July 27, 2011, was a really bad day for Charles Pelkey, an attorney who serves as the Democratic whip in the Wyoming State House of Representatives. A few days before that tough July day, the former journalist and competitive cyclist had casually looped the strap of his courier bag across his chest in preparation for the bike ride home from his job as the editor of a major cycling magazine just like he'd done dozens of times before. But this time, the strap caught on a lump on his chest.

Perplexed, Pelkey was reminded of his favorite Uncle Phillip who had died of breast cancer, so he pedaled home and showed the lump to his wife. She didn't like the looks of it either, and they agreed he would go see the doctor. The doctor ordered a mammogram (which Pelkey jokingly calls a man-o-gram) and a biopsy, and the results came in on July 27: Pelkey had breast cancer. That same day, purely coincidentally, he was laid off from the job he loved and had held for 17 years.

With a bit more testing, it was determined that Pelkey was BRCA2-positive, meaning he had a hereditary genetic mutation that predisposed him to developing breast or prostate cancer. "The red flags went up immediately when I told [the doctors] my family history of my uncle dying of breast cancer and that my father had died from another form of cancer." With all those factors lined up against Pelkey, doctors were not surprised when the biopsy showed he had Stage 2B breast cancer. He was scheduled for a lumpectomy, but says "the margins of the tumor were not clean," so he opted instead for a double mastectomy and underwent five months of chemotherapy. "The cool thing is I looked pretty good bald," he laughs; maintaining his sense of humor "was the only way to make it through," he says.

Rare But Devastating

In the 16 years that she's been treating breast cancer patients, Dr. Maggie DiNome, associate professor of surgery at the UCLA Santa Monica Breast Center at the David Geffen School of Medicine at UCLA, says she's only seen four men with the disease. "That tells you just how rare it is," she says.

Dr. Mahmoud B. El-Tamer, a breast surgeon at Memorial Sloan Kettering Cancer Center in New York who treats men with breast cancer, says men make up less than 1 percent of the breast cancer cases in the U.S. each year. "It's estimated there were about 2,600 cases of male breast cancer in 2016, and if you look at the rate across the whole population, approximately 1.3 per 100,000 men would get breast cancer. Clearly, this figure is for all men, but if you look at older men, the rate increases." He notes that among men younger than 40, the rate falls to 0.2 cases per 100,000 men, "and once you get to 85 years or above, the rate increases to 8.7 cases per 100,000 men."

Although breast cancer in men is quite rare, it can be a devastating diagnosis because it's often caught later than in women – men get breast cancer so infrequently that widespread screening doesn't apply. Whereas women typically begin routine screening for the disease once they hit 40, 45, or 50 years of age, men are virtually never screened for the disease. The disease is usually found when a palpable lump begins to show, meaning that it has grown large enough to become noticeable – often signaling later-stage cancer than when a doctor might find a similar cancer on a woman's routine mammogram film. "The first symptom is always a lump," DiNome says.

"The only men who might get screened," says El-Tamer, "are those who are known carriers of the BRCA2 gene mutation. Breast cancer in men is quite frequently associated with a mutation." He says that somewhere between 10 and 20 percent of men carry a BRCA1 or BRCA2 gene mutation. "Most commonly it's the BRCA2 mutation that predisposes men to getting breast cancer. So that's the important thing – men need to know how many women in their family had breast cancer, and if there's a BRCA2 mutation in the family that puts them at a higher risk than the general population."

Treatment Options

For men who've been diagnosed with breast cancer, the course of treatment is much the same as for women and highly dependent on the individual needs of the patient and his particular subtype and stage of cancer.

Because of his strong family history of breast cancer and his status as a BRCA2 carrier, Pelkey underwent a double mastectomy and chemotherapy. "Reconstruction for me involved tattooing nipples on my chest," he says. "I was 53 at the time, and I'm not walking around with my shirt off anyway," he laughs, adding that staying clothed is "a public service."

But not all men are so comfortable with the change in their physical appearance after breast cancer treatment; just as some women experience body image issues after surgery, men can, too. El-Tamer says he's "finding that more and more men have issues with losing their breasts. We used to think, 'what's the big deal?', but I'm finding that more frequently there is another way of doing this."

DiNome says these other ways include breast-conserving surgeries like lumpectomies rather than total mastectomies. Much of how male breast cancer is treated is based on extrapolated data from years of treating breast cancer in women. And although the male hormone profile is different, many men will receive hormone therapies as part of their treatment just like women do. "Men don't have as much breast tissue as women, so the original tendency was to do a mastectomy, but we're finding that less surgery may be equal in terms of survival rates so now we consider doing breast conservation as well," DiNome says, which means a "lumpectomy, radiation and tamoxifen or a hormone-blocking therapy if it's also hormone-positive" – that is, a cancer that uses estrogen and/or progesterone to grow.

See Something, Say Something

Dr. Marleen Meyers, assistant professor of medical oncology at NYU Langone Medical Center in New York, told U.S. News in 2014 that although treating breast cancer in men is the same as in women, diagnosis is often delayed in men because of an insidious misconception that men don't get breast cancer. "It's hard in the midst of all this pink to have a man stand up." But Meyers hopes that will change with greater awareness. "As more people talk about it, it will begin to lose some of its stigma."

To that end, Pelkey says men need to know their own bodies and speak up if something changes. Most men are encouraged to pay attention to changes in their testes, given that testicular cancer is a common disease in men. Similarly, know your breasts, too, especially if breast cancer runs in your family.

"The odds are really good that you won't get breast cancer," Pelkey says. "Only 1 percent of breast cancer cases happen in men. But when it does happen, men tend to put off diagnosis and treatment longer than women, at which point it may be a more serious disease." Such was the case for Pelkey's uncle who died of breast cancer, which wasn't diagnosed until it had reached Stage 4, the final and deadliest stage.

But Pelkey knew to take that lump he found in his chest seriously, and he's glad he got it checked out immediately. "I was diagnosed at Stage 2B, which is much easier to treat than a Stage 3 or 4 cancer that's spreading. If your cancer is a later stage like that, the likelihood of survival is pretty low. Therefore, if you find a lump on your chest, check it out. It won't kill you to go to the doctor, but it might kill you not to."

He also reminds men who do find a lump to stay calm. "Medical science is to the point where things can be treated, as long as you follow through. It's not the end of the world if you get a cancer diagnosis. You can live through it and do pretty well."