Breast cancer — it’s a guy thing, too

Mark Goldstein jokes that it's easy to pick him out of the throng of runners in the five-kilometer races he competes in. He's the tall, thin guy with the gray hair and the pink hat.

But there is another, easier way he neglects to mention, for that would spoil the joke: He is the only guy.

That's generally how it is when you run in races for breast-cancer survivors.

"This is supposed to be a disease for women only," he says. "I guess conventional wisdom would have it that men's cancers are below the belly button. We get testicular cancer, we get prostate cancer, but we're not supposed to get breast cancer."

But they do. It afflicts approximately 1,500 men a year and kills about 275.

As one of the fortunate 1,225 in 1988, the year he was diagnosed, Goldstein thanked his lucky stars and adopted a philosophy: That which didn't kill him gave him an opportunity.

He says the fact that he's something of an anomaly attracts reporters to his story, which in turn gives him the opportunity to advocate "for a speedy identification of the causes and the cures of breast cancer for all persons."

Goldstein, 63, notes that since the number of male breast cancer cases pales in comparison to the number of female cases (183,000 cases and 45,000 deaths a year), his message of early detection and self-examination is as much for women as men.

But the disease can be particularly unforgiving in men, who aren't conditioned to examine themselves.

"It's lethal in the sense that they usually discover it at a more advanced state, not because it acts more lethally," says Dr. Ted Potruch, director of BreastCare, a local clinic. "The chance of it spreading is higher simply because they don't look for it."

Men can develop what Potruch calls "silent masses." The mistake they make is chalking it up to nothing.

"By the time they do something, it's usually more advanced," he says.

Potruch, who treats perhaps one male a year for breast cancer, says the reality of male breast cancer is relatively unknown to the general public "because it's not as rampant" in men as lung, colon and prostate cancer.

"Breast cancer accounts for only 1,500 cases a year and there are 100 million men. You tell me where it stands in importance."

The diagnosis

Goldstein, who resides in a New Jersey township 40 miles from New York City, was spared a death sentence because of early detection. He noticed a growth beneath his left nipple, which was beginning to recede as a result. But he still put off a doctor's visit for two months.

"I was lulled like everyone else would be. I was thinking, 'It's nothing. It will go away.'"

When he finally broke down and went -- first to his dermatologist, then to a surgeon the dermatologist recommended -- he was told the growth could be anything from a benign cyst to breast cancer. Seeking a definitive answer, he underwent a mammogram. It proved inconclusive as well.

"I can certainly empathize with the ladies," he says of his mammogram experience.

Finally, he found a surgeon in New York City who had performed numerous breast-cancer surgeries on men.

"Her attitude was, 'We can do a needle biopsy of it and see what it is. However, if you approve, let's take out the growth and do a frozen section on it, and see if it's malignant. If it is, we're gonna take it out anyway. We'll remove the lymph nodes to see if it's metastasized throughout the body. If it hasn't, we'll give you back your nipple, sew you up and get you on your way.'"

As it turned out, it was breast cancer, and it was malignant. Fortunately, it wasn't spreading.

"The shock was that it was in my breast, not that it was cancer," he says.

Goldstein was released from the hospital a day and half after undergoing a modified radical mastectomy. It was then, after his surgery but before he underwent chemotherapy and radiation therapy, that he decided the disease wouldn't rule his life.

"I came home and my wife sticks her head out the front door and says, 'Mark, what on Earth are you doing?' I said, 'Mowing the lawn.'"

What followed was an exchange between an upset spouse and a determined cancer patient who vowed to lead his life as normally as he could after cancer as he had before.

"We weren't going to give it any quarter," he says. "Why concede anything to the disease? We said, 'Whatever we want to do, let's do it.' And that's the way we've led our lives ever since."

For women only?

Goldstein is a member of a number of breast-cancer support groups (in person and on the Internet), and he is frequently asked to speak on the subject. It wasn't until 1992, however, that he was compelled to run for the cause.

"I learned about this race that was being run in New York City," he says. "It was being advertised as a race for the cure of breast cancer."

