By B. D. Colen
It began with an itch I just had to scratch. Doesn’t every adventure begin that way?
I was lying in bed reading on a Saturday evening, and without even looking I idly scratched a spot on the right side of my chest –- at that point I had a chest, not breasts. As I did, my fingers rode over a small something, a little like a speed bump about an inch below and two inches to the left of my right nipple.
I stopped reading and started poking. And prodding. And pushing. And feeling. And manipulating. And panicking.
"That’s a lump!" I thought, and suddenly I had a right breast. With a lump in it.
I spent Sunday attending to the usual chores and pleasures, with a good deal of poking and prodding added in. There was absolutely no question that something was dwelling there, beneath my AAAA right breast. But what was it? And what was I worried about? After all, I’m a man, and men don’t...Well, yes, men do get breast cancer. In fact about one in every thousand men will develop breast cancer during their lifetimes. Granted, that’s barely worth mentioning compared to a woman’s one-in-nine chances, but it still means that the possibility was indeed real that something ugly and malignant was barely hiding beneath my skin.
The following day, I already had an appointment with my primary care physician about something else, and when we were finished I said, “So, Sam, I seem to have this lump in my right breast.”
Suddenly, my normally garrulous physician grew serious. “Let’s take a look,” he said, asking me to lie down on the examining table. He had me show him where I thought the lump was and I instantly isolated it – I’d already felt the damned thing enough times to be able to go right to it.
He felt it, felt around it, poked and prodded, and in less than a minute said, “You’re right, there’s something there.” Then, without further kidding – which I’d expect from him – and without any "Well, it’s probably nothing, but let’s be sure," he sat down at the computer and started typing. “I’m putting in an order for a ultrasound and a mammogram,” he said. “For tomorrow.”
Mammowhat?! Mammogram? Me? But I’m a man! And at 67? Is this some really, really weird dream I’m about to wake up from? How in God’s name were they going to do a mammogram when there’s practically no mam on my chest?
But into the rabbit hole, through the door marked "Women (almost) Only" I went. Though not before Googling “male breast cancer” and convincing myself that I was going to die: Family history? Check. Average age of 68? Check. Sometimes Google is not your friend.
The nice woman down in radiology scheduled me for 10 the next morning, and told me that I shouldn’t worry. “It’s probably nothing,” she assured me. I thought, "That’s probably what you tell all the guys."
I don’t need to tell any of you who are women what a painful, essentially degrading experience having a mammogram is. I’ve since read the jokes advising women to prepare for the procedure by placing a breast on the edge of their freezer and slamming the door on it – and that is pretty close to the reality.
I had decided ahead ahead of time that I wanted to photograph the whole thing; I teach documentary photography at MIT. And I was blissfully distracted by trying to hold the camera out with one arm, figure out how to frame my shot semi-blindly, and shoot. But even with that distraction, having a virtually non-existent breast pulled, pushed, stretched, tugged, and crushed was not fun.
In fact, it was way beyond not fun. As a female friend said afterwards when she saw my photos, “If men routinely had to have mammograms the entire procedure would have been either eliminated or totally reinvented decades ago.” I agree. It is a somewhat barbaric procedure, as I believe these photos show.
After suffering through the indignities of the mammogram, I was taken to another room for my ultrasound. (I should note here that the tech who administered the mammogram, as well as the ultrasound, was quite lovely under the circumstances, and did her best to make the procedure as bearable as it could be.)
The ultrasound was an absolute piece of cake after the mammogram; a couple of squirts of cold jelly on my by then very sore right breast, a few minutes of having the transducer moved back and forth over and around the lump as the tech and a staff radiologist watched the screen, and that was that.
"There’s nothing,” the radiologist announced at the end of the procedure. So, much relieved, I gathered up my clothes and camera gear and left.
But wait a minute! “There’s nothing?” Is that a medical term for the lump that I felt and that my primary care physician felt? That "nothing" was most definitely something. Now, it might have been a nothing something, but it was something. And I wanted to know what that something was and whether it was something I should forget about because it was nothing, or whether it was a quietly multiplying collection of deranged cells that were going to take over my body and kill me.
So I sent an email to my primary care doctor, telling him that I had been told the something he had felt was nothing, which, I told him, is not a term in my medical dictionary. "What do we do now?" I asked.
