Breast not Chest – why calling #malebreastcancer by its correct name is critical

There has been some recent discussion about how to talk about male breast cancer, specifically whether to use the word breast or instead euphemize it with ‘chest’. I wanted to share my opinion, which is based on my training as a cancer biologist and my experience as a survivor. In brief, using the correct word, breast, is vital.

Breast is correct

The main reason to call the male disease ‘breast cancer’ is that this is correct. Cancers are named and classified based on the tissue or organ from which they arise, because this classification is biologically and medically meaningful. A key step in any medical treatment is accurate diagnosis, and this is delivered in the form of a label that tells people what they are dealing with.

Breast is the name of the organ or tissue of origin for breast cancer. Most male breast cancer is of a type called ductal carcinoma, which simply means that the cancer arises from the malignant transformation of the cells that form the ducts of the breast tissue – the tubes through which milk flows in active breasts. Calling it by the right name tells you things that are important. For example, breast tissue is hormone responsive and so are most male breast cancers. Carcinomas have a well described series of stages of invasion and spreading that help classify the disease’s severity.

The chest is not an organ, or a tissue, but rather a region of the body. The google definition of chest is: “the front surface of a person’s or animal’s body between the neck and the abdomen”. As such, medicine or biology do not recognize the term ‘chest cancer’ and so it does not carry any useful information. You could, I guess talk about cancer ‘in the chest’ but this could be any number of types of cancer. For example, you have organs in the chest such as lungs. Also, in addition to breast tissue you have skin, muscle and bone in the chest (and in many other areas of the body). So a cancer in the chest could be from any of these. Since they have very different biologies and so medical approaches, the location in the chest is not a good way to classify or describe them.

Conflating location and cancer type is not unusual. For example, often when lay people or the press refer to ‘brain cancer’ they are actually talking about metastatic cancer from another tissue that has appeared in the brain (this is relatively common) rather than a cancer that arose from the brain’s tissue (relatively rare). This leads to misunderstandings.

In regards to breast cancer, in some instances, diagnosis occurs at the metastatic stage – the cancer has already spread around the body. Given that men are often diagnosed relatively late, diagnosis at the metastatic stage is more common among men. In such cases the therapy may not focus on the ‘chest’ at all, but may very well focus on the fact that it is a hormone driven cancer that originated in the breast. Talking about chest cancer in such a case is far from helpful.

Using the correct term is essential if you want to have meaningful conversations with others. This includes caretakers, of course (and they are not going to use ‘chest cancer’) but should also include everyone. Imagine talking about ‘chest cancer’ to a friend or relative and they then go and google it. What would they find? The top hits I just got were about thoracic cancers and chest wall cancers – very different diseases from breast cancer, with different treatments and prognoses. Or, let’s imagine you are looking for a clinical trial to join – searching for ‘chest cancer’ will not give you the results you are looking for. Using the right name empowers everyone to understand what is going on and find the information that they need to manage the disease.

Stigma is defeated by openness

I understand that some people use ‘chest cancer’ because they feel it relieves the supposed stigma of a man having ‘breast cancer’. I believe that this is misguided. Sure, when I was diagnosed and my elementary school-aged son mentioned it at school he got kids saying “your dad has breasts!?” and smirking. But he managed it well – explaining that men do have breast tissue, although it is not active. I think we can all do what he did.

Let’s not forget that back in the 1970s all of cancer was taboo and people could not talk openly about it. It was women with breast cancer that led the change, showing courage and determination in bringing the topic into the open, and thanks to them people can now talk about their disease freely. They had to overcome the stigma of a disease that affects a body part that has a complex role in human society, sexuality and culture and they managed it. I expect nothing less of men – we should not be concerned that admitting the biological reality that men have breast tissue and can develop breast cancer will make us less manly. In fact, I would argue, calling it by a wrong name communicates that we should feel shame and that it needs to be hidden, and so worsens the stigma That is just wrong to the people who have been diagnosed and their loved ones. Again, using the right name empowers everyone whose life has been affected by male breast cancer.