In 2012, Len Robertson, a 46-year-old high school music teacher and musician in Brooklyn, New York, noticed a discharge coming from his left nipple.
“It was worrisome. I did some research and learned that it’s never a good sign when this happens,” Robertson says. He went to a breast specialist to get checked out, and she removed a benign (noncancerous) tumor from his left breast. While most breast lumps are benign, Robertson took this as a sign to be on the lookout for any other changes in his breasts.
Six years later, in the summer of 2018, Robertson was lifting weights and working on getting in shape. One day, he was doing chores when he felt a sharp pain in his left breast. Then, it began to swell. “I talked to one of my friends at the gym and he said, ‘It looks like you pulled something. Take a break for a couple of days,’” Robertson remembers.
A week or two passed, and the swelling still hadn’t gone down, so Robertson scheduled another appointment with the breast specialist. She, too, suspected that he’d likely pulled a muscle, but to be safe, she performed an ultrasound of his breast.
In the middle of the scan, the technician made a telephone call and asked Robertson to make a noise. He did. She told him that typically tissue that is noncancerous would move when he talked. His didn’t.
After reviewing his results, the doctor told Robertson he needed to get a mammogram right away and made another phone call to discuss the results. “At this point, I knew something was up,” Robertson remembers.
A week later, Robertson’s breast was no longer swollen, but he could feel a lump. After a series of biopsies, in September 2018, he was diagnosed with stage II breast cancer. This meant that his cancer was larger in size but had yet to metastasize or migrate to any other parts of his body. He had two tumors in his left breast, and both of them were growing. They’d found them just in time.
“I was shocked. I didn’t know that a man could get breast cancer,” says Robertson. “The first thing I thought was, I have to prepare for the worst. I really thought that I was going to die at that point, that this was it for me.”
Breast cancer in men is rare and accounts for less than 1% of all cases of breast cancer.
Every year in the United States, about 250,000 women and about 2,300 men are diagnosed with breast cancer, according to data from the Centers for Disease Control & Prevention (CDC). The incidence of male breast cancer has increased slightly, from 1 case per 100,000 men from 1975 to 1979 to 1.3 cases per 100,000 men from 2010 to 2014.
Because breast cancer in men is so uncommon, the hospital where Robertson was diagnosed was not prepared to treat him. Thankfully, his teachers’ union, the United Federation of Teachers in New York City, connected him with the Memorial Sloan Kettering Cancer Center (MSKCC) in Manhattan.
After an examination and a slew of tests, the doctor told him, “Mr. Robertson, you have cancer, but you’re going to be okay. We have a plan.” As soon as possible, he would undergo a double mastectomy surgery followed by chemotherapy.
While men are more likely than women to be diagnosed with advanced-stage breast cancer, possibly due to a lack of awareness, 95% of male breast cancer cases are like Robertson’s—still in early stages and highly treatable, notes Shari Goldfarb, M.D., a board-certified medical oncologist who treated Robertson at MSKCC. Like Black women, Black men are disproportionately affected by breast cancer and more likely to die from breast cancer compared to white and Latino men, per the National Cancer Institute.
When it comes to signs of breast cancer, “men tend to present with firm, painless masses, while women’s breast cancer is often detected on screening mammograms before they are palpable,” Dr. Goldfarb says. Symptoms that may indicate breast cancer in men include:
- A lump or thickening in or near the breast or underarm area
- A change in size or shape of the breast
- Swelling, redness, or flaky skin in the breast, nipple, or areola (darkened skin surrounding the nipple)
- Irritation, puckering, or dimpling of the breast skin that may resemble an orange peel
- Nipple discharge, pain, or inversion (turning inward)
It’s also important to be aware of risk factors for breast cancer in men. These include:
- Older age (most breast cancers are in men 50 and up)
- Being overweight or obese
- Genetic mutations such as BRCA1 and BRCA2
- A family history of breast cancer
- High estrogen levels due to a disease such as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder).
- Having had radiation therapy on your chest in the past
After Robertson told his family and friends about his breast cancer diagnosis, they rallied to support him.
Although Robertson’s adopted son, three younger siblings, and mother and father were devastated and worried, they did everything they could to be there for him. In mid-September 2018, Robertson’s 73-year-old mother, who was living in Charlotte, North Carolina at the time, hopped on a bus to surprise Robertson at his home.
The day before his surgery, Robertson’s family and friends held a cancer party for him at a bar he and his friends often went to when they were teenagers. “There were people I hadn’t seen in 25 years that came to see me,” Robertson remembers. “I felt really good because I had a chance to say everything I wanted to say to my family and friends, and no matter how it went, it was okay. My mindset through this whole thing had been, I’m going to die. But then it switched: I’m not gonna die. I’ve gotta get better. I want to live.”
In September 2018, Robertson went to the cancer center with his family for his double mastectomy surgery.
When Robertson woke up, he was relieved to learn that a biopsy of his sentinel nodes (the first lymph nodes that breast cancer typically moves into) indicated that his cancer had not spread.
But the greatest challenge came next: sixteen rounds of chemotherapy over a period of four months. “The most brutal part was the chemo,” Robertson says. “My skin and nails changed, my hair fell out, and I looked and felt horrible.”
During his treatment, Robertson also witnessed stories that weren’t as fortunate as his. “I was sitting there, the only man waiting for breast cancer treatment, watching women, their husbands, and their families get good news and bad news. I saw people finding out that there was nothing they could do for them. That messed me up for a while.”
As Robertson was recovering, he joined the cancer center’s choir, Rising Voices. After speaking with two chaplains, he committed to raising awareness of breast cancer. “I decided if I live through this, I’m going to become an advocate. This is a very bad disease. It takes out a lot of women and men, and I’m going to talk about it as much as I can.”
As of October 2020, Robertson is cancer-free, back at work, and an advocate for breast cancer awareness and support.
He continues to sing with the Rising Voices choir and volunteers with the Breast Cancer Research Foundation, His Breast Cancer Awareness, and the Male Breast Cancer Coalition to spread the word about male breast cancer.
Robertson says the stigma surrounding male breast cancer is real, but men shouldn’t let that stop them from seeking help if they have concerning symptoms.
“I try to educate men—especially my students and other young people—about the importance of going to the doctor. Most of the time, guys say, ‘Eh, it’ll go away,’ but if something’s wrong, you have to go to your doctor. If you just go to the doctor, you can get it fixed. Why let tumors grow? Why let things like that happen? Don’t be afraid. Just go. And if you are afraid, bring your family and friends with you. They’ll be there for you,” he says.
Genetic testing revealed that Robertson had no genetic mutations that would explain why he’d developed breast cancer. Doctors believed his cancer was related to levels of hormones in his body.
“The vast majority of male breast cancers are estrogen-receptor positive,” says Dr. Goldfarb. This means that their breast cancer cells have receptors (or proteins that can attach to certain substances) that rely on estrogen to grow. Because of this, Robertson and patients like him can take estrogen-blocking drugs like Tamoxifen to prevent these receptors from using estrogen and in turn prevent cancer from recurring.
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As a cancer survivor, Robertson aims to make himself available to anyone living with cancer, from colleagues and former students to the wives of old friends undergoing breast cancer treatment.
“I tell them, ‘I’m there for you. Reach out to me, and I’ll talk to you and help you through it.’ For someone living with cancer, just talking to them means a lot. You don’t have to do much besides ask, ‘How are you this week? What do you need? How can I help?’ The COVID-19 pandemic has shown us a lot of things, the good and the bad. But one thing we can do is be more compassionate with each other.”
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