Management of breast cancer in an Asian man with post-traumatic stress disorder: a case report

Journal of Medical Case Reports, Mar 2016

Background Migration to the UK has increased considerably, which is reflected in the diverse multicultural population which includes asylum seekers and economic migrants. Differences in ethnic and cultural values between the host and newcomer populations could impact on effective health care provision, especially in gender-biased conditions such as breast cancer. Breast cancer is rare in men and the diagnosis is often met with disbelief. This case report describes an unusual case of breast cancer in an Afghan man who is an asylum seeker of Asian ethnic origin. Case presentation A focused ethnographic case study and in-depth interview was used to gain qualitative data and insight into the personal experiences of a male Afghan asylum seeker, age unknown (estimated to be in his 30s), with post-traumatic stress disorder who was electively admitted into hospital for the investigation of a suspicious lump in his left breast, which was subsequently found to be breast cancer. He was extremely reluctant to accept a breast cancer diagnosis and initially would not consent to any treatment, preferring to seek further opinion. During consultation with various members of the breast team he continually declined to accept the diagnosis and felt there was an error in the investigative protocol. Through the involvement of a Muslim nurse, fluent in Urdu and knowledgeable of the Afghan culture and religious background, we learned about his experiences and feelings; he opened up to her about his experiences in Afghanistan, detailing his experiences of trauma as a result of war, and disclosing that he had been diagnosed as having post-traumatic stress disorder by his physician. He saw breast cancer as a “woman’s disease” which deeply affected his feelings of masculinity and left him feeling vulnerable. Conclusions While sensitivity is undoubtedly required when diagnosing gender-biased conditions such as breast cancer in men, our experience showed this is exacerbated in ethnic minority groups where language barriers often exist and awareness of cultural differences is required. Awareness of the possibility of post-traumatic stress disorder in migrant populations from conflict-torn areas is also recommended during consultation.

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Management of breast cancer in an Asian man with post-traumatic stress disorder: a case report

Patel et al. Journal of Medical Case Reports Management of breast cancer in an Asian man with post-traumatic stress disorder: a case report Faaizah Patel 1 Rajgopal Achuthan 1 Lucie Hyklova 1 Andrew M. Hanby 0 Valerie Speirs 0 0 Leeds Institute of Cancer and Pathology, University of Leeds , Leeds LS9 7TF , UK 1 Breast Unit, St James's University Hospital , Leeds , UK Background: Migration to the UK has increased considerably, which is reflected in the diverse multicultural population which includes asylum seekers and economic migrants. Differences in ethnic and cultural values between the host and newcomer populations could impact on effective health care provision, especially in gender-biased conditions such as breast cancer. Breast cancer is rare in men and the diagnosis is often met with disbelief. This case report describes an unusual case of breast cancer in an Afghan man who is an asylum seeker of Asian ethnic origin. Case presentation: A focused ethnographic case study and in-depth interview was used to gain qualitative data and insight into the personal experiences of a male Afghan asylum seeker, age unknown (estimated to be in his 30s), with post-traumatic stress disorder who was electively admitted into hospital for the investigation of a suspicious lump in his left breast, which was subsequently found to be breast cancer. He was extremely reluctant to accept a breast cancer diagnosis and initially would not consent to any treatment, preferring to seek further opinion. During consultation with various members of the breast team he continually declined to accept the diagnosis and felt there was an error in the investigative protocol. Through the involvement of a Muslim nurse, fluent in Urdu and knowledgeable of the Afghan culture and religious background, we learned about his experiences and feelings; he opened up to her about his experiences in Afghanistan, detailing his experiences of trauma as a result of war, and disclosing that he had been diagnosed as having post-traumatic stress disorder by his physician. He saw breast cancer as a “woman's disease” which deeply affected his feelings of masculinity and left him feeling vulnerable. Conclusions: While sensitivity is undoubtedly required when diagnosing gender-biased conditions such as breast cancer in men, our experience showed this is exacerbated in ethnic minority groups where language barriers often exist and awareness of cultural differences is required. Awareness of the possibility of post-traumatic stress disorder in migrant populations from conflict-torn areas is also recommended during consultation. Male breast cancer; Ethnicity; Afghan; PTSD Background Through various national campaigns there is now a high level of general awareness of breast cancer in women. Male breast cancer however, is still comparatively unknown by the general public, and some health care and social care professionals. The incidence of breast cancer is rising in men [ 1 ], but still remains rare, with approximately 350 cases diagnosed in the UK annually, compared to some 50,000 women [ 2 ]. Detection, treatment and management strategies for breast cancer are gender biased in that they are currently based exclusively on those used for women. This includes national campaigns to raise awareness of breast cancer, such as the pink ribbon which further reinforces gender stereotyping of the disease. Topics discussed in support groups, the literature provided for the educational needs of those with breast cancer, and websites that are used as a means of informing patients, all include prosthesis, bra fitting services and advice, as well as breast reconstruction information, which are all directed toward women [ 3 ]. The psychological impact of gender bias cannot be underestimated [ 4, 5 ]. The deficiency of patient-specific care for men with breast cancer [ 6 ] is exacerbated in ethnic minorities where language and cultural issues may present additional barriers. Immigration into the UK has increased significantly over the past decade [ 7 ], resulting in a diverse multicultural population which also includes asylum seekers. Data from the European Asylum Support Office showed that in 2011, 28,000 Afghans applied for asylum in the European Union, the highest number in the decade, a consequence of the political situation and conflict in Afghanistan [ 8 ]. Studies from mental health research indicate that asylum seekers, particularly those from war-torn countries, are likely to develop posttraumatic stress disorder (PTSD) as a result of traumatic events such as military combat, violent personal assault (for example rape), natural disasters, or other threats to life [ 9, 10 ]. We document our experience of the management of an Afghan man who presented to our Breast Unit with a suspicious lump in his left breast, which was subsequently diagnosed as breast cancer. Case presentation An Asian man estimated to be in his 30s presented to our Breast Clinic v (...truncated)


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Faaizah Patel, Rajgopal Achuthan, Lucie Hyklova, Andrew Hanby, Valerie Speirs. Management of breast cancer in an Asian man with post-traumatic stress disorder: a case report, Journal of Medical Case Reports, 2016, pp. 77, 10, DOI: 10.1186/s13256-016-0864-0