The person who collects my contact and insurance information at the local breast health center seems vaguely apologetic when she tells me that the main waiting room is for women only. She directs me back to the reception area, where I take a seat again among a handful of other men, most of whom are presumably there waiting for wives or other female significant others. I grab a bottle of water from the “patients only” fridge, open my book back up, and bide my time until my name is called.
I am here for my mammogram.
***
A few years ago, my mother told us that she had ovarian cancer.
My husband (more perceptive about such things than I tend to be) had noticed that something had seemed off as my parents had arrived for one of their periodic visits. Mom had been preoccupied and not herself. That night, when we asked if something was wrong, she gave us the news.
By luck or providence, her cancer had been detected relatively soon, found in an early stage as part of a workup for an unrelated and benign condition. Thanks to the wonderful care she’s received from her world-class medical providers, she’s done very well since learning of her illness.
However, as part of the initial tests that were run when she first received her diagnosis, it was revealed that she was positive for the BRCA2 mutation, one of a couple of genetic abnormalities that increase a carrier’s risk of various cancers, particularly those of the breast and ovaries. As we sat and listened to her surgical oncologist share the joyful news that he had been able to remove all visible cancer, he told my brother and me that we should both be tested ourselves. While the implications for female biological children of ours would be most significant, if we had the mutations ourselves then it could affect our own health as well.
It wasn’t until my most recent checkup that I finally mentioned this information to my own doctor. It’s not that I hadn’t intended to get tested before then, merely that the distractions that come from having work and kids and everything else had pushed it onto one of my brain’s back burners. Even so, I knew it was something I needed to do. My doctor told me to bring in a copy of my mother’s results to ensure that my insurance would cover the test, and to come back and see her as soon as I had them.
Results in hand, I returned for the test, which involved spitting a bunch of saliva into a little vial until it reached a certain line. It was slightly revolting, but not otherwise unpleasant.
A couple of weeks later, my doctor called to tell me my own results were in. Per my request, she told me over the phone: They were positive. And since I stand on the cusp of the age when male carriers are sometimes recommended to get mammograms, she suggested I get one, too.
***
In the weeks leading up until my appointment, I pondered precisely how my mammogram was going to work. Though nobody should look for me on the cover of a men’s fitness magazine anytime soon, I keep myself in decent shape through a combination of avid running and a pretty strict diet. Simply stated, there isn’t a lot of material there to work with. (As my mother put it when I discussed writing this article with her, “You’re not a particularly buxom person.”)
I am, quite frankly, a little bit concerned that it will hurt like hell. I imagine it feeling like something a particularly depraved schoolyard bully would inflict on vulnerable classmates—were said bully to have access to a steamroller. I’ve found myself looking in the mirror, grabbing as much excess chest flesh as I can and smooshing it between my hands, trying to imagine how much squeezing is involved.
But even though I never dreamed I’d ever say, “Man up and get your mammogram” to myself, the phrase now applies. And so I find myself sitting in a breast health center waiting for my name to be called.
When the moment comes, an incredibly pleasant technician I’ll call Christie guides me into a dressing room, tastefully decorated with quilts made of swatches in various shades of pink and light purple. Either she is the kindest, gentlest human being I have ever met, or she is the best actress. She gathers a little additional personal information from me, offers me a hospital gown (which I decline), and guides me into the room where the test is to be performed.
For you fellas out there who might find yourselves in a similar boat, allow me to reassure you: It’s not nearly as heinous as you might fear. After handing me a warm wipe to remove my deodorant, which (who knew?) can show up on a mammogram, Christie positioned me for a couple of views of each side of my chest (I’ll admit I still have a problem calling them “breasts”), from top to bottom and side to side. While nothing I’d plan a birthday party around, neither were all that uncomfortable and both were very brief. I’d squeezed a lot harder in my worst-case scenarios in the bathroom.
With the scans done, Christie leads me back to the dressing room to put my shirt back on and wait for my results.
