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Masculinity, Emasculation, and Breast Cancer in Men

For some reason news stories on sex-associated cancers are most common in the months of September, October, and November. This may be because September is officially Prostate Cancer Month. October is Breast Cancer Month. And November is the month when the Movember Foundation encourages men to grow moustaches to raise awareness of men’s health issues, in particular prostate and testicular cancer.

Last October, there was a flood of stories about breast cancer. However, what was unusual this time around was the attention given to stories about breast cancer in men. This coverage was driven by a variety of factors, but two stand out. The first is that Beyoncé’s father has breast cancer and that provided a journalistic hook for stories about the challenges men face with that disease. The New York Times, CNN and many other media outlets jumped on the bandwagon.

A second hook, which bridged the three months, was the realization that many of the same genetic mutations that are indicative of aggressive breast cancer are also indicative of aggressive prostate cancer. The best known is a mutation of the BRCA2 gene and sadly Beyoncé’s father has that mutation. But it is not really new news that prostate cancer and breast cancer have genetic similarities. That was covered, for example, by Gail Risbridger and colleagues back in 2010 in a major review aptly titled “Breast and Prostate Cancer: More Similar than Different.”1

What was new this year was the heavy promotion of genetic screening. As we learn more about the genetics of cancer, we are developing targeted therapies appropriate for specific genetic profiles. These targeted therapies though are most likely to be effective if initiated when the disease is in an early stage. Sadly, for male breast cancer patients the disease is too often diagnosed at a late stage when curative treatments are no longer available.

This gets us back to the problem of breast cancer in men. Men are more often diagnosed with breast cancer later than women and have poorer survival statistics as a result… even though they are far less likely to get the disease in the first place.

Men’s attitude toward breast cancer has led to a number of studies by health sociologists, who are concerned about the fact that men take poorer care of themselves than woman do.2 Men go to the doctor less often, and when it comes to signs of breast cancer, they often wait too long to book a medical consultation. There have been a smattering of studies of male breast cancer patients by health sociologists, who have tried to understand why men react the way they do to signs of abnormalities in their chest walls.

Much of this research is predicated on the belief that men are socialized to minimize physical discomfort and ignore signs of illness. To sociologists sensitive to gender differences, this is seen as a problem in gender enculturation that needs to be addressed. Several allude to the idea that men are influenced by “hegemonic masculine” ideals. The researchers, who write within that framework, envision a breast cancer diagnosis for a male as emasculating, since having breasts is a female trait. However, having breast cancer is not female-specific since males get breast cancer even if they have no noticeable gynecomastia (breast development).

How men react to gynecomastia and also to developing breast cancer varies greatly,3 and their perspective on what the organs (breasts) and the disease (cancer) mean to their male identity need not be the same. Depending on who you read, a diagnosis of breast cancer is emasculating for males… or maybe not. The literature is inconsistent4 and part of the problem is a lack of rigor in defining masculinity in the first place. Secondary to that is a problem in defining emasculation.

To some sociologists the acquisition of any female dominant trait is emasculating; in that mindset, “feminization means emasculation.” But the data do not show that to be a consistent perspective for the patients, since men can get cancer in vestigial mammary tissue without overt signs of breast development. A study of how prostate cancer patients understand the impact of that disease on their manhood shows that, for that cancer at least, it is loss of male sexual function more than anything else that they find emasculating.5 And, even when the drugs they take cause some breast development, that is not consistently described as “emasculation.”

Once committed though to a “breast cancer is emasculating” mantra, some health sociologists and patients have come up with a wordplay workaround. That is to relabel the disease as “chest cancer.” As an anatomist I find that imprecise and unappealing. Furthermore, there are no data showing that such rebranding of the disease in any way reduces distress from the cancer diagnosis.

Breast cancer begins as a disease of the superficial anterior thoracic wall, which may invade the chest deep to the rib cage, but it doesn’t start there. The American College of Chest Physicians have been publishing the journal Chest since 1935. Chest deals overwhelmingly with cardiovascular and pulmonary diseases, including the “chest” cancer that kills the most men, namely lung cancer.

