It felt like a pulled muscle in his upper chest. He rationalized it was probably caused from his golf swing. Then he received a huge bear hug from a close friend that sent shooting pain up through his shoulder. "I thought it was just from getting older and even being a little flabbier," jokes Harvey Singer. The warning signs in his body didn't wane after four months or so and, having a sister with a BRCA mutation and three occurrences of breast cancer, Harvey knew, in October 2008, it was time for a medical exam. This began his journey with hereditary male breast cancer and prostate cancers.
"I knew it was coming," Harvey sighs. "The fact that my sister is BRCA2 positive and already had breast cancer, I didn't have much doubt. Still, the doctor looks at me and tells me I have breast cancer and there was just shock and surprise that I could get a 'women's disease.'" The disbelief still resonates in his voice more than five years later.
Three weeks after his breast cancer diagnosis, Harvey, 54 years old at the time, underwent a complete mastectomy of his left breast. Although his lymph node dissection was negative for traces of the cancer, his Oncotype DX test, which quantifies the likelihood of disease recurrence in early-stage hormone estrogen receptor positive breast cancer and assesses the response from certain types of chemotherapy, revealed a high likelihood of a recurrence.
From visits with his internist to surgeons to three oncologists, Harvey quickly discovered there was a definitive and consistent lack of information for treatment of male breast cancer. "I saw three oncologists, actually four," he explains, "as I ran into one from Dana Farber in a snow storm, but the three opinions had three different regimens." Frustrated and confused, he questioned every decision he had to make regarding chemotherapy and hormone therapy. After analyzing what little literature he could find from the internet and comparing notes from the doctors, Harvey decided to have Cytoxan and Taxotere chemotherapy followed by Tamoxifen therapy.
As a result of his mom, aunt, and sister having had breast cancer and his sister's BRCA mutation, Harvey knew genetic testing was also part of his cancer treatment plan and met with a genetics counselor soon after his mastectomy. The test showed he is BRCA2 positive. Harvey is one of the 5-10% of male BRCA2 carriers that develops breast cancer and one of the up to 15-25% of male BRCA2 carriers to develop prostate cancer. BRCA2 carriers also have an increased risk of pancreatic cancer and melanoma.
In 2006, Harvey was under the care of a urologist who monitored his blood level of Prostate-Specific Antigen, which can be elevated in men with prostate cancer. "I had my first prostate biopsy in 2007," he recalls. "It was negative. My PSA was 6.8 at the time." Over the next few years, Harvey's PSA levels continued to rise. At one point the levels jumped every six months and he had another prostate biopsy. "So now I had prostate cancer. I feel maybe my doctor missed it," he says, exasperated. "Having a BRCA2 mutation, there was no option than to have a prostatectomy," he says. That surgery was in June 2010.
Diagnosed with two different BRCA2 cancers 18 months apart, Harvey began researching every possible way he could improve his health and immune system. "Hope is not a strategy," he asserts, "and sugar is the ultimate enemy of cancer because it depletes the body's immune system to fight off diseases. I personally believe this has much to do with cancer." In 2010 Harvey began a ritual of maintaining a healthier lifestyle by reducing sugars, including his intake of alcoholic beverages, and adding more greens and all organic foods to his daily diet. "I've already had BRCA induced cancer twice," he emphasizes. "My life now is about preventing recurrence."
Ongoing screening is a vital part of Harvey's prevention plan. "I'm screened for PSA, I get a breast MRI, mammogram, and also an endoscopic ultrasound for my pancreas annually. The doctor's appointments are never ending," he sighs, "But if I don't do it, it could be detrimental to me."
To help cope with the stresses of managing and living with hereditary cancer, Harvey sees a therapist on a monthly basis. "I seek positivity in my life and try not to dwell on the negatives. My biggest fear is that I did pass this gene along to one or both of my sons. This is the hardest part." Neither of his sons, 29 and 31, are planning on marrying and having children anytime in the near future. "My wife and I have discussed all aspects, as they are grown men with lives and careers. They have decided to wait on genetic testing."
In addition to therapy, Harvey and his sister, Vicki Singer Wolf, in 2010, founded His Breast Cancer Awareness, a non-profit organization that fills the information void on male breast cancer prevention and treatment. "I tell people I have two full time jobs, one that pays me, one that rewards me." This organization serves as a resource for men and their families. To Harvey, the foundation "is as therapeutic for me as it is for them."
One of the most essential things Harvey learned during his journey is, "You have to be your own advocate." He believes it's extremely important for men to check their breasts. "They should ask their doctor to check their breasts at their physical exams. The doctor usually checks the prostate, might as well check the breasts. And it only takes a minute or two," he advises.
More than five years have passed since Harvey heard the words, "You have breast cancer."
He is doing everything in his power to ensure this uninvited guest does not return. Routine surveillance, eating healthy, and staying fit with regular exercise are his primary tools for prevention of recurrence or new cancers.
"I live with the fear of recurrence as all cancer patients do. It is still a work in progress. It will always be a work in progress," he says, recognizing the reality of his situation. "I will always be a cancer patient no matter how healthy I am."