I first noticed a lump in my left breast in 2001 while taking a shower and shrugged it off. After all, men don’t get breast cancer. To assuage my wife’s concern that I at least have the lump examined, I consented to see our family physician, who agreed that men don’t get breast cancer because, he explained, “they rarely produce enough estrogen to feed the cancer.” He told me the lump I was feeling was a harmless cyst, not even worth biopsying. Nothing to worry about, I thought, I am cancer-free.
I don’t know what the next scan or blood test will show…, but after 16 years of living with cancer, I’m finally at peace.— Roger G. Lawrence
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But a few months later, I could feel the lump had hardened and doubled in size, and I was no longer so sure that men don’t get breast cancer. I saw a new primary care physician for a routine exam, and when I pointed out the cyst and asked his opinion, he was less reassuring than the first doctor. Although he agreed breast cancer in men is extremely rare, less that 1% of all breast cancers occur in men, he told me, he was reluctant to rule out cancer without further testing. A mammogram showed a suspicious tumor in my left breast. A biopsy of the tumor proved conclusively that I had stage II breast cancer.
Although I don’t remember if I was given an exact diagnosis of my type of cancer, most breast cancers in men are ductal carcinomas, and I learned much later that the tumor was both estrogen receptor– and progesterone receptor–positive. I had surgery to remove my left breast and several lymph nodes, followed by months of chemotherapy. Although my oncologist also recommended adjuvant radiation therapy and tamoxifen to tamp down the levels of estrogen fueling my cancer, I decided against both treatments. I now wonder whether they would have made a difference in preventing the spread of breast cancer to my lungs 8 years later.
Facing Medical Castration
Ironically, as it turned out, tamoxifen has been instrumental in keeping my metastatic disease stable for more than 7 years. Although I initially rejected the therapy when I was first diagnosed with breast cancer out of fear the antihormone would cause serious side effects, including mood swings, hot flashes, and sexual dysfunction, when my new oncologist, a specialist in male breast cancer, recommended the therapy, I agreed to try it. And although I was able to manage the side effects, unfortunately, the drug stopped working a few months ago, and the tumors in my lungs have once again begun to grow—about 2 to 3 mm every 3 months—not enough to be alarming but enough to recognize complacency is not an option and new action is required.
My oncologist suggested a combination therapy of the antiandrogen drug leuprolide and the aromatase inhibitor letrozole, which essentially causes medical castration. Although I’m not too happy about that, I’ve found the treatment hasn’t really changed me, and if it does its job of cutting off the hormones feeding my cancer, it will be worth any inconvenience the drugs may cause.
Reviewing How I Want to Live My Life
Having metastatic cancer means I can never relax. Visiting my oncologist every 3 to 6 months for blood tests and image scans to measure the progress of my cancer is a constant reminder that I’m likely to die of this disease; what I don’t know is when. That uncertainty has forced me to live my life in 3- to 6-month increments and review how I want to live those months if they turn out to be my last. The exercise has proven to be rewarding—and freeing.
A few years ago, I made the decision to quit my law practice and pursue my other love, writing. It doesn’t matter to me if I never publish a poem or essay. Just the exercise of putting my thoughts on paper is enough satisfaction for me. Living in a compressed time frame has also given me greater appreciation for the other areas of my life I hold dear, including my wife and family and the beautiful surroundings of the Texas Coastal Plains.
I have also learned to resist the relentless fear, denial, and wishful thinking that come with a diagnosis of metastatic cancer. I don’t know what the next scan or blood test will show or whether this is my last few months on earth, but after 16 years of living with cancer, I’m finally at peace. ■
Mr. Lawrence lives in Corpus Christi, Texas.