The intense and persistent pain that Francisco Santiago (Santa María de Guía, Gran Canaria, 1948) felt in his chest after accidentally bumping into a door frame set off the alarm signal. It happened earlier this year, at his house and in the company of his partner and a medical friend, Marta Mancuso, an anesthetist at the Hospital Insular Materno Infantil. The doctor felt the area. “It seemed strange to him that pain was so strong and that it did not go away. She told me to let her know if it didn’t go away in three or four weeks, because then we would have to do tests to see what would happen,” recalls the man who held the Mayor’s Office of Telde, the second most populous municipality on the island (currently around to 102,000 inhabitants), for 24 years divided into three stages, the last in the 2007-2011 mandate.
After those weeks, the pain had not disappeared and Santiago went to the surgeon. “One finds out because of a blow or whatever, but what you have there has nothing to do with the blow. That is from a long time ago and we have to analyze it, ”he says that the specialist told him at that appointment. Then came the tests. First, a mammogram. Then an ultrasound. Some suspicious nodules were already detected there. The biopsy confirmed the diagnosis: stage T3 breast cancer (the tumor is larger than 50 millimeters).
Breast cancer is a rare disease in men. According to Isabel Echavarría, scientific secretary of the Spanish Society of Medical Oncology (SEOM) and medical oncologist at the Gregorio Marañón University Hospital in Madrid, there are no exact figures on the number of cases diagnosed in Spain among the male population, but it is estimated which represent “less than 1%” of all those detected. The SEOM estimates that in 2022 more than 35,000 new cases of breast cancer will be diagnosed, so “around” 300 could occur in men, she says.
Like breast cancer in women, its incidence is growing “due to a higher prevalence of risk factors: overweight, obesity, sedentary lifestyle…” In addition, age “plays a fundamental role” in the risk of suffering from this type of tumor, so the “aging of the population contributes to this increase in incidence,” explains oncologist Echavarría, who stresses the importance of raising awareness “that male breast cancer exists and of the need to consult before the appearance of a lump in the breast or in the armpit or other breast changes (inflammation, bleeding from the nipple…)” The experts also warn that the greater ignorance among the population of its condition in the male population may involve a later diagnosis and, consequently, greater complications when the cancer is detected in more advanced stages.
The former mayor of Telde had a hard time digesting the news. “From the moment the tests begin and they tell you that there is a suspicion of cancer, one places himself in another place and begins to think about things that had never crossed his mind. From then until they confirmed it, I lived a few days of indescribable anguish. I lived it alone, without mentioning it to anyone, not my wife or my children or anyone. I didn’t have a good time.” He told about it the same day he started pharmacological treatment (an anti-estrogen drug). “I asked my wife to tell my two children to come to dinner. Our friend the doctor was also there. I told him there. You can imagine how it was, it is not pleasant news, but you have to accept it because it is life. The next day he explained it to part of his family and that of his partner, “the most direct.” Also to the closest friendships.
From the moment of diagnosis, Francisco Santiago was clear that he wanted to make the disease visible to help raise awareness. “I got surprised. I did not know that men could also have breast cancer. And that is the fundamental reason why I want to make it public. I feel the duty, as my small contribution to society, to make it known so that men know that we are also candidates for breast cancer. It is not common, but it can develop. Knowing this, if we take precautionary and observation measures, it can be diagnosed early and there are many more chances of success when treated”.
The American Society of Clinical Oncology estimates that around 10% of women with breast cancer have genetic mutations, a percentage that rises to 20% in men. Isabel Echavarría, SEOM spokesperson, points out that in the male population this disease has a “greater hereditary component” and that between 10 and 15% of cases diagnosed in men are related to mutations in a specific gene, BRCA2, “although there may be other genes involved.”
The former mayor underwent a genetic study and the results were negative. He was not a carrier of that mutation. “I have eight sisters and five brothers and no one in my family, neither on my father’s side nor on my mother’s side, has had breast cancer.” Years ago, and as a result of a family case (of another type of tumor), they had also carried out tests that ruled out that he carried a mutation that anticipated a greater risk of cancer.
