Everyone knows that a certain pink ribbon is a symbol of breast cancer awareness. From NFL players displaying them on their uniforms to businesses displaying them on their checkout counters, they seem to be everywhere once October rolls around.
While we seem to be doing a great job of raising awareness, we still have a long way to go. In 2022, it is estimated that approximately 287,500 new cases of invasive breast cancer will be diagnosed by December 31. An additional 51,400 cases of non-invasive cancer will also be diagnosed. Sadly, 43,550 women in the United States will die this year from this disease.
Male breast cancer: neglected and stigmatized
We often forget that men can also get breast cancer. In men, it can often mimic gynecomastia, and observation is recommended. Men with breast lumps are often referred to “women’s” health centers for mammograms and treatment. They are often stigmatized and therefore deterred from seeking treatment.
As doctors, we should be the first to consider the possibility of breast cancer in men with breast lumps and make their care as comfortable as possible (not like they’re a man with the disease of a woman as many think). The very use of pink for breast cancer awareness ribbons ignores the fact that men can also suffer from this disease. Additionally, breast cancer is often more aggressive in men and diagnosed at later stages of the disease.
Limited access to genetic testing
Another ugly breast cancer fact is that metastatic breast cancer (MBC) is not curable. Available treatments can prolong life, depending on a multitude of factors, including genetics, hormonal status and cell type. The fact remains that there is no cure available for MBC yet.
While new discoveries are being made regarding genetic mutations and their role in the development of breast cancer, the healthcare system has still not caught up with these new breakthroughs. On the one hand, not all laboratories have the capacity to do genetic testing. Additionally, many insurance companies do not cover these tests, putting them out of the price range for many patients. As doctors, we can often predict which patients are at a higher risk of developing breast cancer. Genetic testing would be a valuable tool to further assess these risks.
Breast cancer disparities
Disparities in the diagnosis and treatment of breast cancer are another stark reality. Despite advances in these areas, breast cancer rates continue to rise in black and Latino patients, who are often diagnosed at advanced stages of the disease. Compared to white women, black women have a 40% higher death rate from breast cancer.
Awareness remains a crucial step to help prevent and diagnose breast cancer at earlier stages. However, we need to do more. We need to explore why health care disparities exist and address those causes. Many theories have been proposed, but we need solutions, not more guesswork. As physicians, we must advocate for minorities, and men in this case, to receive equal care and help them feel comfortable in health care settings. Some factors may be beyond our control, but if we sit back and be quiet, nothing will change.
Our health care delivery system needs to catch up with science. Our knowledge is growing at a rate never seen before. If we don’t make it readily available, it’s as useless as if we never discovered it.
There probably isn’t a doctor who wants to preclear or appeal. However, if this is the only way to obtain services for our patients, we should do everything in our power to provide them with what they need. As a doctor in private practice, I know the waste of time and money these tasks represent, but our patients deserve the best, even if we work in a system that often fights against us. If we give up, who is left to fight for our patients?
In October and each month, we should ensure that all our patients receive the recommended preventive tests. And when someone, male or female, presents with a breast lump, we need to do a quick risk assessment and order appropriate testing. The simple act of asking a patient if she had her mammogram can save someone’s life.