Male Breast Cancer and Dysfunction in Neurotransmitter Signaling

Male breast cancer (MBC), though less prevalent than female breast cancer, carries a distinct set of diagnostic, treatment, and survivorship challenges that extend beyond tumor control alone. Increasing clinical attention is being directed toward the neurological and neuromuscular consequences of cancer and cancer therapies, including chemotherapy-induced peripheral neuropathy, treatment-related deconditioning, chronic pain syndromes, fatigue, and loss of functional mobility. These complications reflect not only structural nerve injury, but disruptions in neurotransmitter signaling, microvascular integrity, inflammatory balance, and neuromuscular recruitment patterns.

Neurotransmitters govern the chemical language of nerve-to-muscle and nerve-to-organ communication, shaping sensation, movement, pain perception, autonomic regulation, and recovery capacity. In oncology populations, neurotoxic therapies, metabolic stress, and inflammatory burden can impair these signaling pathways, contributing to numbness, weakness, gait instability, and reduced quality of life. For male breast cancer patients—who already face diagnostic delays and care disparities—neuropathy and neuromuscular dysfunction may remain under-recognized and under-monitored.

This article examines the role of neurotransmitter signaling in neuropathy, the neurovascular mechanisms underlying treatment-related nerve injury, and the emerging role of non-invasive neuromuscular activation strategies within an imaging-guided, evidence-based model of supportive care for men navigating breast cancer diagnosis, treatment, and recovery.

How Chemical Signaling Shapes Pain, Movement, and Recovery
By: Lennard M. Goetze, Ed.D  | Polina Dembe-Petaludis, Ph.D  | Edited by: Daniel Root

Neurotransmitters are the chemical messengers of the nervous system, responsible for transmitting signals between neurons, muscles, glands, and organs. Every movement, sensation, thought, and autonomic function depends on their precise release, reception, and clearance. Disruption in neurotransmitter signaling contributes to neurological disorders, chronic pain syndromes, neuropathy, muscular atrophy, fatigue syndromes, and impaired neuromuscular coordination.

In clinical and rehabilitation medicine, growing attention has been placed on technologies that interface with the nervous system—such as Electrical Muscle Stimulation (EMS)—to support neuromuscular recruitment, circulation, pain modulation, and functional recovery. Understanding how neurotransmitters operate at the synaptic and neuromuscular junction level provides a scientific foundation for evaluating how such technologies may assist recovery, movement retraining, and symptom management in patients with neuropathy, cancer treatment–related nerve damage, metabolic disorders, and inflammatory conditions.

This review examines what neurotransmitters are, how they relate to neuropathy, how they affect the body, whether they “die” or become dormant, and how neuromuscular technologies such as EMS interact with neurotransmitter signaling to restore functional activity.

Do Neurotransmitters Die or Become Dormant?

Neurotransmitters themselves do not “die.” They are synthesized, released, recycled, and degraded in continuous cycles. What can deteriorate is:

·        The neuron producing the neurotransmitter

·        The synapse’s structural integrity

·        The receptor’s responsiveness

·        The metabolic environment needed to sustain neurotransmitter production

In neuropathy and neurodegenerative conditions, signaling pathways may become functionally “dormant” due to reduced neural firing, impaired circulation, mitochondrial dysfunction, oxidative stress, or inflammatory injury. This creates a state where nerves and muscles exist anatomically but are under-stimulated and under-recruited.

This dormant-like state is reversible in some cases, particularly when neural pathways remain intact but inactive. Rehabilitation strategies aim to re-engage these pathways through mechanical loading, sensory input, neuromuscular activation, circulation enhancement, and metabolic support.

Conclusion

Neurotransmitters represent the biochemical language of movement, sensation, and repair. In neuropathy and chronic disease states, neurotransmitter signaling is disrupted not because the system “dies,” but because metabolic, vascular, and inflammatory conditions impair neural function. Technologies such as Electrical Muscle Stimulation operate within this biological framework by activating neuromuscular circuits, preserving synaptic signaling, and supporting rehabilitation in patients with partial neural compromise.

