Breast cancer in men: “The saddest thing is that it is detected in already advanced lesions”

The breast cancer It has become one of the most diagnosed neoplasms in the country, according to the International Agency for Research on Cancer (IARC). Last year, more than 6,800 Peruvians received the diagnosis and 1,824 died from the disease. They are the main affected by this disease.

But, although it is rare,. According to the National Institute of Neoplastic Diseases (INEN), it occurs in one in every 500,000 men.

Doctors indicate that some men have risk factors that predispose them to developing breast cancer, which is why and to which specialist to go. In this regard, we spoke with Dr. Raúl Goicochea García, an oncologist surgeon at the Regional Institute of Neoplastic Diseases of the Center (IREN Centro).

“Breast cancer does occur in men, we must be clear about that, and”, says the spokesperson for the ‘Couples Therapy’ campaign, which seeks to prevent breast cancer in women and men.

– When it comes to breast cancer, one thinks above all of women because it is the one that affects them the most, but little is known about men with the disease. Are there marked differences?

Breast cancer continues to be, currently, and one of those that also causes the most deaths in Peru, due to multiple factors. The genetic background is taking a bigger push during this last year. It is being seen that it not only manifests itself in women who have had mothers or grandmothers with breast cancer, but also. That is why it is important to ask men if they have a history of cancer.

What males are predisposed [a desarrollar la enfermedad]? Since the incidence is 100 to 1000 times lower in men than in women, the cases are very few, but since we do not have extensive information, not even worldwide,: among them are smoking, alcohol consumption, obesity, history of gynecomastia [aumento en el tamaño de la glándula mamaria en hombres] that can hide masses; We do not mean that all men with gynecomastia will get breast cancer, but it can hide those lesions since they are not as visible or noticeable. And this occurs a lot in men who are overweight or obese. In Peru we have a high rate of men with a body mass index above 25, and that can predispose them to developing cancer.

– And how soon is it detected?

Breast cancer does occur in men, we must be clear about that, and obviously we must be vigilant. ; They are 2 cm lesions, they do not care about it, then they go to the general practitioner and he does not know about these injuries, so he does not know what [exámenes] ask for. It is said that the gynecologist is supposedly the one who best manages breast cancer in Peru, but that is false. Men do not go to the gynecologist. , who are specialists in seeing men’s and women’s cancer. They will give you the exact data, regardless of gender. They will examine you and order tests that will help diagnose. Unfortunately, many of the oncology surgeons are in Lima, it is the saddest thing. And, obviously, many of the general practitioners, without disregarding their ability, do not handle the guidelines and exams that are very important. [para el diagnóstico].

“Breast cancer occurs in older adults in the vast majority”

– And what diagnostic tests are used to detect breast cancer in men?

In the case of men, a breast ultrasound is used, but it depends on who does it because there are places here in Peru that are of bad origin. that can differentiate a benign lesion from a malignant one. As men’s injuries are small, what they do is use the ‘gold standard’ [un estándar general] to be able to see these injuries. Ultrasound and MRI of the mammary gland region are needed.

– Those are the steps for the diagnosis …

Exactly, that’s the way we get there. We see the injury, we examine it, we evaluate it. We asked for a breast and soft tissue ultrasound. The ultrasound done by a doctor specializing in radiodiagnosis has the ability to define whether it is benign or malignant. Once the lesion is diagnosed, you go for a biopsy and

– That happens when the person has already come to a doctor who is going to diagnose it, but a preliminary step is taken when the man has any discomfort. In that sense, what are the symptoms or warning signs that every male should take into account?

Breast cancer occurs in the vast majority of older adults. Those diagnosed in Peru are in a range between 60 and 70 years. There are some symptoms: These are almost definitive symptoms, they can show a malignant lesion, but normally men do not give it that much importance, they think it is a little pimple, a pimple; they think that it is going to disappear, that it is not a bad thing, just like women. So, if the man, when doing his self-examination, notices any significant change, even if it does not hurt, he has to go to a doctor who has to examine him.

What we want for Peru is for cancer to stop killing so many people “

– You mentioned that the majority of patients are between 60 and 70. What is the prognosis since many arrive in advanced stages?