When articles on breast cancer appear in Chest they commonly deal with the metastatic spread of the disease into the chest. So, for example, whereas Chest’s search engine comes up with 91,500 references to the “heart” and “lung,” it flags only 310 papers in Chest that mention the “breast.” Notably, none of those papers is specific to early stage breast cancer. Most instead deal with the metastatic spread of the disease deeper into the thorax.

It has proven unhelpful to presume that the lower survival for men with breast cancer than women is due to men being socialized into a gender hierarchy that is disdainful of females. Even if adherence to hegemonic masculinity is a factor for why men are inattentive to palpable anomalies on their torso, it is frankly silly to assume that it can be solved by renaming a dangerous disease so as to distance it from females.

There is one fact though that should make men more aware of, and attentive to, signs of breast cancer. That is a comparison with testicular disease. Because of Lance Armstrong and organizations like Movember, testicular cancer has had a lot of media exposure. And, admittedly, it is more common than male breast cancer. But both cancers are, in fact, quite uncommon, and testicular cancer is easier to treat.

The American Cancer Society estimates that for this calendar year some 400 USA men will die of testicular disease. By comparison approximately 500 men will die of breast cancer. Similar differences show up in Canadian and Australian statistics, with 25 – 40 percent more men dying each year of breast cancer than testicular cancer.

If men are willing to learn how to examine their testes for lumps, bumps, and irregularities, they surely can learn how to do the same for their chest wall. But we need to get the word out about this.

The Movember Foundation closed out the 2019 “sex-associated cancer season” with their slogan “Changing the face of men’s health” followed in big font by “Prostate cancer, testicular cancer, mental health, and suicide prevention—we’re taking them all on.” The question in my mind is, “What will it take for Movember and men in general to put breast cancer on the list of men’s diseases?”

 

Richard Wassersug is a Canadian-based scientist and anatomist, whose research includes studies on cancer, sex, and gender. You can follow him on Twitter @rjwassersug

References:

1 Risbridger, GP, ID Davis, SN Birrell, WD Tilley 2010 Breast and Prostate Cancer: More Similar than Different. Nature Reviews Cancer, 10(3): 205-212.
2 Tsang, V, RJ Wassersug 2018 Men’s Health Research versus Andrology—Defining the Division and Closing the Divide.  Journal of Men’s Health, 14(3): e20-e32.
3 Wassersug, RJ, JL Oliffe 2009 The Social Context for Psychological Distress from Iatrogenic Gynecomastia with Suggestions for its Management. Journal of Sexual Medicine, 6(4): 989-1000.
4 Quincey, K, I Williamson, S Winstanley 2015 ‘Marginalised Malignancies’: A Qualitative Synthesis of Men’s Accounts of Living with Breast Cancer. Social  Science & Medicine, 149: 17-25.
da Silva, TL 2016 Male Breast Cancer: Medical and Psychological Management in Comparison to Female Breast Cancer. A Review. Cancer Treatment Communications, 7: 23-34.
Skop, M, J Lorentz, M Jassi, D Vesprini, G Einstein 2018 “Guys Don’t Have Breasts”: The Lived Experience of Men who have BRCA Gene Mutations and Are at Risk for Male Breast Cancer. American Journal of Men’s Health, 12(4): 961-972.
Thompson, EH, AS Haydock 2019 Men’s Lived Experiences with Breast Cancer: The Double Consciousness of Marginal Men. Sex Roles, 82: 28–43.
Krumm, S, C Checchia, M Koesters, R Kilian, T Becker 2017 Men’s Views on Depression: A Systematic Review and Metasynthesis of Qualitative Research. Psychopathology, 50:107-124.
Rabbee, Z, S Grogan 2016 Young Men’s Understandings of Male Breast Cancer: “Pink Ribbons” and “War Wounds.” International Journal of Men’s Health, 15 (3): 210-217.
5 Tsang, VWL, C Skead, C, RJ Wassersug, JL Palmer-Hague, 2019 Impact of Prostate Cancer Treatments on Men’s Understanding of Their Masculinity. Psychology of Men & Masculinities, 20(2):  214–225.

