By Kristy Hutchings,
Contributing writer
It began as a dull ache.
Nilton Fonseca’s right breast began hurting in summer 2019. But rather than rush to the doctor, the Redondo Beach resident, now 54 years old, decided to treat the on-and-off aches in his chest with the occasional pain reliever or hot compress.
Fonseca’s home remedies worked for a time.
But in November, intense chest tightness hit three weekends in a row, seemingly resistant to his self-care methods. Fonseca could no longer ignore it.
He feared it was a heart attack.
A trip to urgent care dispelled that concern.
A series of tests followed in the months ahead, spurred by a lump the urgent care doctor discovered. It wasn’t until April 2020 that he received a diagnosis:
Fonseca had breast cancer.
“I was just floored,” Fonseca said. “Why me? That was the first thought that came to my mind.”
He had reason to be floored. Breast cancer in men is rare.
In the United States, about one of every 100 breast cancers are diagnosed in men. Women, however, face a one in eight chance of developing breast cancer in their lifetimes — and breast cancer is the second most common type of cancer among women, according to the American Cancer Society and the Centers for Disease Control and Prevention.
This year alone, the ACS estimates, around 281,550 new cases of invasive breast cancer will be diagnosed in American women — and that around 43,600 will die from the disease.
Breast cancer, no matter who develops it, is a serious and potentially deadly illness that has life-altering impacts.
Fonseca, who will share his experience at Cancer Support Community Redondo Beach’s 24th annual Celebrate Wellness fundraiser later this month, said he hopes to shed light on some of the specific challenges men with breast cancer face — and why early detection and self-monitoring are vital. For everyone. Men and women alike.
“I know that this isn’t maybe that common amongst men. I think there’s probably other men out there, they’ve had breast cancer, but they don’t really want to talk about it,” Fonseca said. “But I usually talk about it more, especially with my male acquaintances and friends. We do live in ignorance.”
Exams, biopsy and diagnosis
Fonseca’s challenges began before he even received his breast cancer diagnosis.
After discovering the lump in Fonseca’s right breast, the doctor referred him to an imaging center for a mammogram and ultrasound.
Mammograms are common for women.
But Fonseca, among the rare number of men who require such tests, had trouble getting his insurance company to approve a mammogram.
It took a few months to get the OK, Fonseca said – only to be turned away at the imaging center because the doctor’s order had been written incorrectly.
“Because men don’t get breast exams regularly, there were just little glitches like that along the way,” said Nancy Lomibao, a licensed marriage and family therapist and chief clinical officer of CSCRB, who’s familiar with Fonseca’s experience. “From the get-go, they’re at a little bit of a disadvantage having a type of cancer that’s just not recognized in general for men.”
And as Fonseca, an international construction director, waited to clear up the confusion with the imaging center, he was called out of state for work— and he left without getting the test.
“The whole issue of the breast discomfort was put on the side,” Fonseca said, “and the symptoms sort of went away during that time.”
But then the coronavirus pandemic hit – and his company sent him home.
Fonseca, a husband and father of three, returned to Redondo and arranged an exam appointment.
During the April 2020 ultrasound and mammogram, doctors recommended a same-day biopsy on the lump.
Not long after, his primary-care physician called him and broke the news: He had breast cancer.
The pandemic and subsequent shutdown, however, may have helped save him.
The cancer, after all, had already started spreading.
Early detection is essential to stopping cancer before it spreads and to the overall prognosis.
Survival rates for women with breast cancer, for example, vary significantly based on how early the disease was caught.
The five-year relative survival rate for localized cases – meaning the cancer hasn’t left the breast – is 99%, according to the ACS. Regional cases, where the cancer has spread slightly outside the breast, have a relative survival rate of 86%.
Cases where the cancer has spread to other parts of the body, meanwhile, see that percentage crater – to 28%.
Had he been diagnosed earlier, Fonseca’s medical team may have been able to treat the cancer before it spread to his lymph nodes.
Still, his treatment got underway quickly.
Within a month of his diagnosis, Fonseca had a mastectomy and a lymph node dissection.
And he approached the treatment with the same mentality he used at work.
“In construction, you approach everything like a project, with a starting and an end date,” Fonseca said. “And that was me. That was my project. I got to get through this. This is my next stage. And that’s all I was focused on.”
