Arnaldo Silva, a well-built 57-year-old New York City fireman and father of four, was taking a hot shower when he noticed something under his right nipple. It looked somewhat like a large pimple, or an ingrown hair. He showed it to his wife, a nurse, and she suggested he get it checked out by a doctor.
When Silva went to see a doctor, the professional took a look, proclaimed it was just fatty tissue accumulating, and dismissed him to go home with no worries. Months went by, 2006 turned into 2007, and the pimple started growing larger, and lumpier. Silva went to another doctor for a second opinion, and this medic also dismissed it as some sort of fatty tissue, but scheduled a mammogram and sonogram, to be safe rather than sorry.
As Silva sat in the waiting room, patiently, he looked up to see women staring at him. He figured they were probably thinking that he was there waiting for his wife. When asked, he would explain, “No, I’m here for myself.” The funny looks notwithstanding, Silva faced another problem: his medical insurance. Because Silva is a man, initially insurance did not want to cover the cost of the examination, as it is not usually protocol.
A week later the doctor called him into the office to discuss the results: “You have breast cancer. We need to operate right away.” Silva was diagnosed with a Stage 2 tumor.
He had a mastectomy and removed his right breast and 80 percent of his lymph nodes, and was sent home with few explanations, no follow-up, no additional treatment, and what to him seemed like barely any support.
“Men don’t like to talk about this stuff, they don’t understand,” Silva said at a talk in April 2019, as he spoke at the Morris Park 1st annual health fair in honor of minority health awareness month.
He is hardly at fault for not knowing who to go to or what to do. Breast cancer in men affects roughly only 1 percent of the population. In the United States, about 2,670 new cases of invasive breast cancer in men will be diagnosed and approximately 500 men will die from breast cancer in 2019, according to the American Cancer Society. Breast cancer also kills men more quickly than women, because they have less breast mass for the cancer to expand in.
It is about 100 times less common for white men than white women to get breast cancer, and 70 times less common among black men than black women according to the American Breast Cancer Society . Yet, black men, like black women, have worse prospects for survival than white men and women after being diagnosed with cancer. Issues of access and insurance coverage may be part of the reason, but even among individuals of equal socioeconomic status, outcomes are poorer among blacks. Research is needed (and some of it is in progress) to find explanations and solutions for these disparities.
“At first I thought it was an issue of insurance and access, but it may actually be down to biology,” said professor of clinical epidemiology Judith Jacobson, pointing to studies she conducted on beast biopsies among women of different ethnicities.
In fact, black women who develop breast cancer have 40 percent higher mortality rates than white women. Black men and those treated in government hospitals are less likely to be aware of male breast cancer, and are more likely to have their perception of their own masculinity affected, according to the American Journal of Men’s Health.
The ignorance and unawareness of the issue was blatant to Silva. Some of his acquaintances were startled at the news, and told him he must be gay to have breast cancer. As there were no support groups for men, Silva joined a female’s breast cancer support group. His now ex-wife was always close to him, and as a nurse could help him understand the medications and implications of the disease while they weathered the uncertainty. But the doctors, to this day, are surprised when they see Silva’s scars, he says.
“That’s not unusual,” said Jacobson, about the way doctors react to male breast cancer. It’s so uncommon, she says, the disease is even hard to study, as very little research on the illness in men is available. Although she’s conducted years of studies on breast cancer, she’s never studied men’s cases, because the sample of the population is so small. “When you hear hoofbeats, you think of horses, not zebras,” she explains. “But this time it was a zebra.”
But for Silva, the worst was yet to come. When he visited a genetic expert in January right after his diagnosis, he discovered he carried a hereditary mutation of a gene that increases risks of cancer, and that his family was at risk of breast cancer too. Both his son and his daughter were tested and also carried the gene, which is called BRCA. His daughter Vanessa, at the time a healthy 32-year-old mother of three, was immediately diagnosed with Stage 0 breast cancer. Vanessa went through chemotherapy with her father, and then had to have a double mastectomy in 2014 when the cancer reappeared. She’s now starting to talk to her teenage children about the possibility of starting check-ups, and whether they would like to undergo the genetic testing too.
This whole time, Silva says, he has felt angry, guilty and ashamed. Although Vanessa reassures him he’s the reason they caught her tumor in time, he still cannot believe he’s passed on this curse to his children, and that he is the reason their lives were changed forever.
To fight back, the family has started the Male Breast Cancer Coalition, an organization particularly for African American men to help them get over the taboo of having breast cancer. They have also produced a documentary, started a foundation called Live-In-Faith-Everyday, and they visit schools across all of New York City to teach classes and raise awareness, especially among minorities. They go round to community events and health fairs to recount their story, answer questions from groups of listeners, and remind everybody that early detection is key to saving lives.
Silva sometimes even takes his shirt off to show his scars: “Men have breasts too!”
In New York City, uninsured and even undocumented people can access mammograms for free. You can research locations here.