A woman noticed the front of Michael Johnston's T-shirt as he got on the Dana building elevator, and smiled.
"Very cute," she said upon noting the credo "Real Men Wear Pink" across his chest.
Johnston returned the grin, and then surprised the woman by pointing at his chest and replying:
"I only fill it out half-way, you know - really."
It's that unique circumstance that has Johnston visiting Dana-Farber these days: breast cancer treatment.
The burly 56-year-old was diagnosed with the disease this past spring, had his left breast removed through a mastectomy at Faulkner Hospital, and is now undergoing a four-month regimen at Dana-Farber that includes chemotherapy every two weeks.
His case is certainly rare. The American Cancer Society estimates that breast cancer is about 100 times less common among men than women, and men have about a 1 in 1000 chance of getting it during their lifetime.
Even so, Johnson reasons, there are still an estimated 1,910 men who will receive a breast cancer diagnosis in 2009 - and about 440 men who will die from the disease.
So rather than be introverted about facing a cancer symbolized by pink ribbons, Johnston is embracing the opportunity to speak out.
"I had a little bit of a medical background as a former hospital corpsman [healthcare provider] in the Navy, so I knew this could happen - but most guys don't," says Johnston, who still puts in several 12-hour shifts a week at Intel as an electro-mechanical technician.
"It's a very real possibility. Anything I can do to spread the word, I'll do it."
The biggest fallacy surrounding men and breast cancer, says Dana-Farber breast cancer oncologist Beth Overmoyer, MD, is that men don't have breast tissue.
Boys actually have the same small amount as girls until puberty: a few ducts under and around the nipple. Girls' breast ducts continue to grow and expand into millions of milk-producing lobules with the help of female hormones produced by the ovaries, but male hormones constrict such growth in boys.
Still, says Overmoyer, there is sufficient breast tissue for tumors to develop in men, and she estimates she's treated a dozen men in the last 20 years.
"The two major components of breast tissue and breast cancer are cells that arise from either the ducts of the breast or the lobules of the breast," she explains.
"The ducts are round, and make masses in the breasts like baseballs. The lobules look more like trees, and cells stack up like coins, causing more of a thickening than a mass. Ductal cancer arises from the ductal tissue; it's more common in both men and women, but almost all men with breast cancer get this type."
In Johnston's case, he was already more aware of his breasts because he had quadruple bypass surgery eight years ago that severed nerves in his left breast and left it feeling numb. He routinely checked it to see if any sensation had returned, and one night in May he felt a lump.
Johnston credits his primary care physician for insisting he get a mammogram, and says he developed a lot of empathy for women when he had his breasts forced into the machine.
A biopsy later revealed a tumor, and Johnston was given the choice of a lumpectomy followed by six weeks of radiation or a mastectomy. He chose the latter, but turned down reconstructive surgery.
"I know this can be a very emotional decision for women, but it was easy for me," he says. "I already had a big scar down the middle of my chest from my bypass surgery, so I'm used to looking different."
He's also accepted being the butt of unprintable jokes from his buddies at Intel; in addition to appreciating the chance to laugh during this difficult time, he knows he's raising awareness.
His wife, Paula, who is his constant companion during the long chemotherapy treatments he gets in the Dana 10 infusion clinic, keeps her quips G-rated. They are already familiar with the venue, as they spent time there with their son-in-law during his successful treatment for testicular cancer a few years ago.
"Michael and Paula have a wonderful attitude, but this isn't always the case. Breast cancer is often found at a much more advanced stage in men than in women. One reason is because men are embarrassed and delay getting examined," says Overmoyer.
"For decades we thought that male breast cancer acted differently, but it doesn't, and thankfully men now are permitted by the National Cancer Institute to take part in state-of-the-art therapy and clinical trials."
As more men take part in these studies, she says, the road will be easier for those who come later. In the meantime, men in pink like Johnston will be a huge help.
"I've never had a better promoter about male breast cancer than Michael," she says.
"It's awesome, because we need to talk about it more. If we can make men comfortable about seeking care, we can attack this disease on every level."
Although Dana-Farber breast cancer oncologist Beth Overmoyer, MD, stresses that women should get mammograms every two years starting at age 40, she says the test is not practical for men because so few get breast cancer. "The best thing men can do is be aware of their bodies and look for any abnormalities in their breasts," she says.
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