve quality of care and provide resources tailored to their patients’ needs.⁴ In addition to a well-informed health care team, men with breast cancer would benefit from professional counseling and peer support. Support groups have long demonstrated improvements in quality of life to those with breast cancer, and that remains true for male breast cancer patients. In one study, most men agreed they would benefit from speaking with another man diagnosed with breast cancer.⁵ Providers who conduct distress screenings and share referrals to resources will have a significant impact on their patients, while meeting their various psychosocial needs.⁴

Even though male breast cancer is rare, all providers can remain conscientious and promote awareness in their practice. Together, we can collectively aim to reduce experiences of stigma and shame and decrease feelings of isolation and fear. Overall, this will have positive effects for male breast cancer patients and generate the respect and support all patients deserve.

References

• American Cancer Society. Breast Cancer Facts and Figures 2019-2020. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf. Accessed May 15, 2020.
• Midding W, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a woman’s disease: stigmatization of male breast cancer patients—a mixed methods analysis. American Journal of Men’s Health. 2018:12(6) 2194—2207. doi:10.1177/1557988318799025
• Robinson JD, Metoyer KP Jr, Bhayani N. Breast cancer in men: a need for psychological intervention. Journal of Clinical Psychology in Medical Settings. 2008:15(2):134-139. doi: 10.1007/s10880-008-9106-y
• Ernst J, Mehnert A, Dietz A, Hornemann B, Esser P. Psychological distress in men with breast cancer. Journal of Clinical Oncology. 2006:24(1):95-101. doi: 10.1200/JCO.2006.10.064
• Williams BG, Iredale R, Brain K, France E, Barrett-Lee P, Gray J. Experiences of men with breast cancer: an exploratory focus group study. British Journal of Cancer.2003: 89(10):1834-1836. doi: 10.1038/sj.bjc.6601305