In men, breast cancer is a rare disease, accounting for less than 1% of cases. About 2,600 men will be diagnosed this year in the United States, according to the American Cancer Society, compared to an estimated 246,660 new cases of invasive breast cancer expected in women, along with 61,000 new cases of in situ breast cancer.
Last year Vern Oakum was among the men surprised with a diagnosis of breast cancer. “I noticed a lump on the left side of my chest and thought it was a pulled muscle because I’d been working out the week before,” says Oakum, who is 54. “When it didn’t go away, I went to my primary care physician, who ordered an ultrasound and mammogram, both of which came back inconclusive.”
After reviewing the imaging results, Oakum’s doctor referred him to Liz Lee, MD, a breast surgeon affiliated with Memorial Hermann Memorial City Medical Center. She saw him early the following morning for an examination and biopsy.
“Within about 45 seconds she had identified the main mass and could tell that it had traveled to the closest lymph node,” Oakum says. “The whole time I was thinking there’s no way I have breast cancer. When my biopsy results showed stage 2B invasive carcinoma, I was shocked.”
Dr. Lee referred him to Ronjay Rakkhit, MD, a medical oncologist affiliated with Memorial Hermann Memorial City. “It all happened so fast,” Oakum says. “They implanted a port under the skin of my chest, and I started six months of chemotherapy to reduce the size of the tumor before surgery. My wife was with me the whole time to help with decision-making, which was great because as soon as you hear the word cancer, you don’t hear anything else.”
After consulting with Dr. Rakkhit and discussing his options with his wife, Oakum decided to have both breasts removed. “As a man with cancer in one breast, which is statistically rare, I was worried about getting cancer in the other breast,” he says. “I decided I wouldn’t want to have to go through this again.”
Surgery was scheduled for June 29, 2015. Because Oakum had significant lymph node involvement on final pathology, Dr. Lee also performed an axillary lymph node dissection, removing all of the lymph nodes in his left arm. To prepare him for radiation therapy, she referred him to Emilia Dewi, OTR, OTD, CLT, an occupational therapist and certified lymphedema therapist at TIRR Memorial Hermann Outpatient Rehabilitation-Memorial City.
“When Vern first came in, he had tightness and limited range of motion, which is typical after a mastectomy that includes a lymph node dissection,” Dewi says. “In order to position himself properly for breast irradiation, he had to have between 120 and 140 degrees of flexion while laying down, so at first we worked on range of motion in his left shoulder. Once he regained most of his range of motion, we switched gears to focus more on lymphedema management.”
Axillary lymph node dissection is associated with a higher risk of developing lymphedema than sentinel lymph node dissection, and the same is true of mastectomy versus lumpectomy. In addition, the greater the area of the chest or underarm treated with radiation, the greater the risk for lymphedema.
“By then I’m figuring I’ve had surgery and chemotherapy and the cancer’s gone, so except for radiation therapy, I’m done with this,” Oakum says. “Then I learned about the possibility of developing lymphedema. Emilia showed me how to do body movements to keep the lymph moving.”
Dewi is one of several certified lymphedema therapists at TIRR Memorial Hermann Outpatient Rehabilitation who provide comprehensive treatment for primary and secondary forms of lymphedema to reduce swelling, improve comfort and increase overall mobility. Lymphedema management programs are available in Memorial City, Sugar Land, Katy, The Woodlands and at TIRR Memorial Hermann Outpatient Rehabilitation-Kirby Glen, just south of the Texas Medical Center.
Oakum saw Dewi again after a three-month regimen of radiation therapy. He remembers the characteristic swelling of lymphedema starting three or four weeks after he completed radiation.
“We used kinesio tape and manual lymphatic drainage, and I also taught his wife how to do the multilayer bandaging,” Dewi says. “Then I sent him off to be fitted for a sleeve.”
Compression sleeves and vests encourage movement of lymph through the body, allowing lymphatic fluid to drain from tissues and immune cells to travel where they’re needed.
"The swelling is minimal, and I’m pretty religious about wearing my sleeve,” Oakum says. “My experience with Emilia was fabulous. TIRR Memorial Hermann is a first-class operation. Everyone I worked with was great, and the scheduling was phenomenal. I always got a follow-up call, which is wonderful, especially when you’re still going through cancer treatment.”
Based on the American Cancer Society surveillance model, Dewi will follow up with Oakum every three months for the first two years after he was fitted with the compression vest and sleeve. “If clients are doing well, as Vern is, we see them every six to 12 months. I remember him as positive, realistic and gentle mannered. He was not stressed out or anxious, and I think that helped. He approached everything with the attitude that he just needed to get past it.”
Dr. Lee agrees. “Although his diagnosis came as a shock and was difficult to accept at first, Vern handled everything in stride and came through it with flying colors,” she says.
Oakum is passionate about informing men about breast cancer. “If women find something wrong, they go right in to see the doctor, but men don’t,” he says. “We wait. It’s like asking for directions. Women on the other hand are incredibly proactive. When I found the lump, my attitude was this is nothing – it will go away. My advice to men is to act fast if you see something unusual on your body. Don’t take it lightly. We never think breast cancer will happen to us, but it can.”