When integrated into a clinically guided, evidence-based model—including imaging validation, metabolic support, circulation enhancement, and movement retraining—neuromuscular stimulation technologies serve as functional tools for preserving performance, restoring activity, and supporting recovery. The future of neurorehabilitation lies not in isolated devices, but in image-guided, physiologically grounded protocols that respect the complex chemical–electrical language of the nervous system.

References:

1) Pieber, K., Herceg, M., & Paternostro-Sluga, T. (2010). Electrotherapy for the treatment of painful diabetic peripheral neuropathy: A review. Journal of Rehabilitation Medicine, 42(4), 289–295. doi:10.2340/16501977-0554. (2) Weintraub, M. I., Herrmann, D. N., Smith, A. G., Backonja, M. M., & Cole, S. P. (2009). Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 90(7), 1102–1109.

2) Transcutaneous electrical nerve stimulation. (2026). In Encyclopedia of Physical Therapy. Retrieved from https://en.wikipedia.org/wiki/Transcutaneous_electrical_nerve_stimulation

3) Pulsed electromagnetic field therapy. (n.d.). In Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Pulsed_electromagnetic_field_therapy

4) Peripheral neuropathy. (n.d.). In Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Peripheral_neuropathy

5) Battecha, K., et al. (2017). Efficacy of pulsed electromagnetic field on diabetic peripheral neuropathy. Bulletin of Faculty of Physical Therapy, 22, 9–14.

6) Graak, V., Chaudhary, S., Sandhu, B. S., & others. (2009). Evaluation of the efficacy of pulsed electromagnetic field in the management of patients with diabetic polyneuropathy. PMCID: PMC2812751.

7) Cochrane Database (2017). Transcutaneous electrical nerve stimulation for neuropathic pain. (This is a systematic review you can cite.)

Disclaimer:
This article is intended for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. The content reflects current scientific understanding and clinical perspectives but is not a substitute for professional medical evaluation or individualized care. Readers should consult qualified healthcare providers regarding any medical condition, diagnosis, or treatment decisions.

Immunolytics Review

 Inside Immunolytics’ Diagnostic Framework

By: Lennard M. Goetze, Ed.D

Mold exposure is increasingly recognized as one of the most pervasive and misunderstood environmental health risks affecting modern buildings. While often framed as a household maintenance issue, mold contamination carries wide-ranging implications for respiratory health, immune regulation, neurological function, and chronic disease susceptibility. At the center of translating mold science into accessible diagnostic tools is Immunolytics, a laboratory founded to bridge environmental assessment with actionable health insight. Guided by J.W. Biava, a chemical engineer with decades of laboratory experience and advanced training in environmental exposures, Immunolytics has positioned itself as a practical yet scientifically grounded authority in mold analysis.

.

Engineering Roots and Environmental Focus

Biava’s background distinguishes Immunolytics from many mold testing services. Trained formally as a chemical engineer with an environmental emphasis, Biava entered laboratory science at an unusually early age, working within analytical labs long before specializing in mold. His career path evolved organically from water microbiology and environmental testing into mold analysis as building designs and indoor air quality challenges changed over time.

According to Biava, modern construction methods—particularly the widespread use of cellulose-based materials—have created what he refers to as “mold candy,” providing ideal growth substrates whenever moisture intrusion occurs. This reality has shifted mold from a regional nuisance to a national health concern, affecting homes, schools, hospitals, and workplaces across diverse climates

 

.

PRACTICAL MOLD TESTING FOR REAL-WORLD ENVIRONMENTS

Immunolytics’ approach emphasizes usability without sacrificing scientific rigor. The company provides do-it-yourself mold testing kits designed to capture meaningful exposure data while remaining accessible to homeowners, clinicians, inspectors, and facility managers. Two primary sampling methods form the foundation of Immunolytics’ testing model:

• Gravity air plates, which measure airborne mold exposure by allowing spores to settle naturally onto nutrient media
• Surface swabs, used to sample visible or suspected contamination from walls, HVAC components, furniture, or water-damaged materials

 

Biava explains that gravity plates are particularly effective for assessing actual breathing exposure, rather than theoretical spore presence. “We’re trying to understand what people are truly inhaling day to day,” he notes, emphasizing that meaningful exposure assessment must reflect lived environments rather than isolated measurements.

