His breasts killed their promising romance, cancer brought it all back

Though cancer of the breast is recognised worldwide, including Kenya, as the commonest cancer in women, there is hardly any awareness of the disease occurring in men.

This was brought home to me once when I was being interviewed on radio on the subject of breast cancer. The interviewer announced at the beginning that questions from listeners were welcome while the interview was in progress. When not a single question came up during the first half of the interview, I started wondering if I was making any impact on my listeners.

However, when I mentioned in the course of the interview that men are not immune from the disease and one per cent of breast cancers are men all over the world, the radio channel was jammed with questions, a majority of them asked by men. On receiving further queries, I elaborated that studies suggested that the incidence of male breast cancer is higher in Kenya, Zambia and Egypt.

I further shocked them by adding that the disease spreads more rapidly in men, because the breast is a rudimentary organ in them and there is hardly any fat to slow its metastasis to the ribs and lungs. That created a panic, resulting in many men coming to the Breast Clinic for check-up of their breasts and also of their existing breast condition, which they had ignored until then.

One of them was Joshua, who had a breast problem and hid it because he was very embarrassed about it. By the time he came to see me, he had already developed a serious complication. He expressed his embarrassment in his reply to the very first question I asked him. As usual, it was. “What’s your problem?”

“I have a ‘girlie’ problem,” Joshua replied.

“Since when?” I asked, guessing what he implied by this new term.

“Since I was in boarding school. I think I was 14 when I first noticed it.

“I soon realised that I became the butt of jokes by my fellow students, some of whom made cutting remarks, especially when we went swimming and our chest was bare. I developed a complex and concealed my enlarged breasts,” Joshua replied ruefully.

“How old are you now?” I asked, forgetting that his date of birth was entered on his file.

“Thirty-five.”

“And all this time you have not sought any medical advice? Have you seen your doctor for this problem?” I enquired.

“I haven’t, because I didn’t want her to know.” Joshua indicated that his doctor was a female, which made it more difficult for him.

REDUCTION MASECTOMY

Not getting very far with his medical history, I said to Joshua, “Please go behind the screen and uncover the part of your body you want me to see.”

As I went behind the screen and saw that Joshua had taken his shirt off and staring at me were his grossly enlarged breasts. To distract him, as I was examining his breasts, I asked him. “Are you married?”

“No,” replied Joshua and after a slight hesitation continued: “I fell in love with Nelly while we were at university. She was ready to start a relationship but I was too shy to reciprocate. Eventually she got tired of waiting and went off with another bloke and married him after graduation.”

Since I had made what we call in our jargon an “Inspection Diagnosis”, I told him: “You have gynaecomastia on both sides.”

“What did you say it was?” Joshua asked.

“Gynaecomastia literally means female breast,” I explained.

“It is a hormone based condition, occurring in some boys at puberty because of the hormonal imbalance occurring then. It usually manifests in enlargement of the breasts which sometimes are painful.”

“I have had no pain until recently which, along with your radio presentation, compelled me to seek a consultation with you,” Joshua confessed.

I was now palpating his breasts, which in gynaecomastia are enlarged by hypertrophy of fibrous tissues but, in Joshua’s case, his right breast was nodular and tender. As I was wondering how to break my suspicions to Joshua with a soft landing, he asked: “Is there anything you can do to help me?”

“Yes,” I replied. “Usually we do what we call “reduction mastectomy” whereby we remove the overgrown breast tissue and save the nipple and areola. That way we give the chest a natural look after surgery and nobody is any the wiser.”

“Are you going to do this type of cosmetic surgery on me?” he asked.

“Yes, except on your right side we must do a needle biopsy to see if it has developed a complication, in which case, we might change our strategy,” I replied.

“What type of complication?” Joshua was not going to let me off the hook.

“Like malignancy,” I replied candidly. I was dealing with an intelligent man who must have done enough reading on the subject and it was no use beating about the bush. “As I said in my radio broadcast, cancer of the breast can occur in a male breast. What I did not say is that gynaecomastia is a predisposing factor, because we were not talking on that subject.”

“If needle biopsy proves that malignancy has set in my right breast, how will you proceed?” Joshua asked.

“I will be forced to do a standard mastectomy on the right side and not save the areola and nipple, because cancer cells could have travelled there already,” I explained. “In which case I might do the same on the left.” As I saw Joshua thinking on the new situation which had arisen, I added: “It will make your chest look symmetrical too.”

CHEMO DATE

“Will I need chemotherapy or radiotherapy?” Joshua asked.

“Both, I am afraid,” I replied.

The needle biopsy was positive for cancer and we put our Plan B in motion and it was while Joshua was having his chemotherapy that the miracle happened. I usually visit my patients on chemotherapy in the Outpatient Unit where they arrive to have their monthly dose injected by my chemotherapist colleague.

I do so to convince them that I have not abandoned them, they still remain principally my responsibility but, above all, to comfort and encourage them because the side-effects of chemotherapy can sometimes be devastating, forcing them to give up midstream. Once when I went to visit Joshua, I found him talking to a lady, both of them waiting for the specialist, who had been delayed. “This is Nelly,” Joshua introduced the lady to me as he saw me entering the unit. Reading the knowing expression on my face, he added: “You must remember her because I mentioned her to you when I first came to see you.”

“I remember her very well because, as you know, all my faculties are functioning full blast in spite of my advanced age!” I was so thrilled to see Nelly, who I knew Joshua was in love with many years ago, that I replied with some levity. I had to curb my lively curiosity until Joshua came to see me next. “I couldn’t ask any more questions that day when presumably you rediscovered your Nelly again,” I bombarded him.

“I am dying to tell you of my romantic encounter after so many years,” Joshua replied, sounding more excited.

“She is the same Nelly who got fed up waiting for me and married another guy.” His smile vanished as he went on. “She tells me that she developed cancer of the body of the uterus, which I understand from her is different from the usual cancer of the cervix, for which she had to undergo hysterectomy. Her oncologist has put her on chemotherapy, after her gynaecologist took her uterus out. Her visit to the Chemotherapy Unit coincided with mine and we have been seeing each other for some time but failed to recognise ourselves. We both have lost our hair, our weight and our zest for life under the onslaught of drugs, until last time, when I took the initiative, when she was called by her name by the Sister in Charge.”

There was a question hanging longingly on the tip of my tongue but before I collected enough courage to ask, Joshua provided the missing link. “Her marriage did not work out from the word go and the cancer uterus proved the last straw on the camel’s back. She is now a divorced lady and, with no children to worry about, it was an amicable divorce.”

“Are we going to hear wedding bells soon?” I asked.

“Not sure,” replied Joshua, with his happy smile disappearing again. “We both have been diagnosed with cancer and don’t know what the future holds for us.”

“For what it is worth,” I reassured him. “I can say with certainty that your prognosis is excellent because, though your gynaecomastia was long standing, we caught the cancer very early. And if it was cancer of the body of the uterus, as you said, Nelly’s outlook is brilliant too.”

As Joshua was mulling over my unsolicited advice, I turned philosophical and added: “Not a lot of people are granted a second opportunity in life. You are one of the lucky one, so why don’t you grab it? As for the future, we don’t have the crystal ball to see through. When we are given life, the question is not if we want it. The question is how we are going to deal with it.”

There is a happy ending to the sad saga. Joshua brought Nelly to see me to whom I explained that Joshua’s lack of response to her overtures at the university was his shyness from gynaecomastia. They are married and have remained well as proved at their regular follow-up.