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


METHODS
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.
Breast Unit, St James's University Hospital, Leeds, UK.
Faaizah
F
Patel
Breast Unit, St James's University Hospital, Leeds, UK.
Rajgopal
R
Achuthan
Breast Unit, St James's University Hospital, Leeds, UK.
Lucie
L
Hyklova
Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS9 7TF, UK.
Andrew M
AM
Hanby
Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS9 7TF, UK. v.speirs@leeds.ac.uk.
Valerie
http://orcid.org/0000-0002-0602-4666
V
Speirs
D000328:Adult; D000346:Afghanistan / Q000208:ethnology; D018567:Breast Neoplasms, Male / Q000150:complications / Q000523:psychology* / Q000628:therapy; D003717:Denial, Psychological; D019468:Disease Management; D006801:Humans; D008297:Male; D012036:Refugees / Q000523:psychology*; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D016312:Treatment Refusal; D006113:United Kingdom
Afghan; Ethnicity; Male breast cancer; PTSD