 

Laboratory Analysis: Genus Identification and Colony Quantification

Once samples arrive at Immunolytics’ laboratory, analysis extends beyond simple detection. Each sample is evaluated for mold genus identification and colony counts, two metrics critical for distinguishing background environmental mold from amplified contamination.

Different mold genera exhibit distinct growth behaviors and health implications. Lower water-activity molds such as Aspergillus and Penicillium may signal chronic moisture imbalance, while higher water-activity organisms such as Chaetomium or Stachybotrys often indicate prolonged water damage. Colony counts further contextualize findings, helping determine whether mold presence reflects incidental exposure or an active environmental problem. Biava stresses that mold rarely exists as a single organism. “It’s the pattern that matters—the types present, their abundance, and where they’re growing,” he explains, highlighting the importance of ecological interpretation rather than isolated results.

.

Reporting Designed to Educate and Guide

Immunolytics’ reports are structured not merely as laboratory summaries but as educational tools. Each report includes:

• Photographic documentation of cultured samples
• Identified mold genera and colony counts
• Contextual explanations of potential health implications
• Guidance on remediation priorities and next steps

This emphasis on clarity reflects Biava’s belief that data without interpretation leaves clients uncertain and vulnerable. Mold testing, he argues, should empower informed decision-making rather than generate fear or confusion.

 

Expert Consultation as a Core Service

One of Immunolytics’ most distinctive features is its included expert consultation model. Every client—regardless of the number of samples submitted—receives a free phone consultation with an Indoor Environmental Professional (IEP). During these sessions, results are reviewed in context, questions are addressed, and practical recommendations are provided.

Biava views this consultative layer as essential. “Mold testing without interpretation is incomplete,” he notes. “People need help understanding what the results mean and what actions actually improve health.” Following consultations, clients receive additional educational materials addressing remediation strategies, air quality improvement, and exposure reduction. 

.

Health Risks: Why Mold Demands Urgent Attention

Central to Biava’s work is correcting misconceptions about mold-related illness. Mold exposure, he explains, affects human health through multiple biological mechanisms:

1. Allergenic responses, such as sneezing, coughing, and asthma exacerbation
2. Infectious potential, including rare but serious invasive mold diseases
3. Mycotoxin production, with toxins capable of disrupting neurological, endocrine, and immune function
4. Antigen and superantigen effects, where mold proteins trigger immune-mediated inflammation independent of toxins

Biava cautions against dismissing “common” molds as harmless. Even ubiquitous genera such as Cladosporium may provoke significant immune responses in susceptible individuals. He also highlights the limitations of current mycotoxin testing, noting that clinical panels typically screen for only a fraction of the thousands of known mycotoxins associated with molds.

From Detection to Prevention

Beyond diagnostics, Immunolytics collaborates on natural and botanical solutions for mold-affected environments, alongside broader indoor wellness initiatives. Biava’s philosophy aligns with a foundational principle of toxicology: either remove the toxin from the person or remove the person from the toxin. Effective mold remediation, he argues, must prioritize environmental correction before medical intervention.

This preventative emphasis positions mold testing not as an endpoint, but as the first step in restoring healthy indoor ecosystems.

 

Conclusion: Immunolytics represents a pragmatic yet scientifically grounded response to a growing public health challenge. Through accessible testing kits, detailed laboratory analysis, comprehensive reporting, and expert consultation, the company offers a model for environmental diagnostics that prioritizes clarity, prevention, and health outcomes. Guided by J.W. Biava’s engineering discipline and environmental expertise, Immunolytics underscores an urgent truth: mold exposure is not a marginal issue. It is a widespread, biologically complex hazard demanding informed detection, timely remediation, and sustained public awareness.