A “commendable” public health system
Francisco Santiago only has words of thanks for the professionals who have treated him at the Hospital Insular Materno Infantil de Gran Canaria. “Fortunately we have a list of specialists in public health worthy of praise, very advanced in these matters.” His first visit was to the surgeon Víctor Vega, who prescribed the pharmacological treatment for him. He prescribed a medication (tamoxifen – one pill per day) with the aim of reducing the size of the nodules. If the answer was positive, he would undergo surgery to remove the affected tissue and, later, radiotherapy sessions.
Isabel Echavarría points out that there are “few studies” on breast cancer in men and specifies that the treatment is carried out “in a similar way” to that received by women.
“About six months after starting to take the medication, they test me again to see the results. The drug had helped reduce the size of the nodules, some more than half, others about half, others a little less. He had a main tumor and later several between the chest and the armpit. When they saw the result of the ultrasound, they told me that they would operate in 15 or 20 days”, he recalls. He was operated on on September 29, a few days after the originally scheduled date, by the surgeon Ana Tejera Hernández, who performed a mastectomy (removal of the breast) with an axillary emptying (to remove the lymph nodes).
“I was looking forward to having surgery. She knew it had to happen, so the sooner the better.” They admitted him the afternoon of the previous day and he left two days later. “The operation went well, I followed the postoperative period at home, after five or six days they removed the drain I had left with and I am controlled by the surgeon (Ana Tejera Hernández) and by the oncologist (Elisenda Llabrés)”. The next step, “when you are ready”, is radiotherapy. They have already told you that there will be fifteen sessions spread over three weeks, from Monday to Friday. “I have been told that the times are short, that each session lasts between eight and ten minutes”. They will begin, predictably, in a few days, when a month has passed since the intervention to which he underwent at the Insular Hospital.
From anxiety to normalization
The former Teldense councilor acknowledges that he went through a process of “anguish”, due to the uncertainty he experienced in the period between the tests and the diagnosis, and that it took him a while to assimilate that he suffered from the disease and to incorporate into his daily life a whole “slang” with “Concepts that I had never heard of”. “You enter a new world, that if you have an appointment with the oncologist on that date, with the surgeon on another, that if you have to come because the test passes the tumor committee, get a CT scan, go through Nuclear Medicine…” , remember.
Over time, their perception has evolved. “As you incorporate all these things into your daily life and you know that you have to live with the disease, you try to normalize it as much as possible. I have already acceptably assumed it and until now I have been able to continue with my normal life, because the medication that they have prescribed for me does not cause me any limitation”.
A fan of walking and hiking, Santiago walks about ten kilometers a day along the coast of the municipality of Telde. Before the operation, he asked the surgeon if he could do the two remaining sections to complete the Camino de Santiago from France to the Galician capital. “I did the section from Logroño to Burgos and then, ten or twenty days later, the one from Burgos to León,” proudly comments the historic mayor, who resumed that habit of walking days after undergoing surgery.
“I have asked everything, if I had to make any changes in my life. They had asked me about my habits and they told me that I could continue leading the life I have led up to now,” highlights Santiago, who insists on extolling “professional solvency” and the “humane treatment” of the health workers who have accompanied him throughout this process. , from her friend Marta Mancuso, inseparable in each of the medical appointments, to the surgeons and oncologists. “They live for that and it is to be appreciated that response and that behavior of professionals when one is in a situation like this”, she sums up.
Santiago has been away from the first political line for nine years, although he continues to belong to the Executive of Nueva Canarias (NC). Before becoming mayor, he was, among other professions, sharecropper, adjuster (dedicated to the manufacture of materials to make cherry tomatoes for export), mechanic or car salesman. His arrival at the local institution took place through the neighborhood associations of the municipality, of which he was a founding member and, occasionally, president. Santiago was in charge of the Faycanes City Council for 24 years in three stages (1979-1987, 1991-2003 and 2007-2011).