Male breast cancer is a rare condition; about 1% of breast cancer cases in the UK are in males. It usually affects men over 60 year old, and the risk factors include genetic predisposition and family history, hormonal factors, or previous radiotherapy to the chest. The presentation is similar to female breast cancer, such as a breast lump, changes to the nipples, or small bumps in the armpit. The treatment options for breast cancer can be surgical, radiotherapy, or chemotherapy. This depends on the investigations and the stage of the condition.
You are a healthcare professional who just started working in a surgical ward. Your patient is Mr. Osman, a 64-year-old man from an ethnic minority, who presented with fluid oozing from the right nipple. You noticed that Mr. Osman was capable of making his own decisions, but he seemed to be uncomfortable to talk about his health condition and skipping some details in his medical history. He was accompanied by his supportive wife, Tooba, who attempted to comfort him and encouraged him to give more details about his condition to you. The surgical team’s opinion was to admit Mr. Osman to the surgical ward for further investigations. Mr. Osman was hesitant about his admission, he asked his wife not to tell his five daughters and sons about his condition and frequently asked you about who can see his information and diagnosis.
Within three days of admission, you developed a better understanding of Mr. Osman’s stance and you found him a sociable person who is embarrassed about his condition. The investigations confirmed the diagnosis of breast cancer. You were going with the surgical team to his room to explain the diagnosis and discuss the different treatment options with him.
Before you entered the room, you were stopped by his wife, she asked you about the diagnosis but you were reluctant to share it. She asked you, ‘is everything okay?’, you only responded ‘I have to discuss this with your husband’. The wife perceived the response as something wrong is happening and then she insisted: ‘if the diagnosis is something bad about his breast then do not tell him, tell him it is his skin’, she explained that in their culture the man is the head of the family who should always be strong. She added ‘diseases that affect women are embarrassing and he would prefer to leave the hospital or die than admitting to having such condition’. You knew that his wife had a better understanding of their culture, which means Mr. Osman might not agree to further investigations or treatment, however, you also knew that Mr. Osman is your patient and he should know his diagnosis. The situation you face is whether you should tell the truth to Mr. Osman on his diagnosis or consider his wife’s request.