Bret Miller, 34, will celebrate two very important anniversaries in 2020: A decade in his job as manager of a recreation facility, and 10 years of being breast cancer–free. Without the health insurance that came with the former, Miller doubts the latter would be possible.
In the summer of 2003, 17-year-old Miller was looking forward to his senior year of high school and his final year on the football team. One day, he casually scratched his chest and felt a lump behind his right nipple. He thought it was odd but not alarming. His family lacked medical insurance at the time, so Miller casually mentioned it to the doctor who performed his football physical. “He said, ‘Let’s keep an eye on this. It looks like calcium buildup because you’re in puberty. It’ll go away.’” Nearly a year later, when Miller got his meningitis vaccine before going off to college, he mentioned the lump to that doctor, who also told him it was nothing to worry about.
Missing the Symptoms of Male Breast Cancer
Although the lump never went away, the doctors’ assurances allayed his concerns. “I don’t think any doctor thinks a 17-year-old male is at risk for breast cancer,” explains Miller. “Besides, it wasn’t noticeable and you had to feel directly behind the nipple to detect it.” He went the next seven years without a physical or giving much thought to the lump. After all, he was a young, healthy man with no symptoms or maladies.
That changed in 2010 when he noticed a yellow-orange discharge coming from his nipple. “If I had bothered to look, these symptoms for breast cancer would have been there.” According to the Mayo Clinic, symptoms of male breast cancer can include a lump or thickening in your breast tissue; changes to the skin covering your breast, such as dimpling; nipple changes, such as a nipple that begins to turn inward; and nipple discharge.
Shocking Diagnosis: Learning You Have Male Breast Cancer
Following a job promotion, Miller had insurance for the first time in recent memory and eventually went in for a checkup. As is common with male exams, the doctor paid no attention to his breasts. “He was almost out the door when I asked him to take a look at the lump,” Miller recalls. “He said there probably wasn’t anything to be concerned about, but he suggested I have a sonogram.”
The following day, he found himself in the exam room at a women’s clinic wearing a pink gown and watching the concerned look on the doctor’s face as she stared at the sonogram monitor. She immediately ordered a mammogram and scheduled a lumpectomy with a general surgeon the following week. Still, rather than being alarmed, having the lump removed gave Miller a sense of relief. That feeling was shattered by a call from the surgeon a few days later.
“The preliminary report says it’s breast cancer,” Bret recalls the doctor blurting out with no preamble. “I haven’t read the pathology report in full, but I’ll call you back in several days and we’ll figure it out.” Miller now belonged to the very exclusive club of men who account for about 1 percent of breast cancer diagnoses in the United States, according to Susan G. Komen.
'An Embarrassing Betrayal': Coping With Male Breast Cancer
After his diagnosis, finding a new physician was first on his list. In addition to his poor bedside manner, the surgeon had no experience with male breast cancer, something Miller considered a must-have. He ultimately chose a doctor who had treated 12 men with breast cancer.
Because the lump had been present for at least seven years, doctors tried to prepare Miller for the worst, but he was very lucky. He was diagnosed with stage 1 ductal carcinoma in situ (DCIS), which is a slow-growing, noninvasive cancer that hasn’t spread beyond the milk ducts. Either the tumor had grown extremely slowly over the past seven years, or it had only recently become cancerous.
Although extremely relieved about the staging and prognosis, Miller considered the diagnosis itself an embarrassing betrayal. “You think boobs, you think women. I couldn’t understand it, didn’t know how to process everything and how I was going to tell everybody.”
Forgoing Breast Reconstruction: ‘This Is My Scar’
On May 18, 2010, doctors removed Miller’s right breast and four lymph nodes under the right arm. There were no initial plans for chemotherapy until he learned about Oncotype DX, a test that helps predict the odds of recurrence and whether chemo could make a difference. When the results showed that chemo could reduce the chance of recurrence by 10 percent, Miller didn’t hesitate, even though chemo is not typically used to treat DCIS. “People asked, ‘Are you worried about losing your hair?’ I’d just lost my nipple forever, but my hair would grow back!”
After some soul-searching and a consultation, he decided to forgo reconstruction. “This is my scar and this my story,” he says. He initially took the selective estrogen receptor modulator (SERM) drug Tamoxifen to reduce the risk of recurrence, because his cancer was similar to that found in women. However, after suffering side effects such as mood swings and hot flashes, his doctors switched him to Arimidex, a type of hormone therapy drug that keeps the body from breaking down testosterone into estrogen, which he took for five years to reduce the chance that his cancer might return.
Finding Community and Removing the Stigma of Male Breast Cancer
It’s not difficult for women with breast cancer to find a community of support, but men like Miller are often isolated. That’s one reason he has made male breast cancer outreach and advocacy his mission. In 2013, he formed the Male Breast Cancer Coalition, a not-for-profit patient advocacy organization to help remove the stigma of the diagnosis that forces far too many men to ignore the warning signs and delay treatment. He also hopes the organization’s advocacy will eliminate many of the institutional biases male breast cancer patients face, such as treatment denials from Medicaid and exclusion from clinical trials. Most of all, he wants to encourage more men to become proactive about their health. “You’ve gotta be your own advocate,” says Miller. “If something feels off, go to the doctor. If you don’t feel okay with the first answer you get, get a second or third opinion.”