 

Upcoming Webinar- 5/19/2026- with Dr. Sarah Persing

Reconstructing Confidence: Dr. Sarah Persing on Breast Reconstruction for Men with Breast Cancer

Male breast cancer remains widely misunderstood and under-discussed, leaving many patients without clear guidance on what comes after treatment. While survival outcomes have improved with earlier detection and better therapies, the physical and emotional aftermath of surgery can be profound—particularly for men who undergo mastectomy and experience visible changes to the chest. On March 19 at 11:00am EST, the Male Breast Cancer Global Alliance (MBCGA) will host a Spring Webinar featuring Dr. Sarah Persing, a plastic and oncoplastic breast surgeon and Associate Professor of Surgery at Tufts University School of Medicine, to address one of the most overlooked aspects of male breast cancer care: breast reconstruction.

Why Reconstruction Matters for Men

For many men, breast reconstruction is not initially presented as part of the treatment conversation. Reconstruction is often perceived as a “women’s issue,” despite the reality that men can experience significant chest wall deformity, scarring, asymmetry, and functional concerns after breast cancer surgery. These physical changes can impact posture, comfort in clothing, and body image—factors that carry psychological weight during recovery and survivorship.

Modern reconstructive approaches recognize that restoration is not cosmetic vanity; it is part of comprehensive healing. Reconstruction can help restore chest contour, address tissue deficits, improve symmetry, and, in select cases, incorporate techniques that preserve or reconstruct the nipple-areolar complex when oncologically appropriate. For male patients, even subtle contouring can significantly influence confidence and the willingness to re-engage socially and physically after treatment.

Dr. Persing’s Expertise in Oncoplastic Reconstruction

Dr. Persing brings a rare blend of expertise in plastic surgery, microsurgery, and oncoplastic breast surgery, with a clinical focus on breast cancer and reconstructive techniques. Her work bridges cancer control with aesthetic and functional restoration—an approach that reframes reconstruction as an integrated part of cancer surgery rather than an afterthought.

In the upcoming webinar, Dr. Persing is expected to discuss how reconstructive planning can begin at the time of cancer surgery, not months later. This “oncoplastic” model coordinates tumor removal with reconstructive strategy to optimize outcomes while maintaining oncologic safety. For men, this may include careful management of skin flaps, contour refinement of the chest wall, and microsurgical options in more complex cases where tissue deficits are significant.

Current Approaches to Breast Reconstruction for Men

Reconstruction for men differs from traditional breast reconstruction in women. Rather than restoring breast volume, the goal is to re-establish a natural male chest contour. Options may include:

·        Local tissue rearrangement to smooth contour irregularities

·        Fat grafting to correct depressions or asymmetry

·        Scar revision and chest wall contouring

·        Nipple-areolar reconstruction or preservation when oncologically appropriate

·        Microsurgical techniques in cases involving extensive tissue loss or prior radiation

Radiation therapy and lymph node surgery can complicate healing, making individualized planning essential. Dr. Persing’s experience in microsurgery and oncoplastic techniques positions her to address these challenges while minimizing functional limitations and long-term discomfort.

A Patient-Centered Conversation

Beyond surgical technique, the webinar will emphasize the importance of shared decision-making. Men are often not informed that reconstruction is an option, and many do not realize that even modest reconstructive interventions can improve comfort, posture, and self-image. Education empowers patients to ask better questions, set realistic expectations, and advocate for comprehensive survivorship care.

Dr. Persing’s presentation is designed to equip patients, caregivers, and clinicians with practical knowledge: when to consider reconstruction, what questions to ask a surgical team, how timing interacts with chemotherapy or radiation, and what recovery realistically looks like.

Why This Webinar Matters

As male breast cancer awareness grows, so must the sophistication of post-treatment care. Reconstruction is not about aesthetics alone—it is about restoring wholeness after a life-altering diagnosis. The March 19 webinar offers an opportunity to bring clarity to an often-overlooked topic and to normalize reconstruction as part of standard care for men with breast cancer.

By spotlighting reconstructive options through the lens of an experienced oncoplastic surgeon, MBCGA continues its mission to close care gaps, challenge outdated assumptions, and elevate survivorship standards for men worldwide.

