Effect of Mammogram on Male

Jack is a fictional name given to the patient in this case study to maintain anonymity.

Jack is an 80-year-old who was referred to the Triple Assessment Breast Clinic by his GP with a painful and swollen right breast.

Jack: ‘I only went to the doctor when it got painful, the swelling alone had been there awhile’.

Breast cancer in men is extremely rare (Cancer Research UK 2016), accounting for 0.6% of all cases of breast cancers and <1% of all cancer cases in men (Munoz Carrasco et al 2010), and progress is equal to that of stage-matched females (Giordano et al 2004). However due to the late presentation of men they have poor prognosis (Jeffries & Grogan 2012). Jack had mentioned during the examination that he had been reluctant to see his GP until it got painful and started to bother him. This type of stoical behaviour was demonstrated in a study by Rabbee & Grogan (2016), whereby men delayed disclosing symptoms 'for fear of being engaging in feminine-typed support seeking’ (Rabbee & Grogan 2016). Many participants in this study said they would ‘self-monitor’ symptoms and didn’t want to be ‘wasting doctors’ time with something ‘trivial’. Jeffries & Grogan (2016) showed that men postponed initial self-referral as they saw themselves as being ‘self-reliant’ and ‘capable of solving their own problems’. Mason & Strauss (2004) also agreed with type of behaviour and stated that men deemed illness to be a failure and they were weak and vulnerable when visiting a doctor.

Jack: ‘Why was I being referred to a ‘breast clinic’, by my GP, sure I don’t even have breasts’.

Jack like many other men, particularly of his age, believe that 'men don't have breasts'. Instead, many men prefer to use gender-specific language to describe parts of their body. Commonly breasts are not seen as part of men's physical essence, therefore many men use 'chests' rather than 'breasts', defining breasts as a female body part and chests as a male body part. Skop et al (2016) stated that 'chest' is seen as more masculine sounding. Men will often define and describe themselves in opposition to women to be seen ‘masculine men' (O Neill 1981). Noone & Stephens (2008) also found that men find it difficult to go to the doctor with breast symptoms, so increasing the awareness surrounding male breast cancer would improve this. Gill et al (2005) found that men with relevant breast symptoms need to be targeted with tailored information and encouraged to access the health services required. A diagnosis of male breast cancer may have different socio-cultural connotations and practical implications for men; therefore, a designated male appropriate pathway is necessary.

Jack: ‘I have never felt so in the wrong place as in that breast clinic waiting room, and the mammogram was so painful’.

A study by Skop et al (2016), established that men found the waiting room experience awkward and uncomfortable in a primarily female patient waiting room. Many felt that eyes were looking at them wondering 'why they were there'. It was also found that the presence of men might make the female patient sitting in gowns uncomfortable.

Many men who had mammography examination recognised that although it may be rare it was important for diagnosis. Some considered that although it may not be the ‘manly thing to do’ it was necessary for cancer prevention. Many words like ‘clamp’, ‘push and prod’, uncomfortable’ and ‘painful’ were used to describe a mammogram (Hines et al 2007).

Mammography given its high sensitivity (Patterson et al, 2006) is the initial imaging modality recommended to further evaluate indeterminate physical examination findings (Chau et al 2016), and ultrasound is the most specific (Munoz-Carrasco et al 2010). Although there is no established protocol or standard of care for the use of ultrasound or mammography in the evaluation of breast symptoms in males (Charlot et al 2013). Munoz-Carrasco et al (2010) stated, many unnecessary biopsies and surgical procedures may be prevented by using mammography and ultrasonography in the diagnosis of male breast disease.

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Jack found having the mammogram very painful, In a study by Skop et al (2016) participants said that if the mammogram had been fully explained to them, for example, ‘here’s what’s going to happen’, you’re going to feel uncomfortable, and all that kind of stuff, that they could anticipate the discomfort. However, in this case, the radiographer had fully explained the examination and what it would involve to Jack. The radiographer asked the relevant questions from the routine departmental questionnaire substituting the 'chest' for 'breast' where necessary, to reduce anxiety or embarrassment, thus ensuring Jack understood and related to the questions asked. The radiographer prefers not to use the word 'painful' to describe the compression applied during a mammogram, as people can negatively interpret thus creating more anxiety for the patient. However, very small gestures would have made a huge difference to Jack. Engelman et al (2006) suggested creating a spa-like atmosphere in mammography facilities would help decrease women’s anxiety. However, with regards to men’s experience in a mammography facility, Skop et al (2016) purpose scheduling men at less busy times minimising their exposure to female dressing room areas. Al-Haddad et al (2010)  suggested that brochures and posters containing educational information tailored toward male mammography and male breast diseases should be made available to aid increasing awareness that people of all sexes and genders get mammograms, this may help normalise the experience and increase men’s comfort and sense of inclusion.