Comments

  1. They can, Geary. And obesity raises the chances of breast cancer, along with a host of other cancers. As a larger fraction of the population have become obese, these problems have become more frequent.

    Some of the cancers such as bowel cancer, it may not be that obesity itself gives them the cancer, but that the diet needed to become obese is also not good for the bowels. But it’s the same end result, and the same prescription either way: eat better food and go for a walk, this should help the person lose weight and even if it doesn’t they’ll be better off.

    This is why I said you can make your fate.

  2. What are you waiting for?

  3. Look, I can’t keep abreast of every single medical advance, and I would feel a right boob trying.

  4. Wow, what a turnout in the comments.

    I do wish men would get sufficiently medically checked out (I’ve had to practically force two men in my life to do it, and they were the only two men I tried to make do it) and among men I’ve observed way more bitching about minor troubles then there is going to the GP for serious ones.

    With that as context, I don’t think male breast cancer is the topic to focus on. It is extremely rare compared to female breast cancer (over 99% of BC cases are in women) and other cancers and heart disease are so much larger risks for men.

    All my sympathy to men with breast cancer but if the will to get check ups is so weak in men it ought to be spent on blood pressure, cholesterol, bowel, and prostate etc. High blood pressure has no symptoms till you’re about dead so get it checked!

  5. From here, the main things are:

    • smoking
    • drinking
    • obesity
    • dangerous driving
    • suicide

    with the ones leading depending on age group. Gender just swaps them around a bit, like males 25-44 are more likely to have fatal car accidents, women breast cancer.

    In the chart below “accidental poisoning” is basically alcohol and prescription opiates. Coronary heart disease, chronic obstructive pulmonary disease, and cerebrovascular disease (ie heart attacks and strokes), and of course lung cancer, are associated with smoking, drinking, and being obese. None of those help with alzheimers and dementia, either. And the sort of diet making you obese with vascular problems tend to be terrible for your guts, too - colorectal cancer.

    Everyone has better or worse genes for these things, but improving or making worse your chances are due to factors largely under your control. And you have to die sometime of something, but it can be earlier or later, and you can have a good quality of life followed by a 1-3 month decline and death, or you can start dying 10-30 years before you finally die.

    These top 5 are about 1/2 of all deaths.

  6. Please read a post closely before responding to it. This saves needless repetition.

  7. Strange post…

    Should I have to take care of myself as women care of themselves? Honestly, I never thought so. Most men, it seems to me, deep down feel the same on the instinctive level. We careless about comfort, we are more prone to risky behavior, and if we complain that the wife spends a lot of money, it is only because we are afraid that we are not able to satisfy her spending needs on our comfort and on the comfort of our children.
    I have long come to the conclusion that men’s lives are cheaper than women’s lives, because the long-term success of society is more ensured by women than by men.

    Excuse me, it’s the biology, stupid. Social “masculinity” norms based on it, nothing else.

    If we need to take care of ourselves, it is only from the point of view that we require some care as a tool, used by women for survival.

    Recently, I underwent rather unpleasant preventive procedures and did that by demand of my wife. At our age, we can allow ourselves to be a little cynical and she said me straight, she needs me, life without me would be more difficult for her and she wants me to be healthy. She was right.

    Have no doubts, she sincerely loves me, as I love her after decades of living together, not clouded by single insulting word either from me to her or her to me.

    Life is arranged this way and not otherwise. Accept it for what it is.

  8. It’s no surprise that men experience breast cancer, that it is discovered later, and is therefore, frequently more progressed at diagnosis. What should be surprising is the exclusion of men from breast cancer services and assistance programs which continue to be run along sexist policies.

    The myth that men are not concerned with the health, is simply a myth, propagated by lazy academics who accept the writings of sociological feminist academics who impose their strawman definitions of masculinity on men and boys (the hegemonic, toxic, traditional masculine model based on Solanas), rather than look at and listen to men and boys with an open unbiased mind. Men and boys spend billions every year and devote large amounts of their time to health. they see health differently from the reductionist medical model and the feminised reproductive model, and are not provided appropriately shaped services.

