Breast cancer in men; women with thinning hair; children with high cholesterol; men with large breasts (gynecomastia); and skin cancer among blacks. They may not occur frequently, but these conditions, usually associated with different genders, races or ages, should not be ignored.

In the early 1970s, on-screen private eye John Shaft was the epitome of urban male “coolness.” Years later off-screen, Richard Roundtree, the actor who portrayed Shaft, was diagnosed with a medical condition overwhelmingly associated with women: breast cancer.

Breast cancer is one of those conditions that our brains lock into a single-patient category: the sight of a pink ribbon triggers thoughts of mothers, sisters, wives, and female friends who have battled the disease. Rarely, however, breast cancer does occur in men. In this article, doctors from University Hospital discuss male breast cancer and some other unusual but not insignificant medical paradoxes: large-breasted men who opt for breast reduction surgery; skin cancer in African-Americans; balding women; and children with high cholesterol.

Dr. Suresh Raina

A Small Fraternity

Breast cancer in men accounts for less than 1 percent of all breast cancers; that’s about 1,400 new cases a year, according to the American Cancer Society. “Although uncommon, breast cancer in men definitely occurs,” says Dr. Suresh Raina, chief of staff at University Hospital and a breast cancer expert. “When it does, the man is usually in his 60s or older, and there’s often a family history of breast cancer. But unlike women, who are educated about self breast exam early on, most men are blasé about the knot they feel in their breast. They tend to shrug it off.” While most lumps found in men’s breasts are non-cancerous, breast cancer leads to the deaths of about 400 men each year. Dr. Raina advises anyone with an unusual knot, lump, or thickening in the breast or other breast abnormalities, such as nipple discharge, to see a doctor.

For the most part, breast cancer in men is similar to the female version. However, there are some important differences. “A man with a breast abnormality typically waits longer than a woman would to see a doctor, increasing the possibility that the cancer will be in an advanced stage when it is diagnosed. And unlike women’s breasts, which contain a fair amount of tissue, men’s breasts are leaner. They don’t have much tissue, so the cancer often grows into the muscle,” says Dr. Raina. “Also, while lumpectomy is an option for some women, it’s difficult to conserve the breast in men. Men are usually treated with modified radical mastectomy, which is supplemented with chemotherapy when needed.”

Mr. Roundtree had both chemotherapy and a mastectomy, and today he’s not only a film icon, he’s a breast cancer survivor.

To arrange for a consultation with Dr. Raina, call (973) 972-2400.

	Dr. Mark Granick

When Less is More

Some non-cancerous breast lumps found in men are associated with a condition known as gynecomastia, in which the breasts are also unusually large.

“The breasts take on a more feminized appearance in boys and men with gynecomastia, a benign enlargement of male breast tissue. This can be tremendously embarrassing and even socially limiting to them,” says Dr. Mark Granick, professor of surgery at the New Jersey Medical School and chief of plastic surgery at University Hospital. “A man with gynecomastia might refuse to swim without a shirt on, and for boys, the teasing can be relentless.”

There are few things more embarrassing for a man than to have enlarged, feminized breasts (gynecomastia). Most men with this condition avoid swimming and other sporting activities where their deformity can be easily seen. Fortunately, it is now relatively easy to achieve normal looking male breasts using minimal incisions. A combination of liposuction and direct removal of the excess tissue can correct most cases of gynecomastia.

What causes this unusual growth in men’s breasts? For adolescent boys, gynecomastia is often the result of a natural growth phenomenon that resolves within one or two years. But liver failure, obesity, certain over-the-counter drugs, endocrinological problems, and marijuana use can lead to gynecomastia, which is why a thorough physical exam is necessary. “Most often, though, there’s no identifiable reason,” says Dr. Granick.

Some gynecomastia patients - about 9,000 in 1999 - have surgery to reduce the size of their breasts and thus, eliminate any embarrassment. The minimally invasive, same-day procedure typically involves removal of excess breast tissue and liposuction; extra skin can be tightened up as well.

For more information about the Cosmetic Surgery Center at University Hospital or to arrange for a consultation with Dr. Granick, click here.

Raising Awareness
about the Sun’s Rays

By far, melanoma, an often-deadly type of skin cancer, occurs in lighter-skinned people more frequently than those with darker complexions. “People with darker skin are blessed with a natural photoprotection from the harmful ultraviolet (UV) rays that can damage the skin,” says Dr. Robert Schwartz, professor of dermatology at New Jersey Medical School and director of dermatology at University Hospital.

