In the video: the innovative treatments for metastatic breast cancer/edited by: Dina Meffutz
"There was a period of several months when I suffered from back pain. One that feels as if a muscle is under me or something is caught," recalls
Tzvi Lebanoni
(63), a citizen working for the IDF from Haifa, how it all started, "but despite the painkillers there was no improvement. At one point there was even an aggravation. Two months ago I felt a fatty lump in my nipple, but it's not something I took seriously. I did a mammogram and the result showed that it was something benign."
Following the medical problems, Lebanon returned to the doctors and continued with the investigations. A back CT scan found lesions in the spine and pelvis, which turned out to be malignant in the biopsy.
"We still didn't know what kind of cancer it was at that stage," he says, " But when I came to be examined by Dr. Itai Waldharan, the oncologist at Rambam, the diagnosis was made within a minute. He palpated the lumps with a manual examination, as any woman knows how to do at home, and gave it a name. Breast cancer, later it also turned out to be metastatic."
"It is important for me to say to every man and every woman - warning signs, a combination of abnormalities in the body, should be considered, and not ignored. The doctors in the community should also be more aware of the warning signs of breast cancer in men"
The treatment Lebanese has been receiving since she was diagnosed with breast cancer is based on a combination of biological drugs in pills and a monthly injection, when these suppress the hormones, treat the existing tumors and stop the spread of the cancer. Along with the drug treatment, Lebanon receives support from the staff of the Rambam Oncology Institute, counseling and accompaniment, which enable him to deal with the various aspects of life in the shadow of the disease. Despite the aggressive course of his disease, it seems that the biological treatment is effective and he responds well to it.
"Doctors in the community should be more aware"
The diagnosis he received only a few months ago caught him by complete surprise: "Obviously, a man with back pain is probably not going to look for breast cancer," he says, "I know how to take care of myself. I definitely check if there is something that needs investigation, but that direction did not come up Never in my mind, and certainly not in view of the problems I suffered from. I, like many others, did not know that a man could get breast cancer. There is a lot of ignorance on this subject. Even the nurse at the hospital where I receive the monthly injection for treatment did not understand what was happening here When she saw me in line, it was the first time a man came to receive the injection. She just doesn't know.
Lebanese proves himself as a man of mission. From the moment of discovery, he changed his mind and dedicated himself to treating the disease and understanding the issue in depth. As part of the research, there was also a genetic investigation for the disease: "We did an investigation regarding the genetic background of the disease, and it was found that I am a carrier of the BRCA2 gene, which means that my cancer is genetic and may be passed on," he clarifies, "Me and my partner do not have children, so I have nothing to do with This finding, but I have family members who entered surveillance following this finding and for them this is significant information."
"Even the nurse at the health fund where I receive the monthly injection for treatment, didn't understand what was going on here when she saw me in line. It was the first time a man came to receive the injection. I answered, she works in the health field."
In the meantime, Lebanese is learning to live with the new title: "The disease is not simple," he says, "there are severe pains and consequences. So far I have dealt with it well, I can't say easily. After all, I have cancer. But the bottom line - you have to deal with it I have a supportive partner at home who took care of me during the first months. He also has a bachelor's degree in psychology. I believe that everyone has their own toolbox to deal with Impact on it, and it's not in my control, I won't let it crush me. From where I am today, it's important for me to say to every man and every woman - you need to pay attention to the warning signs, to the combination of abnormalities in the body, and the doctors in the community should also be more aware of the signs The warning of breast cancer in men is a population that needs to be thought about in this direction as well."
A combination of lack of awareness, lack of knowledge and shame
"Every man with breast cancer says the same things," clarifies
Rita Wortman
, nurse coordinator of the follow-up clinic for BRCA carriers at Rambam. "There will always be similar questions: What, do the men have breast cancer, in the milk ducts? Who even knew things had milk ducts? Why don't they explain to us, why don't they talk and check?