"See a surgeon," he wrote back, and he put in for a consult.
The surgeon I was sent to was a young general surgeon who spends a few hours a week seeing patients at my HMO. He asked why I was seeing him, and I told him my story. He had me lie down, poked and prodded, said he could definitely feel my nothing, which he didn’t think was much of anything, and told me I had three options:
• I could just watch and wait – "That's fine for you, fella," I thought, "but not for me."
• I could make an appointment to have him cut it out and send it to a pathologist, which I thought was premature.
• Or I could go get a second opinion from a breast surgeon.
Bingo! I’ll take door number three! (Especially when the surgeon acknowledged that not only was he not a breast specialist of any kind, but he had only seen about two cases of male breast cancer in his fairly short career.)
So the process began again. My “films” – CDs – had to be sent to Brigham and Women’s Hospital, where they had to be read by their radiologists before I could get to see a specialist. (I’ll admit I couldn’t really see the point in that, given that the first radiologist said that there was nothing detected by either the ultrasound or the mammogram, but maybe the Brigham radiologists would see something.)
During those weeks, I poked and prodded my 'nothing,' convinced it was growing and changing shape.
Of course it turned out that someone forgot to send the report over with the “films,” so everything dragged on for weeks. And during those weeks, as I nightly poked and prodded my nothing, convinced that it was growing and changing shape, I, like perhaps every woman who has had a lump, alternated between being convinced that it really was nothing, being terrified that it was malignant and was going to kill me, and thinking that I really didn’t care one way or the other.
Finally, about four weeks after first discovering my lump, I found myself in the Comprehensive Breast Health Center at Brigham and Women’s for an examination by a nurse practitioner. And boy, did I feel out of place. The young women at the front desk did their best to make me feel less uncomfortable, but it’s hard to feel you belong when you’re filling out a form filled with questions clearly written for women. How many pregnancies had I had? Well....
I spent my time trying to guess the stories of the three women waiting to be seen. One was a 30-something – mammogram follow up, I figured. One was a woman in her 70s with a younger woman I assumed was her daughter – not a good sign. And then there was a woman of indeterminate middle age, with her husband, who was alternately rubbing her shoulders and looking concerned as she filled out the forms – I wanted to weep.
The nurse practitioner who examined me was just the kind of person I had hoped for: she was calm, professional, and reassuring. She had been examining breasts for 15 years, she told me, so I was comfortable offering her my right breast and its lump.
Her examination technique was completely different from that of the young surgeon I had seen, who had tapped my breasts as though he was checking the hull of a wooden boat for rot. She gently ran her fingers over my breast – immediately locating the lump, the "nothing." And other lumps. Uh oh! Then she switched to the left breast, and found a lump almost identical to the first one I had found, in a spot in the left breast that mirrored where I had found the first lump in my right breast. And she found additional lumps in the left breast.
“I think everything’s okay,” she reassured me. “It’s definitely a good sign that these are in both breasts, and in the same place. They’re soft and pliable, and they can be moved.” I think they’re just anomalies, she said. Anomalies I have probably had all my life but — until I went on a diet last year and lost 45 pounds — I had never been able to feel them.
I will continue to examine my breasts on a regular basis, as every woman and man should, I would argue.
So my lump was indeed something, but the something appears to be nothing to worry about. I am now scheduled for a follow-up exam in September, just to make sure that the something hasn’t changed. At this point I am assuming that my lumps and I will be together for a number of years to come.
But you can rest assured that I will continue to examine my breasts on a regular basis, as every woman, and man, should, I would argue, whether or not the latest recommendation is to forego breast self-examinations.
Granted, self-exams may turn up countless nothings, and their discovery may lead to unnecessary fears, biopsies, and even mastectomies. But will that overtreatment occur because of the discovery of nothings, or because of physician fear of possible lawsuits if they aren’t aggressive enough? And suppose my nothing had indeed been something, and I had not discovered it for, three, six, or 12 more months. Then what?
Frankly, I’d be willing to bet that if one man in nine developed breast cancer, the recommendation would be to do weekly breast self-examinations.
B. D. Colen is a Pulitzer Prize-winning former medical writer and columnist for The Washington Post and Newsday, who teaches science journalism and documentary photography at MIT. You will find more of his photography on his website and at SocialDocumentary.net here, here and here.