However, a darker shade of skin is not a 100 percent barrier against UV rays, and people with dark complexions can develop skin cancer. “Acral lentiginous melanoma (ALM) is the most common type of melanoma (a dangerous skin cancer) found in darker-skinned patients,” says Dr. Schwartz. “ALM typically develops on the soles of the feet and the palms of the hands. While it is an uncommon form of melanoma, ALM can be very aggressive.”

A March 2000 study in the Cancer Epidemiology, Biomarkers & Prevention journal reported that melanoma was the cause of death for about 2,300 blacks from 1973-1994; during the same time period, about 123,000 whites died of melanoma. The study’s researchers also suggested that the more blacks are exposed to sunlight, the more likely they are to develop skin cancer.

For more information about Dermatology at The University Hospital or to arrange for a consultation with Dr. Schwartz, call (973) 972-DERM (3376).

Hair Loss in Women

For many women, hair is their “crowning glory.” So when hair begins to thin excessively, especially when the woman is young, it can be very upsetting. Baldness can be equally upsetting to men, but American society is often more accepting of a bald man than a woman with thinning hair.

“The most common reason for hair thinning or hair loss in men and women is an inherited condition known as androgenetic alopecia,” says Dr. Robert Schwartz, professor of dermatology at New Jersey Medical School and director of dermatology at University Hospital. “But there are other explanations for hair loss in women: thyroid problems, emotional stress, and hormonal changes. Even some things women do to their tresses, such as the tight braiding of hair, can cause hair loss.” Because the reason for hair loss isn’t always straightforward, Dr. Schwartz advises anyone concerned about the problem to see a dermatologist.

For some women, the answers to hair loss are simple: style the hair over the thinning area, or braid the hair more loosely. But for women with hereditary hair loss, there are products available that contain minoxidil, a topical solution that can stimulate hair regrowth. Minoxidil can be helpful for some women, but only as long as it is used. Hair replacement surgery, such as grafting hair from one area of the head to another, can be a longer lasting, if more expensive, option.

To arrange for a consultation with Dr. Schwartz, call (973) 972-DERM (3376).

High Levels, Young Hearts

A high cholesterol level—a total 200 mg/dL or above— is usually considered an adult problem. Increasingly, however, medical research indicates that children and adolescents can have high cholesterol levels, which can lead to coronary artery disease later in life.

According to the American Heart Association, about 1 of 10 adolescents (12 to 19 year olds) have total cholesterol levels above 200. That’s significant, says Dr. José Antillon, associate professor of pediatrics at New Jersey Medical School and a pediatric cardiologist at University Hospital, adding that a study of young people who died in their late teens showed many had formation of fatty deposits in their blood vessels.

“Family history is the biggest risk factor associated with high cholesterol in children. If a parent, grandparent, or aunt or uncle died at an early age from coronary artery disease, then we might begin testing cholesterol levels of the related children as young as two years old,” says Dr. Antillon. Overweight is another risk factor that could lead a doctor to recommend cholesterol testing, but not every child needs to have his or her cholesterol levels checked.

When high cholesterol is suspected in a child, two especially sensitive blood tests are recommended to precisely measure the HDL and LDL levels. If theses tests confirm a high level of LDL (the “bad”) cholesterol, then a plan is created to lower the levels through a modified diet and increased physical activity. Well-balanced meals and healthy snacks that include five servings of fruit or vegetables a day and limit the daily intake of saturated fats to 7 percent of total calories and cholesterol to less than 300 milligrams, as well as regular exercise, can help many of these children. “Ideally, these changes are made by the whole family. It’s difficult for the child if she’s trying to eat healthy foods while the rest of the family eats ice cream and potato chips,” says Dr. Antillon. “The parents should be the role models in terms of the food they eat, the activities they do, and by stopping smoking, if they use tobacco products.” He cautions that children two and younger need higher levels of fat in their diets to promote growth and development, and should not be placed on a low-fat diet.

In cases where diet and exercise fail to lower a child’s cholesterol, the drug lovastatin can be prescribed. It is approved by the Food and Drug Administration for use by children.

To arrange for a consultation with Dr. Antillon, call (973) 972-0543.