"The claim is that there is a lot of lack of information and knowledge among the general population and those who are at risk in particular, and this needs to change. Since the series aired, there seems to be more awareness of the issue and I receive more inquiries from friends, family members of female patients, on the street. On the networks. Who knows that I am involved in the field , asking questions. There seems to be a lot of thirst for information."
In view of the stage that the subject is receiving these days, it is important to be precise: breast cancer is the most common type of cancer in women in Israel and in the world. In contrast, breast cancer in men is extremely rare. Only one in every hundred cases of breast cancer is diagnosed in a man, when every year, about 60 men in Israel are diagnosed with breast cancer.
"Although it is a relatively rare disease, men can also get breast cancer, and it is much better to catch the tumor when it is still located in the breast and has not yet developed metastases, because then the cure rates are high - just like in women," explains
Ayelet Shay
, director of the breast cancer unit at the Ramb Medical Center "M, and sharpens: "This is why awareness is so important. If changes appear in the breast, a lump develops or a discharge from the nipple begins, you should go to be examined by a doctor or a specialist doctor, and if necessary, also do a biopsy," emphasizes Dr. Shay. "In most cases, because the male breast is smaller, it is easier to notice the appearance of a lump, therefore, if there is awareness, it is possible to catch the tumor at the local stage and remove it surgically."
Dr. Shay adds that just like women, men also have factors that increase the risk of developing the disease. "Even if the risk factors for the disease are relatively rare, it is still important to know them and be aware of the possibility of developing the disease," she says. The most significant risk factor is a mutation in one of the two genes BRCA1 and BRCA2, which are known as genes that significantly increase the risk of developing breast cancer, ovarian cancer and cervical cancer in women. It's the same for women," explains Dr. Shay.
One out of nine associations are waiting for men who are facing breast cancer and are ready to "come out of the closet". "The minority of contestants, and the fact that it is a disease that is perceived as female, prevents them from asking for and receiving the accompaniment and support that we know how to give them, just like for women who are dealing with the disease," says
Tali Rosin
, CEO of the association, "The accompaniment and support coordinator will accompany them from the moment of discovery until recovery, They can receive assistance in exercising their rights from a lawyer, free of charge, a subsidy for emotional treatments nationwide and with high availability, and if they wish - also a support group for men only. It is important to remember that the carrier gene can also come from the father, that men also get breast cancer, and especially - as with women - early detection saves lives."
Dr. Shay explains that most cases of breast cancer in men are what is known as hormonal breast cancer. "To date, I have treated not many cases of breast cancer in men - all of them had hormonal breast cancer." When the tumor is detected in the early stage, the accepted treatment is to remove it surgically, and continue with the radiation treatments, with the addition of chemotherapy in case the cancer is defined as high risk, followed by hormonal therapy in the following years after the surgery.
"There aren't many studies in men, so the treatment protocol is based on what is customary to do in women," says Dr. Shay. "Another difference is that men usually don't do breast-conserving surgery, but do a full mastectomy. A scar remains under the shirt, but unlike with women, this has no real effect on the appearance.
" The hormonal treatment after surgery is also usually relatively easy and without significant side effects. "Dealing with breast cancer in men is easier when it comes to cancer that is located in the localized stage. And this emphasizes the need to be aware and get tested if there is suspicion, even if it is not the first thing that jumps to mind. If the cancer is detected at a later stage, when it has already metastasized, the treatments become much more significant and challenging."
"There is a combination of lack of awareness, lack of knowledge and shame," Wortman adds. "All three are deadly. The lack of awareness of breast cancer among men is a major reason for the delay in diagnosis. The later it is diagnosed, the lower the chances of recovery. There is not much information available to men about the issue or about the warning lights, and men are ashamed to contact medical professionals if they discover something suspicious in the breast The cases I know, unfortunately, involve situations where cancer penetrates the milk ducts and metastasizes to other organs, and from experience in the field, I can say clearly: cancer is a race against time. Prevention and early detection save lives! Be attentive to your body, get tested on time, get tested for prostate cancer, skin and more, get genetic counseling if you have a history of cancer in the family or have had cancer in the past. Don't be ashamed, don't neglect yourself, because there's nothing in the world More valuable than our health."