Osteoporosis, Breast Cancer, and Eating Disorders: Not Just for Women
Seymour, 70, noticed a patch of what looked like blood on his pajama top three years ago and thought he had cut himself. But he wasn't scratched. His doctor tested the discharge and told the New Jersey man he had breast cancer .
Dan, also 70, a retired Michigan engineer, was pulling weeds three years ago. For no apparent reason, he fractured two vertebrae. Doctors told him his bones were wasting away. He has osteoporosis .
As a teenager, Gary was obsessed with having a trim, "athletic" body. The Wisconsin resident shunned food and exercised excessively. Sometimes he'd do sit-ups and push-ups for three hours before school. He ate little and shrank from 160 to an unhealthy 104 pounds. Over a six-year period, he was hospitalized four times. Now 26, Gary says he is "completely recovered" from his eating disorder.
What do these men have in common? They all suffer from illnesses typically thought of as "women's diseases." Breast cancer, osteoporosis, and eating disorders all occur in men, too, though their prevalence is much greater in the female population. As a result, many men, unaware that the diseases affect both sexes, may fail to recognize symptoms. Likewise, doctors and families often don't suspect these illnesses. This can delay therapy and make disorders difficult to treat.
Medical experts say men may shy away from seeking medical treatment for disorders they feel are unmasculine. In support groups, men use terms like "very scared" and "ashamed" to describe initial feelings about their illnesses. Others express frustration at the difficulty in finding information and therapy.
High on the list of such conditions is osteoporosis. Though women are four times more likely to acquire it, about two million men in this country have osteoporosis and another 12 million are at risk, according to the National Osteoporosis Foundation. In fact, the American College of Physicians (ACP) recommends that older men are screened for this condition. The ACP also recommends that those who are at increased risk and are candidates for drug therapy should have bone mineral density testing done.*
A disorder in which bones become weakened, osteoporosis is sometimes called the "silent disease" because it has no symptoms. It often manifests itself in fractures of the hip, wrist, spine, and other bones. Among both sexes, it is responsible for 1.5 million fractures a year. Scientists are still piecing together just how osteoporosis develops, but it is well known that a key factor is deficiency of the mineral calcium.
About 99% of the body's calcium is stored in bones and teeth. Bone is continually being broken down and rebuilt. If the amount of calcium absorbed equals the amount lost, a state of balance occurs. When dietary intake of calcium can't meet the body's needs, the body draws the mineral from bones to allow a constant bloodstream supply. Ultimately, the breakdown process can exceed deposits, causing a possible reduction in bone mass and density.
Osteoporosis is seen less often in men than in women for several reasons. Men generally have greater bone mass than women, and in males, bone loss begins later and advances more slowly. But men do have a hormonal drop in testosterone similar to women's reduction of estrogen after menopause. Testosterone may diminish as a result of hypogonadism, a condition marked by decreased function of the testicles. Testosterone levels may also naturally become lower as a man ages.
Loss of sex hormone accelerates bone loss. Women find relief from osteoporosis with estrogen therapy, and men who have low testosterone levels may respond to testosterone injections. But successes with hormone therapy come most often from seeing young men in the early stages of the condition.
The FDA has approved alendronate (Fosamax), a biphosphonate drug that prevents or slows the weakening of bones, as a treatment for osteoporosis in men. Other therapies have been approved for use in women and may work in men, but they need further study. One such drug, calcitonin (Miacalcin, Calcimar), has been shown to slow bone breakdown and reduce pain associated with fractures attributed to osteoporosis. If doctors see a benefit, some will prescribe this drug for men. Currently under study for osteoporosis treatment are sodium fluoride, which some researchers think may help increase bone mass; vitamin D, which helps the body absorb calcium; parathyroid hormone; and a nasal spray version of calcitonin.
Lifestyle factors that raise the risk of osteoporosis include cigarette smoking, alcohol consumption in excess of two drinks a day, and an inactive lifestyle. Other factors that can increase your risk are long-term use of certain medications, such as steroids or aluminum-based antacids. Also, increasing age, undiagnosed low levels of testosterone, and chronic lung or kidney disease can raise your risk.
Though osteoporosis cannot be cured, it can be slowed down, and steps can be taken to prevent it. The National Osteoporosis Foundation suggests these preventive measures:
Primarily associated with women, breast cancer also occurs in men, although rarely. In the US, an estimated 2,030 men will be diagnosed with invasive breast cancer, and 450 men will die from this condition, according to the American Cancer Society (ACS).
Men typically do not perform breast self-examinations to detect tumors, and doctors do not ordinarily examine men for breast cancer during physicals. Unlike women, men do not get routine mammograms. Consequently, a tumor may be present and go undiscovered.
As with breast cancer in women, symptoms include the presence of a breast lump that is usually firm and painless. The nipple can have an abnormality such as retraction, crusting, or a discharge. Patients frequently are over 60.
According to the ACS, risk factors for male breast cancer include:
- Age—Sixty-five is the average age at diagnosis for men with breast cancer.
- Family history of breast cancer—About one out of five men with breast cancer have a close family relative with the disease.
- Prior radiation exposure to the chest—This is usually from treatment of another cancer.
- Liver disease—This can lead to higher estrogen levels and gynecomastia.
