Male mastectomy

Not many men get breast cancer, but too few are aware of the risk.

Published October 12, 1999 12:00PM (EDT)

Dale Hackbart played three NFL games with a broken neck, but his missing nipple gets all the attention these days. That's because he lost it to a mastectomy.

The 60-year-old Hackbart was diagnosed with breast cancer during last year's holiday season, then endured the same procedure that changed the chests of Ann Jillian and Nancy Reagan. Despite 14 years as defensive end, Hackbart suddenly had more in common with a former first lady than with a fullback. He felt like a piece of meat.

"My immediate reaction was like somebody had stuck a branding iron on the back of my butt," said the former Bronco just before the start of October, national Breast Cancer Awareness Month. "I was getting hot, like I was on fire. I wondered how long I had to live. I had heard the words 'male breast cancer' and gone into shock."

And why not? He watched his diet, exercised regularly and submitted religiously to an annual prostate exam because his father died of prostate cancer. The lump in his chest seemed but an annoyance, hardly worthy of a special visit to the doctor. So it remained, for months.

Then, during a routine physical his doctor suggested removing it. Hackbart obliged, only to discover a shocking diagnosis and the prospect of more surgery. The mastectomy occurred in February, removing an entire breast and adjoining lymph glands.

Once he got over the initial shock of contracting what is largely considered a woman's disease, Hackbart realized his good fortune. Each year in this country, 400 men die of breast cancer, while 1,300 are newly diagnosed.

Meanwhile, most Americans don't even know men have the same ducts beneath their nipples as women do. There are other tissues in the female breast, and about 100 times more mass -- which is the main reason women are 100 times more likely to contract the disease -- but the male endowment is more than enough for cancer to take hold.

Most men and women, however, fail to see the danger. Another victim, David Norlach, a 62-year-old consultant from Yarmouthport, Mass., said he never thought his inverted nipple and pea-sized lump signified cancer. Even after his doctor suggested a mammogram, he continued to think only women got breast cancer.

"I wasn't really thinking cancer, because men didn't get that," he said.

Ironically, the lack of awareness results not from a lack of interest in the disease, but rather from the media and medicine's emphasis on its most common sufferers -- women. In public service announcements and on pamphlets, in the words of everyone from Jillian to Reagan to Peggy Fleming, women are all we see and hear.

Public health advocates consider this a triumph, and rightly so. This year alone, 180,000 women will be diagnosed with breast cancer according to American Cancer Society statistics, and 53,300 are expected to die from it. Conventional wisdom holds that the "get-tested" chorus has saved lives.

But a whispering backlash appears to be gaining a serious listen. A new book by cancer survivor Elaine Ratner "The Feisty Woman's Breast Cancer Book," argues that breast cancer publicity is scaring women away from testing, a point that rang true for fellow survivor Jane E. Brody, who asked in the New York Times if victims had induced "a paralyzing fear" into the public domain.

Hackbart and Norlach would seem to beg for more not less publicity, but in stressing that men are being hurt by being forgotten, they too question the assumption that breast cancer is simply "a woman's worst nightmare."

Men can feel comforted by the lack of evidence that male breast cancer is on the rise, and by the low incidence numbers. But every mother or father with breast cancer increases their children's chances of developing it. Daughters, because of the greater tissue mass and because of estrogen, which is also a contributing factor, run a higher risk, but sons do not escape the genetics.

Also, men and the male breast bear special burdens. Because there is less breast tissue to attack, tumors that form there jump more quickly, first to the nipple then to other areas of the body.

That makes early detection is even more important. The male psyche, however, makes it more problematic. Apparently we simply aren't used to scrutinizing our own busts.

"Some men ignore breast lumps or attribute them to an infection or some other cause, and they do not get medical treatment until the mass has grown significantly," wrote researchers at the American Cancer Society. "Also, some men who think breast lumps occur only in women are embarrassed about finding one, and worry that someone might question their masculinity."

Few have spoken so boldly to Hackbart. The same has proven true for Norlach, despite his less-intimidating 170-pound frame.

But now that both men have only one breast, stares are common. Neither seems to mind. Their cancers have not spread, prognoses remain positive though neither has reached the five-year mark that connotes a cure.

"I'm doing as well as could be expected," Norlach stressed, noting that when asked, he speaks openly about the surgery and the physical changes, including three months of rehabilitation for his arm. And when Hackbart feels eyes boring into his chest at the gym in Boulder, Colo., he addresses the subject quickly, removing the cultural corset of masculinity to let his story hang out.

Ultimately, both men have accepted that their breasts -- or lack thereof -- have become their most personal and boldest billboards. Whenever the looks or questions come, the word goes out: Breast cancer is not just a woman's disease.

"I guess my alternative is to get a tattoo and maybe plastic surgery," Hackbart said in an interview with the Denver Post. "I guess I'd probably have them put 'I survived.'"

By Damien Cave

Damien Cave is an associate editor at Rolling Stone and a contributing writer at Salon.

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