But what really fueled his interest was the legend accompanying the ad: "For women only."

"My wife and I sat down and I said, 'Look, if I don't run in this race, I'm going to allow this mythology (that men don't get breast cancer) to perpetuate. Why don't I go out there and run in this race?'"

Goldstein knew that if he submitted a race application with his name on it, it would be rejected.

"So, my wife and I and our three children, we submitted our applications using our first and middle initial and last names only." He also paid his entry fee with a money order instead of a personal check to avoid being caught.

When he showed up for the race, however, he was told he couldn't run. "I said, 'Look, except for the genitalia, I qualify.' So, we started running, the whole family. Some of the guards there tried to stop us, but they were standing still and we were moving, so we finished the race."

Afterward, Goldstein approached the race director.

"I said, 'Look, I'm not going away. Next year, God willing, I'll be back. Why don't you try to find a way to exploit me?' To their credit, the New York race and a number of other races find ways to utilize my uniqueness for the benefit of the cause."

Racing for the cure

There are still some localities that resist, and Goldstein respects their wishes that he not run.

"Breast cancer is a very personal and emotional subject for ladies," he says. "It's not just a physical disease but a social disease. I guess some organizations believe that this is their disease. They think maybe I'll be a distraction. I used to get very upset, but very quickly stopped. They're entitled to their feelings, and I don't want to be disruptive.

"There are a number of races out there that accept me. I'm better off supporting them than being combative with people who don't want me."

One of the races that does accept him is the Susan G. Komen Breast Cancer Foundation's Race for the Cure. The foundation was established in 1982 by Nancy Brinker to honor the memory of her sister, Susan G. Komen, who died from breast cancer at age 36.

It sponsors Race for the Cure events in 60 cities throughout 32 states and the District of Columbia. Runners and relatives alike are encouraged to wear pink -- the official Race for the Cure color -- to honor the memory of those who have succumbed to breast cancer. Proceeds fund breast cancer education, screening and treatment projects. The first race was held in Dallas in 1983. The first Las Vegas race was held last year. Goldstein will make his Las Vegas debut with this year's race.

Always a winner

Until 1992, when he entered the New York event, he had never run a road race.

"The most running I had done was for a commuter train. That was about it."

Goldstein, who works for a satellite communications company, takes a decidedly non-competitive approach to the 3.1-mile races, as evidenced by the nearly 10 minutes it takes him to complete a mile.

"I take the attitude, 'I win just by showing up.' All I have to do is be there. The view that I have when I'm running is the back of the sneakers ahead of me. I'm just satisfied and happy to be there."

Goldstein says he gets a gamut of reactions from the women he runs with.

"Some are very supportive. Some don't believe it. Some ignore it. But most are very supportive. Those that don't know that a man can develop it are intrigued by it."

Personal assault

Goldstein says the emotional impact of breast cancer affects men and women differently.

"For women, it is certainly a social issue because, in our society, we place so much emphasis on the female breast as a measurement of sexual beauty and enticement. So it's much more than just a gland to support a nursing infant. It's a sexual symbol with great emphasis on it. Many women who lose their breast believe it is an assault on their femininity and sexuality. That's a highly charged thing to go through.

"On the male side, to some men I've spoken with, it appears to be an assault on their masculinity. They've developed a female disease, and men aren't typically open about disease in the first place.

"The second aspect is from a business standpoint. The number of men I've bumped into have been reluctant to admit they have breast cancer because of the impression they felt it would leave on their business associates."

Goldstein says the message has been worth the miles.

"When I say I've been given an opportunity, that's what it's really turned into. Typically, most people as they go through their adult lives, they're preoccupied with, certainly, financial objectives, but also personal and social objectives.

"Here I found myself in the fourth quarter of my life -- which betrays my corporate background -- and up to this point I had preoccupied myself with the financial well-being of a company. Now I had the opportunity to preoccupy myself with the physical well-being of the people that I came into contact with. What a wonderful opportunity it turned out to be."

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