Everyone knows that a certain pink ribbon is a symbol for breast cancer awareness. From NFL players who display them on their uniforms to businesses who exhibit them on their check-out counters, they seem to be everywhere once October rolls around.
While we seem to have an excellent job 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 be diagnosed as well. Unfortunately, 43,550 women in the US will die this year from this disease.
Male Breast Cancer: Overlooked & Stigmatized
Often overlooked is the fact that men can get breast cancer as well. In men, it can often mimic gynecomastia, and observation is recommended. Men with breast lumps are often sent to “women’s” health centers for mammograms and treatment. They are often stigmatized and, therefore, put off seeking care.
As doctors, we should be the first to consider the possibility of breast cancer in men who present with breast lumps and help make their care as comfortable as possible (not like they are a man with a woman’s disease as many feel). The very use of pink for breast cancer awareness ribbons ignores the fact that men can suffer this disease as well. Additionally, breast cancer is often more aggressive in men and diagnosed at later stages of disease.
Limited Access to Genetic Testing
Another ugly fact of breast cancer is that metastatic breast cancer (MBC) is not curable. Available treatments can prolong life, depending on a multitude of factors that include genetics, hormonal status, and cell type. The fact remains that there is no cure yet available for MBC.
While new discoveries are made regarding genetic mutations and their role in developing breast cancer, the healthcare system still has not caught up to these new breakthroughs. For one thing, not all labs have the capabilities to do genetic testing. Additionally, many insurance companies are not covering 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 for developing breast cancer. Genetic testing would be a valuable tool to be able to further evaluate these risks.
Breast Cancer Disparities
Disparities in breast cancer diagnosis and treatment are another harsh reality. Despite advancements in these areas, breast cancer rates continue to grow in the Black and Latino patients, who are often diagnosed at later stages of the disease. When compared with white women, Black women have a 40% higher rate of dying from breast cancer.
Raising awareness remains a crucial step in helping prevent and diagnose breast cancer at earlier stages. However, we need to be doing more. We need to be exploring reasons for why healthcare disparities exist and addressing those causes. Many theories have been proposed, but we need solutions, not more guesses. As physicians, we need to advocate for minorities, and men in this case, to receive equal care and help them feel comfortable in the healthcare setting. Some factors may be outside our control, but if we sit and remain silent, nothing will change.
Our healthcare delivery system needs to catch up to the science. Our knowledge is expanding at a never-before-seen rate. If we don’t make it readily available, it is as useless as if we never discovered it.
There probably isn’t a doctor who wants to do prior authorization or file appeals. However, if this is the only way to get services for our patients, we should do all in our power to get them what they need. As a doctor in private practice, I know the time and money drain these tasks represent, but our patients deserve the best, even if we are working in a system that is often fighting against us. If we give up, who is left to fight for our patients?
In October and every month, we should be making sure all our patients are getting recommended preventative testing. And when anyone—man, or woman—comes in with a breast lump, we need to make a quick risk assessment and order appropriate testing. Simply asking a patient if they’ve had their mammogram can save someone’s life.