***
In the past few years, there has been a lot of attention paid to BRCA1 and BRCA2 mutations, at least when it comes to women. Angelina Jolie’s courageous decision to come forward about carrying the BRCA1 mutation and the steps she has taken to mitigate her own risk of developing breast or ovarian cancer has understandably gotten a lot of press. Closer to home, one of my Daily Beast colleagues has written about having the same mutation that I do. As a physician myself, I am thrilled to see more women being made aware of the risks they may face and the options they can consider when meeting them.
But there’s not a lot out there about us guys.
“Men do come through my door,” said Dr. Judy Garber, director of the Center for Cancer Genetics and Prevention at the Dana Farber Cancer Institute, when I spoke to her recently. “But not nearly the increase in men [compared to women] since Angelina Jolie’s story became public.”
Most of the men Dr. Garber sees with the mutation come in because they have daughters and are worried about the implications for their children’s health. Others are in my situation, and have a family member with cancer and a BRCA mutation. For those concerned about passing the mutation to their offspring, assisted reproductive technologies are available, though insurance coverage can be spotty and availability varies greatly depending on where people live. In situations where both parents are BRCA2 positive, there is a risk of children developing rare blood disorders, as well.
When it comes to the risk men face themselves, knowing they are BRCA positive can help them avoid overlooking important signs that they need to seek further medical attention.
“The main problem with men,” Dr. Garber told me, “is that they get a lump, but don’t think they can get breast cancer.” This leads to their allowing the cancer to progress beyond the earliest stages, when the prognosis can be much better. While Dr. Garber considers mammograms optional, regular breast exams by medical professionals are definitely recommended.
For my own part, the chance of a suspicious lump being overlooked stands at roughly 0 percent. As soon as I got my results, I began checking my chest on a daily basis with metronomic regularity. Perhaps as time goes by my obsessiveness will abate a bit, and I’ll taper off to every other day.
***
It feels simultaneously true and false to say I’m in the same boat as Jolie and other women with BRCA mutations. The implications for their health are much more pressing than mine, and it seems somehow self-dramatizing to claim the same stakes. My risk of breast cancer is still quite low, after all.
But compared to the risk in the general male population of 0.1 percent, the 5-6 percent risk Dr. Garber quotes is still a lot higher for men like me. It’s no longer some barely-considered abstraction, but a real possibility. An unwelcome ship has appeared on my horizon, and though it may never sail to shore, it promises never to disappear again, either.
That little blobs of physiologically useless tissue house some inchoate threat seems both ludicrous and infuriating. Offering neither aesthetic appeal nor child-rearing advantage, they just sit there, inert and menacing at the same time.
On the other hand, it’s hard to stay mad at my chest when I consider some of the other cancers I now know I’m at increased risk of facing. My chances of developing prostate cancer are higher, not necessarily at a younger age, but of a more aggressive form. Yet it’s the thought of pancreatic cancer that my mind has already begun to polish smooth with worry. I know members of my maternal grandmother’s generation died of it, and there are no good screening tests for it at this time. Though my increased risk is still likely to be small, when Dr. Garber mentions clinical trials of screening methods for BRCA carriers with pancreatic cancer in their family, I make big circles on my hastily scribbled notes and mentally resolve to look into them.
But really, there’s not much more for me to do right now beyond keeping my other risk factors as low as possible. Gone are my cavalier “do as I say, not as I do” days of going for a summer run without bothering much with sunscreen. (My melanoma risk may be slightly increased, too. Thankfully no family history of that one.) Keeping my belly fat to a minimum has been an issue of vanity up until now, but I’m mentally recategorizing it as “risk reduction.”
And of course, there’s the mammogram.
***
A few minutes after leading me back to my dressing room, Christie reappears to give me the news that my scan is negative. Even though my diligent probing had yielded nothing alarming, the news is a bit of a relief nonetheless. I grab my things and head out the door. Unless my doctor or I find something that warrants investigation on our manual exams, it may be some time before I’m back.
On my way out, I spy a quilt made from a pair of blue jeans, with lots of signatures going up and down the legs. Feeling it’s best I not linger, I don’t stop to take a closer look. I imagine it tells a woman’s story, and I wonder what that story might be on my drive home. I think of all the women whose lives have been irrevocably changed by what they may have learned in that same suite of rooms. And I take a moment to be grateful that, at least for now, my story is no different than it was when I walked in.
