Richard Roundtree 'Knows the Score' on cancer By Rachel Evans-Biermann, Spotlight Health

With medical adviser Stephen A. Shoop, M.D. Richard Roundtree says his decision to go straight to the doctor probably saved his life. Help on the Web The Susan G. Komen Breast Cancer Foundation

The National Cancer Institute

UCLA/Jonsson Comprehensive Cancer Center

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Revlon stars lead race to fight breast cancer Richard Roundtree was the man who personified masculinity in the iconoclastic film Shaft. But he doesn't have any trouble relating to women  especially when it comes to breast cancer. Eight years ago Roundtree discovered a lump in his right breast. "When I got the news, I was shocked," says the 59 year-old actor, who is working with the Susan G. Komen Breast Cancer Foundation to raise men's awareness about the disease. "I thought, 'I couldn't possibly have breast cancer. Men don't get this.'" But they do. According to the Susan G. Komen Foundation, this year between 1,400-1,600 men will be diagnosed with the disease, and 400 men will die from it. While this pales in comparison to the more than 40,000 American women who will succumb to the disease in 2001  the risk to men is all too real. The highest recorded incidence of male breast cancer is in parts of Brazil, Colombia, Hungary, and Singapore, though it is not clear why. "I don't think there is an expert on breast cancer for men since the cases are so few and far between and it has not been well studied," states Dr. Mark Pegram, assistant professor of oncology and hematology at UCLA/Jonsson Comprehensive Cancer Center. "There are lots of people trying to do this research but you can only go as fast as there are patients coming in with male breast cancer," adds Dr. William Wood, professor and chairman of the department of surgery at Emory School of Medicine. The group with the highest risk are men with Klinefelter syndrome  a rare condition in which a man inherits an extra 'X' chromosome, says Wood. Instead of the normal male 'XY' configuration, they are 'XXY.' Other breast cancer risk factors include: A family history  According to Wood, approximately 5% of women who develop breast cancer have a family history of the disease. So it's possible that men may inherit breast cancer as well.

Gynecomastia  An excessive growth of male breast glands.

Dysfunctional testes  This can lead to hormonal imbalances. Like women, another risk factor for men appears to be alcohol consumption. "Women who have one alcoholic drink a day don't have any increase in the risk of breast cancer. However, two drinks of alcohol a day increase the risk by 30% and three drinks by about 50%," states Wood. "Although for men it might be higher amounts of alcohol because males break down alcohol twice as effectively as women." Making the bust What is frustrating in Roundtree's case, and in most cases of male breast cancer, is that there was no obvious reason that he got breast cancer. He has no family history of the disease, does not have Klinefelter syndrome, and rarely drinks. And at 51, Roundtree was much younger than the average male with breast cancer. The typical male gets breast cancer in his late 60s  10 years later than women are diagnosed. But when it comes to symptoms, male breast cancer is not very different from female breast cancer. Men should look for the same symptoms, including: Breast lump

Nipple discharge (often bloody)

Inverted nipple Roundtree found his lump accidentally. "I'm a hypochondriac," laughs the actor, "as soon as I felt the lump I immediately went to my doctor. I don't mess around that way." Wood says that Roundtree's attention to his lump makes him a rare breed. "Men are wonderful deniers of their own health, and this leads to a high mortality rate with breast cancer." Wood explains that machismo and lack of awareness are probably the major contributing factors in late diagnoses of male breast cancer. "I think it's hard for men to pay attention to their bodies unless something is really hurting them. Some men think they just have a pulled muscle or a knot in their chest," says Wood. "While most women will see a doctor if they feel something the size of an M&M in their breast, most men won't even think about it until the lump is the size of a golf ball, which means the cancer is advanced and has probably spread." Treatment Treatments for breast cancer are the same for men and women. Both are treated with chemotherapy, radiation, hormone therapy, and surgery  including lumpectomy and mastectomy. But men and women differ in their response to the popular treatment tamoxifen. "We use tamoxifen for both men and women who are hormone receptive positive," explains Wood. "About two-thirds of women with breast cancer are hormone receptive positive, whereas 95% of men are hormone receptor positive. This means that almost all men with breast cancer respond to tamoxifen, whereas about 1/3 of women don't." But because men catch their disease late, Wood says that the survival rate for men is lower than for women. Men have very little breast tissue and do not typically receive mammograms. Also, men are not taught to do regular breast self-examination. Roundtree was fortunate to catch his cancer early and received chemotherapy, radiation treatments, and a mastectomy. Although Roundtree did not experience hair loss from the chemotherapy, he said he lost a lot of weight because he was extremely nauseous and couldn't even look at food. But the most difficult part about the disease for the actor was his inability to tell anyone but his family. He says he had to hide his illness from the entertainment industry for fear that it would exclude him from working. "No insurance company would insure me if they found out,' says Roundtree. "And in order to work on a film, you need the stamp of approval from an insurance company. So unfortunately I had to keep it a secret." But one fact that shouldn't be kept secret is that breast cancer rates have dropped. "It's exciting," says Wood. "In the U.S. and the U.K., the national rates of breast cancer over the last 10 years will have gone down almost 25%. That's really incredible. For the most part, we are catching it earlier and have great treatments." Roundtree doesn't hide his illness at all anymore. He cherishes his survival and works passionately as a spokesman for both the Komen Foundation and a men's health care initiative called Know Your Score. Along with Ervin "Magic" Johnson, Roundtree is encouraging African-American men to see their doctors regularly. "Know Your Score is really important," says Roundtree. "We've already saved a few men. Whether it's breast cancer or heart disease, our goal is for men to start taking their health more seriously." More Spotlight Health stories

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