Influencing Factors of Health Inequity among Male Breast Cancer Patients in Germany

Abstract

Breast cancer (BC) is considered a typical woman’s issue and is quite rare in men (1% of BC cases occurs in men). Accordingly, cancer care systems and research mainly focus on female breast cancer patients (FBCP), and men are underrepresented. There is less knowledge on male breast cancer (MBC) within patients and society, and male breast cancer patients (MBCP) have lower survival rates than FBCP. It remains unclear how MBCP fare with regard to the female-dominated cancer care situation and what constitutes health inequity. Therefore, a medical sociological perspective can help to understand health inequities, as it is a focus of this discipline. The theoretical approach of Mielck (2005) is used in this study, which aims to find out what could cause health inequities of MBCP in Germany, in order to be able to avoid health inequities for them in the future. Therefore, mediators for health inequities such as differences in health burdens, coping resources and provision of health care are regarded. <br /> Within this cumulative dissertation, a mixed methods design is applied using data of the interdisciplinary N-MALE project (Male breast cancer: Patients’ needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care), conducted in Germany. Semi-structured interviews with N=27 MBCP and standardized survey data of N=100 participants were evaluated. <br /> Findings show that differences in health burdens, coping resources, and provision of health care can be found within MBCP. Differences in the experience of having BC for men and women include stigmatization due to ignorance of MBC and feminization of the disease, difficult access to gynecological care for MBCP, study uncertainty in medication with tamoxifen and inconsistent follow-up regulations. Among MBCP, the number of treatment steps taken and the age of the patients are different with regard to experienced stigmatization and the use of social support. Differences in cancer care can be found especially in diagnosis and follow-up care. <br /> To prospectively reduce health inequities in MBCP, structural barriers should be eliminated. To do this, there must be more publicity about MBC, greater equality of men and woman in BC therapy, and improved access to gynecological care for MBCP. Future research should be extended to health care systems of other countries and the analysis of health inequities of MBCP with routine data.