    How many men’s health services do you know of?
    When did you ever hear of men being encouraged to check for breast cancer?
    When did you last see a government health response on the scale of the breast cancer scanning, for any male health issue?

    Any professional who points the finger at men for not caring about the health is propagating a lazy sexist lie.

  9. No. Men avoid medical services, but they also avoid gyms and the like. Men are slightly more likely to join a gym than women, but women stick around for much longer. Men engage in more health-risking behaviours such as heavy drinking, smoking, dangerous driving, poor food and no exercise.

    Those are the facts, unfortunately, and you can’t blame

    Sorry, but no. It’s our fault.

    Now, you are of course free to adopt any ideals of masculinity you like. But one masculine ideal present in many cultures over the centuries is that funny mix of self-reliance and taking responsibility. With that ideal in mind, we can’t blame academics or feminists or doctors. It’s down to us.

    A man gets shit done. This should include looking after himself so he can get shit done. Eat some vegies, go for a walk, if anything seems off see a doctor and do what they tell you. Don’t be careless with your health.

  10. Hi Caitlin. Thanks for the example of your flat mate who hasn’t been to the doctor in ten years because he is fit. That’s common. We often hear of men who haven’t been to a doctor in years.

    But this just an example of how our health systems and services adhere to the “illness” model of health for men. Your flat mate is perfectly correct. He has no reason to go to the doctor if he is not sick. This is why men don’t use existing health services, they are not related to men’s experience of health and wellbeing.

    If you want to support the notion that men should just change the nature of masculinity to fit our health services, then go ahead. But masculinity is just as wonderful and flawed as femaleness. A few decades ago there was a revolutionary challenge to how health services were failing women. Health services changed. Now we are looking at evidence that health services are failing men. Are you suggesting an entirely different approach? If so, ask yourself why? Talk to your flat mate about his perception of health. Try listening to understand rather than validating your current opinion.

    Sorry, but if you read more about men’s health seeking you would have come across the writings of R.W. Connell (Raewyn Connell (2005) Masculinities (2nd ed.) Berkeley, California: University of California Press), and Michael Flood (University of Queensland). The American Psychology Association has also identified masculinity as an ideology damaging to men and women, and the confession of male privilege as the first step in addressing mental health issues in men and boys. These framings of mens health are imposed on men by feminist trained academics, often despite the voices of men telling them otherwise.

  11. That’s not what I said; this is what I said:

    This:

    Is a false statement. As someone who subscribes o medical websites I am constantly reading more about men’s health. I just haven’t read the things you think I should have read.

    You’re making of assumptions that come from your own biases. Why is that?

    And why on earth should I listen to my flat mate about his perception of health? He is incredibly ignorant and arrogant in his ignorance to the extent he has tried to override me on my own prescribed medications. ‘You’re taking far too many of those’ not knowing what ‘those’ are or that I’m taking them correctly to manage my blood pressure.

    He literally laughed in my face when I told him my tiredness was caused by anaemia thinking anaemia was something like going to bed too late (as he later explained). He’s a moron in nearly every topic, having no curiosity about the world or any will to inform himself. He come out of the womb already knowing everything there is to know.

    I ask YOU why you think ‘perspectives’ on reality mater. Reality is not based on perspectives but facts.

    Yeah and I hate feminism with a vengeance. It’s vile terrorism.

  12. Yes they do. But these are risk factors, not illnesses. These require health services to address behaviours rather than illness. There has been a very successful program for reducing smoking in several countries (e,g, Australia), where smoking has been reduced to a tiny fraction of what it was once. This is an example of men responding to health programs aimed and designed for men. Evidence that when services are designed with men in mind, and address wellness rather than illness or reproductive needs, men respond very positively.

    These are not overtly harmful behaviours. It’s very easy to suggest these are the reason for men not attending health services, but often minor illnesses are appropriately and effectively managed in just this way by both men and women. We shouldn’t run off to the GP for every sniffle or ache.

