Breast cancer? But I'm fit, I'm healthy... and I'm a man! Breast cancer affects around 370 men in the UK a year The prognosis for men with the disease is worse than it is for women It also goes undetected in men for longer because of lack of awareness Lifestyle factors (obesity, lack of exercise) might increase the risk in men By Mark Palmer Shock: Andy Nichol, 59, was exceptionally fit for his age, so he was astounded to learn not only that he had breast cancer but that he needed a mastectomy As a well-informed, health-conscious man, Andy Nichol knew that men his age should be on the lookout for signs of prostate or bowel cancer. He never imagined that he'd have to worry about breast cancer. But one evening just before Christmas last year, while taking a shower, Andy noticed a small lump under his right nipple, about the size of a tiny pea. It was causing no pain or discomfort, so he thought nothing more of it. I assumed it was a cyst and that it would go away. I knew I was fit, and I had no previous medical conditions, so there was nothing to make me worried,' says Andy, 59. At the time, he was looking forward to an exciting new chapter in his life. He and his wife, Marilyn - with whom he has two children, both in their 20s - were enjoying life in their new apartment in Dubai and having the occasional visit to the UK, where they have a house in Glastonbury, Somerset. They were planning to see more of the world together because Andy had opted for semi-retirement two years earlier after more than 22 years working in finance, latterly as chief financial officer for the international division of Pepsi. Andy was exceptionally fit for his age, having clocked up ten marathons and 50 half-marathons, in addition to playing cricket and football to a high standard in his youth. When he went for a routine medical in Dubai in January, he mentioned the lump in his breast in passing. He was given an ultrasound scan, but the surgeon to whom Andy was referred couldn't tell what it was. He says: 'When I got the ultrasound images I emailed them to Marilyn, who at the time was back in England. I also sent them to my 26-year-old son Cameron, who's a medical student. There was no panic at all on my part. I just thought Cameron might find the images interesting. Cameron found them deeply worrying - and immediately telephoned his mother, who spoke to her GP. 'I was given the name of Simon Cawthorn, a breast cancer specialist at the Spire Bristol Hospital, and made an appointment to see him,' says Marilyn. I did my homework and felt strongly that it was, in fact, cancer. But the hard part was getting Andy to concentrate and treat the issue urgently. I told him to get on a plane. Spreading the word: Andy and his wife Marilyn want to increase awareness of male breast cancer It was only when he and Marilyn walked into Mr Cawthorn's consulting room in mid-April, a full month after the medical, that Andy realised the gravity of his situation. 'Simon said he was 99 per cent certain it was cancer and that the normal treatment is a mastectomy,' says Andy. I reeled in shock. I knew that men could get breast cancer, but I had no idea what a mastectomy would involve for a man. In those first few days I went through many emotions - anger, sadness, self-pity, a sense of "Why me?" Then I thought: "I can get through this."  Breast cancer in women has been one of the success stories of health campaigning, with most now knowing to regularly check their breasts for changes. But what's far less well known is that the disease also affects men - around 370 in the UK a year. As for women, early detection raises the chances of successful treatment. 'The prognosis for men with breast cancer is worse than it is for women, but we don't know why,' says Mr Cawthorn. 'It's also the case that breast cancer in men often goes undetected for longer because the disease does not register with men as it does with women.' Research suggests men who have breast cancer in the family are at raised risk (there is no history of it in Andy's). Another known cause is a rare genetic condition called Klinefelter's syndrome, where men are born with an extra X (female) chromosome. Lifestyle factors, such as obesity, lack of exercise and high alcohol intake might also increase the risk of male breast cancer, although this hasn't yet been established for certain. Professor Anthony Swerdlow, from the Institute of Cancer Research, has been carrying out a study on 1,000 men with breast cancer across England and Wales since 2007. 'We have already found several genetic factors associated with risk, and are optimistic that we can find a great deal more about the cause of this cancer in men,' he says. Thankfully, in Andy's case, his cancer was caught early enough to be successfully treated. Within 24 hours of seeing Mr Cawthorn, he was booked in for surgery and had the operation a week later. A mastectomy is essentially the same for both men and women, but in Andy's case the cancer had spread into his armpits to the lymph nodes, and they had to be removed, too. The four-hour operation was successful, but then there was a wait while the lymph nodes were sent to the U.S. for testing with a technique called Oncotype DX. This can predict the chances of a tumour returning and, therefore, establish how effective chemotherapy would be. 'No one wants chemo unless it's absolutely necessary,' says Mr Cawthorn. On the other hand, no one wants to risk a recurrence, which is why women and men should be offered this test to help them decide. The NHS rationing body, the National Institute for Health and Care Excellence, has recommended that breast cancer patients in Britain should be offered the Oncotype DX, and a decision is due next month. Andy's results showed that the chances of the cancer returning were low, so he didn't need chemotherapy, sparing him the gruelling treatment. Male victims: Breast cancer affects around 370 men in the UK each year This was a great relief, he says, since his son Cameron's wedding was planned for early August, and Andy had visions of himself in the official photographs either bald or wearing a wig. Instead, Andy was prescribed Tamoxifen, a drug often given to women with breast cancer as it suppresses production of the hormone oestrogen, which is known to fuel the growth of cancer cells. Men have lower levels of oestrogen, but still enough to keep cancer cells alive. Andy expects to take Tamoxifen for ten years. Some patients suffer side-effects such as hot flushes and weight gain, but not Andy. In fact, he has shed about 20lb since the operation, mainly through better diet and exercising. Not only did he attend his son's wedding with a full head of hair and a clean bill of health, but - to the surprise even of Mr Cawthorn - nine weeks after his surgery he went ahead with a 1,000-mile cycle ride from Land's End to John o' Groats, planned before he became ill. 'My wife thought I was bonkers and she was probably right' says Andy. But Simon was supportive, otherwise I would not have done it. Andy secured £6,500 for BUST, a small charity in the Bristol area that raises money for equipment to diagnose and treat breast cancer. He has not had any reconstructive surgery (reconstruction is uncommon in male patients). Andy's chest on this side is flatter. But that doesn't bother him, and his scar is 'merging nicely into the background'. But what Andy and Marilyn don't want to fade away is the importance of making people more aware of breast cancer in men. Marilyn says: 'In the beginning, I think he thought: "How can I tell people I have breast cancer, because that's a woman's disease?" I told him he would be a trail-blazer and that he could help other men. Andy is now happy to talk openly about his experience. 'The fact that men can get breast cancer at all is seldom mentioned,' he says. 'And that means there's a big chance it will go undetected. 'I'm one of the lucky ones. Now I want to do something about it. n Visit bustbristol.co.uk. To contribute to Andy's charity appeal, go to justgiving.com/ Andy-Nichol