A study by Hamilton & Barlow (2003) demonstrated that women’s anxiety levels were decreased, and the quality of the mammography service provided depended on the professionalism and interpersonal skills of the mammographer, the same would apply to men attending for a mammogram.

Although Jack felt the mammogram was painful as opposed to the described 'discomfort', what some may describe as painful others may only feel mild discomfort. May be the radiographer in future could pay more attention to the patients’ facial expressions as to how the compression feels, although adequate compression is necessary for a diagnostic mammogram. 

References

• Al-Haddad, M. (2010). Breast Cancer in Men: The Importance of Teaching and Raising Awareness. Clinical Journal of Oncology Nursing, 14(1), pp.31-32.
• Charlot, M., Béatrix, O., Chateau, F., Dubuisson, J., Golfier, F., Valette, P. and Réty, F. (2013). Pathologies of the male breast. Diagnostic and Interventional Imaging, 94(1), pp.26-37.
• Chau, A., Jafarian, N. and Rosa, M. (2016). Male Breast: Clinical and Imaging Evaluations of Benign and Malignant Entities with Histologic Correlation. The American Journal of Medicine, 129(8), pp.776-791.
• Engelman, K., Cizik, A. and Ellerbeck, E. (2006). Women's Satisfaction with Their Mammography Experience: Results of a Qualitative Study. Women & Health, 42(4), pp.17-35.
• Gill, R., Henwood, K. and McLean, C. (2005). Body Projects and the Regulation of Normative Masculinity. Body & Society, 11(1), pp.37-62.
• Giordano, S., Cohen, D., Buzdar, A., Perkins, G. and Hortobagyi, G. (2004). Breast carcinoma in men. Cancer, 101(1), pp.51-57.
• Hamilton, E. and Barlow, J. (2003). WOMEN'S VIEWS OF A BREAST SCREENING SERVICE. Health Care for Women International, 24(1), pp.40-48.
• Hines, S., Yasrebi, M., Tan, W., Perez, E. and DePeri, E. (2007). The Role of Mammography in Male Patients with Breast Symptoms. Mayo Clinic Proceedings, 82(3), pp.297-300.
• Jeffries, M. and Grogan, S. (2012). ‘Oh, I’m just, you know, a little bit weak because I’m going to the doctor's’: Young men's talk of self-referral to primary healthcare services. Psychology & Health, 27(8), pp.898-915.
• O'NEIL, J. (1981). Patterns of Gender Role Conflict and Strain: Sexism and Fear of Femininity in Men's Lives. The Personnel and Guidance Journal, 60(4), pp.203-210.
• Patterson, S., Helvie, M., Aziz, K. and Nees, A. (2006). Outcome of Men Presenting with Clinical Breast Problems: The Role of Mammography and Ultrasound. The Breast Journal, 12(5), pp.418-423.
• Mason, O. and Strauss, K. (2004). Testicular Cancer: Passage through the Help-Seeking Process for a Cohort of U.K. Men (Part 1). International Journal of Men's Health, 3(2), pp.93-110.
• Muñoz Carrasco, R., Álvarez Benito, M., Muñoz Gomariz, E., Raya Povedano, J. and Martínez Paredes, M. (2010). Mammography and ultrasound in the evaluation of male breast disease. European Radiology, 20(12), pp.2797-2805.
• Rabbee, Z. and Grogan, S. (2016). Young's Men's Understanding of Male Breast Cancer: 'Pink Ribbons' and 'War Wounds'. International Journal of Men's Health, 15(3), pp.210-217.
• Skop, M., Lorentz, J., Jassi, M., Vesprini, D. and Einstein, G. (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), pp.961-972.
• UK Breast Cancer Research Symposium 2016: Submitted Abstracts. (2016). Breast Cancer Research and Treatment, 159(1), pp.177-197.

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