Breast cancer, currently, internationally, has had a huge turnaround. Even when it’s advanced [el cáncer], you have to go for treatment. Instead, she has to face a struggle with chemotherapy, surgery, and radiation therapy, which is the same standard of treatment for a woman. We surgeons who treat this disease do not tell the person that they are going to die. We tell him he’s going to get into a fight. Obviously, in order to fully define the extent of the disease, the stage of the disease, we do a series of examinations and with that we can tell how far this lesion has spread. Even in the most widespread injuries, you are not sentenced to death. You must be receiving drug treatment or radiotherapy treatment to shrink the cancer and improve your quality of life. In Peru, treatment for breast cancer is free, both for men and women, and there are specialists, the trouble is that they are in Lima. Currently, I work at the IREM Centro, which is a regional institute, it is the last one that has been opened in Concepción [Huancayo]. For me it is gratifying to be able to attend to this type of patient with a much more complex logistics, which includes not only doctors specialized in this pathology, but also doctors who know how to give chemotherapy, radiotherapists, and a battery of specialties such as medical technologists, technicians, nurses trained …

– The idea is that they get the best care

and people can live for more than 20 or 30 years with this disease, which is what is happening in other countries. We are fighting to have a fence of trained professionals, with adequate health accessibility. We want fewer women to die from breast cancer, as do men. All diagnosed and, obviously, well treated. That is improving in Peru with regional institutes. It is something very good that is happening, not everything is bad, that is why I am happy to belong to that human group where cancer patients are being treated for free, unlike other countries, for example, like Bolivia, whose patients even come to be operated in Peru.

– Access to health services is key. How have you seen it with your patients?

People with cancer often live in remote areas. Some of our patients live in the central jungle, eight hours by boat from a central location. Ty rents a room in Concepción for 35 or 60 soles to be able to receive his treatment for a month. There are many NGOs that have taken this into consideration, and it is good that they are no longer going that far, to Lima, where life is more expensive, more cruel and there is much greater indifference. And now they come to the center of Peru from very distant areas, such as Pucallpa, Pangoa, Huancavelica, Oxamapapa, Ayacucho … it is a trip to receive specialized attention, there are no specialists in those regions. That is why one of the insignia that we have in the institution is that the patient who has also made a long journey should not be treated badly. Imagine that you have already traveled eight or 10 hours, you arrive, they yell at you, they treat you badly, they tell you that you are going to die, they do not give you hope … it is fatal. Oncology surgeons say to the patient: ‘You have cancer, but you have to do this, you have to give you an alternative.

– And are there case experiences?

I recently saw a male patient, over 70 years old. Noticed a lump, thought it was a lipoma [acumulación de grasa] in the pectoral region, it did not cause pain. Her daughter was concerned, she came and we detected that the lesion was cancerous. Currently, he is already operated, he is going to receive systemic treatment, after that he may be cured of this disease, and he will have to do his controls annually, for 5 years, and if he passes those 5 years, he can calmly return to his normal life, that is what we seek with patients: even if you are an older adult, so that you can live a quiet life, without fear, of course.

– Is there a marked difference between the symptoms presented by a woman who has breast cancer and a man?

There are no differences, because it affects the organ, which is the mammary gland. So there are no significant differences. Both are solid lesions, which can retract the skin, can be associated with discharge from the nipples, can be associated with trophic changes of the skin (dimples) or an ulcer.

– What can a man do in terms of prevention, to reduce the risk of developing breast cancer.

And when does one begin to have a healthy life? Not at 50. Healthy life is acquired in adolescence, with a diet rich in vegetables and fruits. Obviously avoid saturated fats, which are related a lot like Peruvian food; We are not saying not to eat it, we are saying to decrease [la cantidad]. And the use of tobacco is contraindicated for multiple types of cancer. Not to excess alcohol. Obviously, it is necessary to do a self-exam of the body always. If you see any change that is attracting attention, a lump, a pain, you should go to a general practitioner at least. If you have the possibility, you should go to an oncologist surgeon, who has the ability to define whether it is benign, malignant or nothing.

– What remains to be known regarding breast cancer in men in Peru?

The statistics are currently held by the INEN, and the Ministry of Health has almost biased information because we have cancer in all parts of Peru. So, what is missing is to unite data at the national level, both from the Ministry of Health, EsSalud, the Armed Forces. T, in addition to scientific research on breast cancer in men. And I am of the idea that a unique cancer history should be handled at the national level. It is also important that there is less discrimination against cancer patients. Just because a person has cancer does not mean that nothing can be done for him anymore. I have the idea, and that I teach my medical students, that there is always something to do

– What to say to people who are facing cancer today?

Telling them that we doctors are trained to help and accompany them in this disease, that they leave the stigma that if they have cancer, then they will die. If you have cancer, then we are going to fight, we are going to fight you. When we break that culture of fear, many people, many women and men, will be saved, because we can fight the disease. If it is incipient, we can even cure them completely, and if the disease is already there, we can attenuate it and make it – in simple words – sleep. If in case it is already a terminal illness, to be able to accompany you throughout this process.

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