Male breast cancer?

Yes, and Environmental Exposure Is Implicated 

In 1988, John Connole, of Bristol, Connecticut was diagnosed with breast cancer. Less than a year later, after recovering from the shock of her husband contracting a disease usually associated with women, Lois Connole developed the same type of breast tumors. Even though doctors told them it was pure coincidence, the Connoles wondered if their breast cancer had an environmental cause.

Numerous studies have attempted to link breast cancers with environmental factors, including electromagnetic fields (EMFs) and chlorinated pesticides. But with hundreds of studies inconclusive about the harmful effects of EMFs, and debate raging over pesticide dangers, links are difficult to pinpoint, especially in men.

In the U.S., males account for one of every 100 cases of breast cancer, causing 300 deaths each year. The American Cancer Society estimates that, of the 183,700 cases of breast cancer in the U.S. in 1996, over 1,400 were in men. Unlike women, men do not receive routine mammograms or breast exams by physicians, allowing cancerous tumors to go undetected, often until the later stages of malignancy - which places male victims at high risk of dying from the disease.

According to Dr. William L. Donegan, of the Medical College of Wisconsin at Milwaukee, "While the frequency of breast cancer in men is strikingly less than that in women, the disease in both sexes is remarkably similar in terms of epidemiology, natural history and response to treatment."

Do EMFs Increase Men's Risk?

In spite of recent findings by the National Academy of Sciences' National Research Council, which reported last October that evidence linking EMFs to cancer was insubstantial, studies continue to probe whether EMFs could be a cancer culprit. EMFs are invisible fields produced by the flow of electrical charges in an alternating current and are generated by anything powered by electricity, such as electric blankets, televisions and alarm clocks.

The first report linking EMFs with mammary tumors was published in 1991, and revealed that rats exposed to EMFs showed much higher incidences of contracting mammary tumors than non-exposed rats. Another study published in the American Journal of Epidemiology suggested that men occupationally exposed to EMFs "may experience an increased risk of breast cancer," and of the 227 men in the study diagnosed with breast cancer between 1983 and 1987, breast cancer cases were six times more likely than the control group to report they had worked in the electric trade or related occupations (electrician, telephone or electric line repairman, electric appliance repairman, communications or broadcasting technician, welder or engineer).

The results of a Norwegian study, which concluded that men were contracting breast cancer at twice the expected rate in those occupations with high EMF exposure, spurred the Occupational Safety and Health Administration (OSHA) to make breast cancer studies linked to EMF exposure a high priority in the early 1990s. Since then, studies remain controversial.

Meanwhile, researchers are still unsure of the mechanisms at work between EMFs and mammary tumors, and recent studies continue to focus more on female cases than male, leaving many unanswered questions concerning male breast cancer causes.

The Pesticide-Estrogen Link

Chlorinated pesticides, in wide use since the 1940s, gained widespread attention last year over their link to many health risks after the publication of Our Stolen Future by Theo Colborn, Dianne Dumanoski and John Peterson Myers. Chlorinated pesticides are thought to "mimic" estrogen in the body. This fools the body into thinking that high levels of estrogen are present, thereby disrupting hormonal cycles. Such disruptions alter the body's mechanisms related to tumor growth and cancer development. Colborn says, "Because total estrogen exposure is the single most important risk factor for breast cancer, estrogenic chemicals are an obvious suspect when searching for the cause of rising rates over the past half century."

Cornell University researchers suggest that chlorinated pesticides may trigger breast cancer by adversely affecting the metabolism of estrogen. A 1993 study of the Journal of the American Medical Association reported that an imbalance of estrogens and androgens was in part responsible for the cases of male breast cancer. "A number of recent studies of male breast cancer suggest risk is associated with excessive estrogen exposure," Donegan reports.

Pesticides like chlordane, kepone and heptachlor proliferate breast tumor cells, as studies suggest estrogen does. Because estrogen levels are so strongly linked to breast cancer incidence, estrogen mimicking has led researchers to seriously scrutinize the link between breast cancer and pesticides. Coincidentally, pesticide use and breast cancer rates have both steadily risen worldwide since 1940.

While researchers debate the causes, the American Cancer Society says doctors agree that male breast cancer is attributable to certain risk factors, such as abnormal levels of estrogen; Klinefelter's syndrome, a male genetic disorder; gynecomastia, enlargement of male breast tissue; obesity; radiation exposure; and age (the average victim is 64). Donegan says, "Men below age 30 are rarely affected, and only two cases have been documented in male children." Also, many doctors believe risks increase for males related to breast cancer victims: "33 percent of male [cases] have a family member with breast cancer," reports Donegan.

And though Klinefelter's syndrome is a risk factor, it is rarely the cause of male breast cancer, according to Donegan: In one study, only one of 181 cases had Klinefelter's, leading doctors to examine other factors.

Certain other conditions have also been found to increase men's breast cancer risks: cirrhosis, chronic malnutrition and liver fluke infestation, conditions prevalent in impoverished countries, correlate with higher rates in such areas: men account for 4.6 percent of breast cancer cases in India; 6.4 percent in Egypt; and 15 percent in Zambia.

Other risk factors include head trauma, previous radiation treatment, or history of gonadal injury or inguinal hernias. High risk has also been linked to men in the perfume and soap industry, where men are often exposed to estrogen-containing creams.

As with breast cancer in women, symptoms usually include the presence of a hard, painless lump and nipple discharge (usually bloody). The nipple may also be inverted, and be accompanied by local pain or itching, affecting the left breast more than the right. "A firm mass directly beneath the nipple is by far the most common presentation of breast cancer in men," says Donegan, adding that it is found in 75 percent of cases.

Because of such physical symptoms, men who meet certain risk factors should perform monthly breast examinations, as women do, to detect lumps as early as possible. This involves lightly pressing down on breast tissue with fingers in a circular motion, taking note of any changes in tissue consistency since the previous exam, while looking for any abnormal lumps, discharge or pain during the exam. Males can also ask their physician to perform the exam during routine physicals. Avoiding concentrated EMF and pesticide exposure is also wise, as well as practicing healthy eating and exercise habits, and performing exams after radiation treatments or hernial injury.

And no matter what the cause, males diagnosed with breast cancer go through the same ordeal as females: mammograms and biopsies followed by radiation therapy, hormone therapy, chemotherapy, lumpectomy or mastectomy. Males in breast cancer support groups, even though largely outnumbered by women, agree that they have much to offer to other victims, including an awareness that breast cancer can affect anyone.

CONTACTS: American Cancer Society, 1875 Connecticut Avenue, NW, Suite 730, Washington, DC 20009/[phone]; Environmental Protection Agency's EMF hotline (800)EMF-2383; National Cancer Institute hotline [phone].

TRACEY C. REMBERT is managing editor of E.