Fonseca’s doctors removed 12 lymph nodes that tested positive for cancer from his right underarm. He developed some nerve damage and is now at risk of developing lymphedema, the swelling of the lymph nodes. Both are common side effects of the surgery.
“I still feel tingling sensations, or even like somebody running a cold spoon on the outer arm,” Fonseca said. “But it was basically to save my life.”
After the surgery, though, came a potentially scarier treatment. Chemotherapy.
Finding community
Chemotherapy is not for the squeamish.
It’s essentially pumping poison into the body and hoping it kills the cancer before killing the patient.
Fonseca witnessed the cost years earlier when a close friend had chemo.
“Her decline was very quick. She told me many times that she didn’t even want to live,” Fonseca said. “That was the part that scared me the most.”
“I was honestly scared,” he added. “Chemo basically is the proverbial throwing the baby out with the bathwater.”
But he didn’t really have anyone with whom he could share his fears.
Fonseca said he internalized the trauma. He didn’t divulge everything to his family. He didn’t want to be a burden.
But then, before starting chemo, he found Cancer Support Community Redondo Beach. That nonprofit offers free services to anyone diagnosed with cancer.
Aside from support groups and individual counselling sessions, CSCRB provides its members with social events, exercise and nutritional classes, and wellness activities to help them learn about and cope with their cancer diagnoses and treatments.
“It really is about community,” said Joey Shananan, executive director and CEO of CSCRB. “We find that people, even decades later when they’ve recovered from their cancer diagnosis, are still friends.
The support that they give each other,” she added, “is just as important as the professional support that they’re given by our staff.”
The organization’s support group offered Fonseca an outlet.
“You’re in a forum with peers who are going through the same things you have, or they’re in different stages of their journey,” Fonseca said. “So you can speak more openly about it.”
The support group also provided Fonseca with practical advice: tips on how to prepare for the process of chemotherapy and how to handle the side effects – from people who had been through it themselves.
Still, the 12 weeks of chemotherapy were brutal.
He lost his hair and eyelashes. His fingernails and toenails turned black. He was fatigued and severely nauseated after chemo sessions.
Then, in January, he started radiation treatment, a standard post-chemo protocol.
Fonseca received radiation therapy every day for about four weeks.
“You do get some of your skin slightly burned,” Fonseca said. “Luckily for me, my skin didn’t break. Some of the ladies in my group have had radiation and they’ve had their skin break, and it becomes a bit raw and painful.”
Fonseca’s treatments proved successful, however. He’s been in remission since February.
“Yes, it’s a ‘yay,’” Fonseca said. “But I thought it was going to be a big celebration. But it’s OK. That’s good to know. It’s just been a process.”
Struggles continue
Fonseca’s battles, though, did not end there.
One of the most challenging components of his entire cancer experience, he said, were the months spent wrestling with his insurance company to find a qualified surgeon to perform male breast reconstructive surgery.
An initial meeting with a surgeon provided by Fonseca’s insurance company went poorly, he said.
Fonseca said he felt dismissed by the surgeon’s outlook on male breast reconstructive surgery, who told him that women need reconstruction more than men.
“At least that’s the way it came across to me,” Fonseca said. “That men don’t really need to have reconstructive breast surgery.”
Fonseca petitioned his insurance company to allow him to seek out-of-network services, but was denied twice.
He even pleaded his case with the Department of Managed Healthcare, California’s health care regulatory body — but the agency sided with the insurance company. Fonseca was forced to stay in-network.
After a long search, Fonseca found a surgeon he liked.
He underwent the first of many reconstructive surgeries planned to reshape his right breast and nipple three weeks ago.
“It’s something that hits you, and it’s really hard,” Fonseca said about the mastectomy. “So for me, I want to go all out and just become whole again.”
Fonseca must also remain “under surveillance,” as he put it, by his doctors.
He takes a pill daily to prevent the production of hormones that helped the cancer develop, he gets mammograms and breast examinations regularly, and he schedules check-ups every three months.
“It’s now keeping an eye on it, and always in the back of my mind is whatever happens, happens,” Fonseca said. “I’ll be ready for it.”
Now, Fonseca puts his energy toward educating the people around him, both male and female, about the need for proactive and preventative health-care when it comes to breast cancer.
The message, for Fonseca, is simple:
It’s as easy as a self-exam.
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