- Gynecomastia (enlargement of the male breast)
- Hyperestrogenism, estrogen treatment (eg, for prostate cancer) or abnormal secretion of the hormone estrogen
- Klinefelter's syndrome—This is a male disorder characterized by reduced or absent sperm production, small testicles, and enlarged breasts
Though medical professionals typically don't recommend detection exams for the general male population, doctors may advise men with gynecomastia to perform periodic breast self-examinations.
As in women, the approach to treatment is geared to the stage, or extent, of the disease at diagnosis. Since there are so few cases of breast cancer in men, the data on effectiveness of treatment comes from clinical trials in women. If the cancer is found in an early stage before it spreads to surrounding tissue or to the lymph nodes, surgical removal of the breast and lymph nodes is often all that is required. For cancers larger than half an inch, or when lymph nodes are involved, some additional (adjuvant therapy) is recommended. Depending on the type of cells in the tumor, and a person’s general health, hormone, radiation, or chemotherapy may be used. Later stages of breast cancer may be treated with multiple adjuvant therapies. If the breast cancer has spread to other organs, a regimen of hormonal or chemotherapy is tailored to each patient. Once hormonal or chemotherapy is not longer effective, there are still options for immunotherapy as well as other treatments to relieve symptoms.
Possible complications after surgery or radiation include decreased shoulder function, fluid retention in the arm, and pain or stiffness in the operated or radiated area. The ACS emphasizes that, besides tending to the physical consequences of breast cancer therapy, "attention should be paid to the psychological aftereffects."
Patients also need follow-up monitoring—including regular exams, blood chemistry, imaging (such as magnetic resonance imaging), and bone scans—to discover any recurring tumors quickly.
Though many people associate eating disorders with women, these illnesses also occur in males. In one disorder, anorexia nervosa , the person limits food intake to the point of starvation. In another, bulimia nervosa , sufferers alternate between eating large amounts of food and ridding the body of it through vomiting or laxative use. About half of those with anorexia also have bulimia symptoms.
According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), men make up about one million of the eight million Americans with eating disorders.
Medical professionals say the disorders most often surface during the teen years, but in rare cases, men as old as 60 and boys as young as eight can be afflicted. In both sexes, the illnesses can lead to lifelong medical and psychological complications. An estimated 6% of cases result in death. Most people find it difficult to halt the behavior without professional assistance. Though some men ultimately seek help, many continue untreated with the disorders, often for years, and sometimes for a decade or more.
Diagnosis is complicated by a reluctance some men have to seek medical help for disorders that are still primarily related to women. Many men are ashamed to have an illness of this type and thus, suffer in silence.
Another problem is that a great number of doctors and healthcare professionals are not trained to identify or treat male eating disorders, especially anorexia. Families, too, often fail to see the diseases' symptoms. The illnesses then can progress to a more advanced stage where they are harder to treat.
Unlike many women, who acquire eating disorders because they "feel" fat, men often are medically obese at some point in the illness and feel pressure to be thin. Sometimes athletic activities induce this struggle to be lean, prompting not only the eating disorder but also compulsive exercising. Men also may adopt disease behaviors when teased or criticized about being fat at critical development stages, such as puberty.
Treatment can be very effective, according to Arnold Andersen, MD, an expert on eating disorders in men. Andersen wrote a book on the subject of eating disorders in which he describes a regimen of inpatient or outpatient hospital treatment, depending on the severity of the illness. In his book, he provides information on how to treat conditions, such as anemia and depression, advice on proper eating habits, and some psychotherapy, which helps men understand why they have the illness.
One option for men during recovery is a support-group, but men are sometimes unwilling to participate in support-group sessions because the groups are mostly female. Another option is antidepressants. One such drug, Prozac (fluoxetine hydrochloride), is FDA approved as a treatment for bulimia. Other antidepressants also are being studied. One, Wellbutrin (bupropion), was shown to induce seizures in both anorexia and bulimia patients, and should thus be avoided in these people. Doctors sometimes prescribe tricyclic drugs—a class that includes Elavil (amitriptyline), Tofranil (imipramine), and Norpramin (desipramine). FDA has approved tricyclics for other uses but not specifically for eating disorders. However, doctors may prescribe approved drugs for "off-label" uses if, in their judgment, the patient will benefit.
Patients also undergo what Andersen calls "nutritional rehabilitation," which allows them to regain a desirable body weight. Treatment is followed by weeks, months, even years of follow-up to ensure complete recovery.
Men in support groups for eating disorders, as well as those for breast cancer and osteoporosis, say the public gradually is becoming more aware that these disorders can occur in men. They also say there's a long way to go. Some think doctors need to be enlightened. Others bemoan the lack of research. But most seem to agree that men should be educated about the disorders and how to detect them.
National Association of Anorexia Nervosa and Associated Disorders
National Cancer Institute
National Osteoporosis Foundation
Bulimia Anorexia Nervosa Association
Canadian Cancer Society
Breast cancer in men. University of Maryland Medical Center website. Available at: http://www.umm.edu/men/brstcan.htm. Accessed November 16, 2005.
Detailed guide: breast cancer in men—what are the key statistics about breast cancer in men? American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_male_breast_cancer_28.asp?sitearea=. Accessed October 19, 2007.
Food and Drug Administration. FDA Consumer. 1995;29:6.
Men and osteoporosis. National Osteoporosis Foundation website. Available at: http://www.nof.org/men/. Accessed October 12, 2007.
*5/20/08 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;148:680-684.
Last reviewed October 2007 by Rosalyn Carson-DeWitt, MD
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