A Million Little Things: Male Breast Cancer on TV

A circle of Boston friends is thrown into freefall when one of them dies by suicide. Gary Mendez is the group's deflector-in-chief, and he is a male breast cancer survivor. He met his wife Maggie at a survivors' support group, and he jokes his way past every feeling he has.

In the fourth-season finale a breast lump he has been quietly worried about turns out to be benign. But a scan afterwards finds a mass in his lung, and he starts chemotherapy without telling anyone. The final season is built around him. He tells the group, marries Maggie, keeps working, and is told the disease is treatable but not curable. Late in the season it reaches his other lung and stops responding. He turns down a dubious overseas clinic and chooses how the end will go.

Spoilers below. This page says what happens to Gary Mendez, and what the series never tells you about his second diagnosis.

The show's real contribution is putting a man in a breast cancer support group and letting the awkwardness be the point. "Men get breast cancer, too" is a line it comes back to across five seasons.

NCI puts the rarity precisely: fewer than 1 in 100 breast cancers in the United States occur in men. Men of any age can get it, though it usually turns up at a later age than in women. Most male breast cancers start in the milk ducts, so they are ductal cancers. Most are invasive by the time they are found, meaning they have grown into surrounding breast tissue.

Rarity is not only a statistic here. It is part of why a man may not think of a lump as a possibility, and why the pathway he ends up on was designed with women in mind.

NCI's list for men is short and worth knowing. The most common sign is a lump or thickening in or near the breast. The others are a nipple that changes shape or direction, a nipple that turns inward, fluid from the nipple that may be clear or bloody, an open sore in the skin of the breast, scaly or red or swollen skin on the breast or nipple, dimpling that looks like orange peel, and swollen lymph nodes under the arm or near the collarbone.

Most breast changes in men turn out to be something less serious. NCI still says to check with a doctor about any unusual change. The reason is the one the show dramatises: the delay is usually social, not medical.

This is where the show's message and the guidance part company slightly, and it is worth being exact.

NCI states that screening mammograms are not usually recommended for men, even those at increased risk of breast cancer. What it suggests instead is staying alert to changes in the breast or the skin of the breast, and having regular clinical breast exams.

So the useful thing for a man is not a test to book. It is knowing the list above, and knowing what raises risk: chest radiation in the past, female relatives who have had breast cancer, inherited changes in BRCA1 or BRCA2, Klinefelter syndrome, cirrhosis, testicular problems, and obesity. NCI notes that if a BRCA change is found it can affect treatment decisions and has implications for relatives. Breast cancer in men goes further into this.

Gary's breast cancer is explicit from the first episode. What kills him is not. The series describes a mass in one lung that later reaches the other, and never applies the phrase "lung cancer" to him. Asked directly after the fourth-season finale, creator DJ Nash said he did not want viewers to know yet, and set out both possibilities: the old cancer spreading, or a different cancer showing itself.

Some coverage has reported it as advanced lung cancer anyway. That is press shorthand, not something the show states.

The distinction the show is playing with is not ambiguous in practice. NCI's example happens to be exactly this one: breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer, and it is treated as stage 4 breast cancer. A cancer that begins in lung tissue is a different disease. Calling the first one "lung cancer" is not a shortcut. It points at the wrong treatment. Metastatic cancer sets out how the naming works.

One more thing NCI records that the show gestures at: men with breast cancer have a slightly lower five-year survival rate than women, and NCI links that partly to being diagnosed at a later stage.

Maggie's position is unusual on television and common in life. She is a former patient herself, and she becomes the spouse of a patient.

The show is good on this. It is also good on a smaller indignity: Gary hides his diagnosis less out of nobility than because being pitied would cost him the role he has built his identity on. Caregiver burnout covers what happens to the person doing the holding.

Cancer Explained sells nothing and runs no ads. If this page told you something about breast changes in men that you had not heard before, you can help keep that information free for the next person who needs it. Support our work.

A Million Little Things did something almost nothing else on television has done. It made a man with breast cancer a lead character for five seasons. It also left his final diagnosis deliberately unnamed. If you have read that he died of lung cancer, that came from the press, not the show.

• NCI — Male Breast Cancer
• NCI — Metastatic Cancer: When Cancer Spreads
• Give Me My Remote — DJ Nash on the season four finale

This page discusses A Million Little Things: Male Breast Cancer on TV for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].