    What is missing for men is a health service shaped to men’s experience of health and wellbeing. Men don’t have the regular interactions with health services that women experience in the management of their health bodies. Men are ignored by health services until they are ill.

    How many GPs would advise men on healthy exercise regimens and health supplements? Very few understand or even care about non-pharmaceutical/non-surgical interventions.

    Just one final word. We have hundreds of publicly funded women’s health units in Australia. Every community centre has a women’s health advisor. Every university acknowledges women’s health as an important educational objective. This is good, and effective.

    How many men’s health units are there is Australia? ZERO!!! How many universities run men’s health courses in Australia ZERO!!!. Blame that on men.

  13. Where do you get this idea?

    It’s just so weird.

    I see a hospital dermatologist every year or two years. It’s not a woman-centric experience to wait ages for my appointment because the doc is always late, and then stand mostly naked in front of him, him being a man around my age with zero bedside manner.

    I go not because this healthcare model ‘suits me as a woman’ but because I have a high skin cancer risk and I summon up the courage to get checked out for my own benefit.

    Edit to add:

    Women have higher trait neuroticism than men do so I expect this is partly what drives us to get checked out. This and other big 5 differences also explain why men do better in careers. You get the good with the bad in sex dimorphism. In an opposite sex pairing such as heterosexual marriage the two sexes can make up for what the other lacks: I push you to go to the doctor, you push me to ask for a raise at work. I pushed my flat mate to get a medical checkup.

    Edit to add:

    I read an article about a study that looked into why women get worse outcomes with heart attacks. Turns out men do a better job at reporting their symptoms. So this is obviously a male-centric way of getting medical information. OR should women just report their symptoms better?

  14. This has been reported on recently:

    the overwhelming majority of their doctors said their advice was not being heeded and patients lacked the craving to tackle their weight issues.

    That’s gender and age-neutral, by the way, both men and women, young and old, are ignoring their GPs. But men have higher rates of being overweight or obese, which suggests that they’re ignoring it even more aggressively than women are. Just look at the posts in this forum. Without looking at the names, you can generally tell when it’s a man writing: he’s more likely to essentially be telling people to fuck off. Now imagine blokes like that at the doctor’s.

    Women have Karen - the annoying entitled middle-class woman - and men have Barry, the obnoxious overweight snarling man. He might be a truckie, he might be an accountant, he might even be a member of parliament, but he’s still a Barry, and Barry does not live to be running marathons at 85.

    Doing a google search for “men’s health clinic” pulls up quite a lot of results. I’ve no idea if they’re publicly-funded or not. It doesn’t interest me much, I’m more interested in prevention than cure. As I mentioned earlier, the leading causes of early death, you can improve your chances a lot by being active, eating vegies, not smoking and drinking, not driving like an idiot, and so on.

    But I’m not sure why even a doctor’s advice is needed for most of these things. Obviously if there’s pain or a lump somewhere, you go sort it out. But prevention? “Healthy exercise regimens and health supplements”? Let’s be logical about this.

    Do you think it is better to,

    • smoke, or not smoke?
    • drink more booze, or less?
    • sit on the couch, or go for a walk?
    • eat less vegies and fruit, or more?
    • drive drunk and speed, or sober and within the limits?
    • if suffering depression ignore it, or talk to someone?

    You know the answers here. Everyone does. They do not become more true because someone in a lab coat says them, nor are you any more likely to follow them, as doctors are complaining in the article above.

  15. I came across this report on male values and mental health. I draw you attention to the following paragraph in the conclusion:

    “Martin Seager, consultant clinical psychologist with the Male Psychology Network, describes the ‘double bind’ of men being encouraged to contact telephone helplines, but then their call isn’t taken seriously if they happen to use humour (‘banter’) or if they want to talk about solving their problem rather than talking about their feelings. It seems that banter and reluctance to talk about feelings are male-typical communication styles that result in men not being listened to, and it would make sense
    that psychologists question whether they need to improve their listening skills when it comes to
    men.”

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