Best line of defense against breast cancer: know your risk, be alert to body changes

Cancer detection is often about noticing a change, something that's not quite right, and doing something about it.

Just ask Darby Steadman. She was used to checking herself for changes. At age 34, she already had a long history of what many women call "lumpy" breasts. She'd had many biopsies, too, which all came back negative.

But during the summer of 2004, she noticed something different about a lump in her left breast that the doctor had been monitoring since 1999 and thought to be benign. It felt larger, and there was discharge from the nipple.

Steadman decided to wait a couple of months to see her doctor, when her kids were back in school and she wasn't so busy.

"I remember the look on the technician's face as she was doing the sonogram. I knew it wasn't good news," said Steadman, now a 46-year-old homemaker living in Tampa with her husband and two children. The doctor suggested a lumpectomy, removal of the lump and a little surrounding tissue, preserving as much of the breast as possible. But Steadman opted for a double mastectomy. She wanted maximum peace of mind.

Three years later she made another troubling discovery: a lump, about the size of a pea, in the area of her left breast. Further testing revealed more tumors: under her arm, in her rib cage, in the bones in her neck and in her lungs. The cancer was back and it had spread.

"Today the recommendation is for women to get five years of the drug Tamoxifen after the initial cancer is found, to prevent recurrences. But that wasn't being done when I was first diagnosed in 2004," Steadman said. She started chemotherapy, including the drug Herceptin, which she still receives nine years later at Moffitt Cancer Center.

"I've been in one clinical trial, taken 12 to 15 different chemotherapies, but I'm most grateful for Herceptin. It's one of the reasons I'm still here," Steadman said with confidence. That, plus checkups every three months and being on the lookout for changes.

"It's important to know yourself and if something is off, go and take care of it," she said.

"Just relying on screening recommendations isn't enough. You need to know yourself. Know your boobs," she quipped.

That advice applies to men, too. Clarence Banken was 65 years old in the spring of 2015 when he noticed a blood-tinged discharge from the nipple of his right breast. While checking it out, he felt something hard and small, about the size of a grain of rice, near the nipple. Banken was about to retire and relocate to Florida, so he decided to wait until he was situated in the Tampa Bay area to see a doctor.

"The doctor said I was lucky to find it when it was so small," said Banken, who is now 66 and lives in Sun City Center. "We caught it at a very early stage and the biopsy confirmed that I had breast cancer."

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Less than 1 percent of men develop breast cancer. The American Cancer Society estimates about 2,600 new cases will be diagnosed in men this year, compared to 246,660 for women. And about 440 men will die from the disease in 2016, compared to more than 40,400 women.

"Men don't have to panic over it, but awareness is important — an awareness of changes in your body," said Dr. John Kiluk, a surgical oncologist who specializes in breast cancer at the Center for Women's Oncology at Moffitt Cancer Center.

"And if something is wrong, doesn't feel right, speak up," Kiluk said. "You must be your own best advocate."

He said he is always amazed at the number of people who don't even think it's possible for men to have breast cancer, which helps explain why men usually have advanced disease when they are diagnosed.

"If a woman feels a lump she's calling her doctor in about 10 minutes. With guys, they say, 'It's nothing, it can't be anything serious,' " he said.

What are the signs of breast cancer in men? Typically, it's a very hard mass, lump or growth in the breast, usually under the nipple.

"We're talking rock hard," Kiluk said. Some, but not all, men have a nipple discharge that may be mixed with blood. A very few will notice a change in the look of the breast, such as an inverted nipple, one that looks as though it is being pulled back into the body. Sometimes, some men will feel enlarged lymph nodes under their arms.

Men who are considered at high risk for breast cancer should be aware of their bodies and be alert to any changes. Those at high risk include men with a strong family history of breast cancer, usually a mother, sister, father, brother or child who had the disease. (Banken's older sister had breast cancer before she was 50 and is doing well today.)

Men who have a history of radiation to the chest and those who have been exposed to high levels of estrogen may be at increased risk. Obesity, heavy alcohol use and liver disease also increase risk.

Kiluk, who was one of Banken's doctors, said Banken was lucky to have found his cancer early. "He's the poster child for, if something isn't right, let's tell the doctor and get it worked up," Kiluk said. "He didn't need radical treatment, just surgery."

Banken chose to have his right breast removed, and doctors also took five lymph nodes under his arm. He now goes to Moffitt for an annual mammogram and recommends that all men begin practicing breast self-examination. "Drop the macho and check yourself," Banken said. "If you find something unusual, have it checked out. It's so important."

Contact Irene Maher at imaher@tampabay.com.