PART 2:

Beyond Survival: Why Education on Breast Reconstruction for Men Matters Now More Than Ever

By Cheri Ambrose, Founder & CEO, Male Breast Cancer Global Alliance (MBCGA)

Every time we host an educational forum, I am reminded why the work of the Male Breast Cancer Global Alliance exists. But some conversations land differently. Dr. Sarah Persing’s presentation on breast reconstruction for men was one of those moments—where science, dignity, and long-overdue inclusion intersected in a way that felt both affirming and urgent.

For too long, men with breast cancer have been excluded from conversations about reconstruction. Not intentionally, perhaps—but systemically. The language, the protocols, even the assumptions around post-surgical care have been built on a model that does not fully recognize male patients as needing the same comprehensive, whole-person recovery pathway. Dr. Persing’s presentation made something very clear: reconstruction is not cosmetic—it is restorative. It is about helping people feel whole again after cancer takes something away.

Education on this topic is tantamount in today’s cancer world because survivorship has evolved. We are no longer only measuring success by survival statistics. We are measuring it by quality of life, by how people return to their lives, relationships, work, and sense of self. Chest wall deformity, scarring, asymmetry, and physical discomfort may seem “minor” on a medical chart, but to a survivor, these are daily reminders of trauma. When we normalize reconstruction as part of the continuum of care for men, we validate their experience and restore agency to their healing journey.

What struck me most was how far reconstructive procedures have evolved. We are no longer in an era of one-size-fits-all surgery. Today’s oncoplastic and microsurgical approaches integrate cancer control with restoration of form and function. Techniques like contour refinement, fat grafting, scar revision, and chest wall reconstruction reflect decades of innovation—born from listening to patients and responding with better science. This evolution mirrors what we have seen in male breast cancer treatment itself: improved diagnostics, more tailored therapies, more nuanced understanding of male-specific disease patterns, and growing awareness among clinicians.

As an advocate and as someone who has witnessed countless men navigate breast cancer in silence, I see education as the bridge between medical progress and real-world impact. Knowledge dismantles stigma. It opens doors for conversations that men may be afraid to start. It equips caregivers to support more effectively. And it gives clinicians permission to broaden their standard of care beyond tumor removal to true restoration.

The aftermath of this presentation is not just information—it is momentum. Momentum toward inclusive care models. Momentum toward better-informed patients. Momentum toward a cancer care culture that recognizes men as deserving of the same post-treatment options, compassion, and dignity historically afforded to women.

At MBCGA, our mission has always been to close gaps in awareness, research, and care. This conversation about breast reconstruction for men is one of those gaps finally being filled. The more we educate, the more we normalize these options, and the more we invite men into these conversations early in their care, the closer we move toward a future where no patient is overlooked simply because of gender.

This is what progress looks like: not just treating cancer—but treating the whole person who survives it.

 

Gadolinium, Imaging, and Male Breast Cancer Survivorship

 What Patients Should Know about CONTRAST

By the Male Breast Cancer Global Alliance (MBCGA)

Why This Matters for Men with Breast Cancer

If you are a man who has been diagnosed with breast cancer—or you are living in survivorship—you may undergo multiple imaging studies over the course of your care. MRI scans, sometimes enhanced with contrast agents that contain gadolinium, are important tools used by clinicians to detect tumors, assess treatment response, and monitor for recurrence. These technologies save lives. At the same time, a growing number of patients and clinicians are asking informed questions about long-term contrast exposure, especially when scans are repeated over months or years.

This article is not meant to discourage appropriate imaging or undermine the role of radiology in cancer care. Instead, it is designed to help male breast cancer patients make informed decisions, understand emerging conversations about gadolinium retention in the body, recognize symptoms that may warrant discussion with a clinician, and advocate for thoughtful, individualized imaging strategies as part of survivorship care.

---

What Is Gadolinium and Why Is It Used?

Gadolinium-based contrast agents (GBCAs) are injected during certain MRI scans to improve the visibility of tissues, blood vessels, and areas of concern. In oncology, contrast-enhanced MRI can be helpful for:

·        Tumor characterization

·        Monitoring treatment response

·        Surveillance for recurrence

·        Evaluating suspicious findings when other imaging is inconclusive

For most patients, GBCAs are considered safe and are widely used in clinical practice. Modern protocols include kidney screening and agent selection to reduce known risks. However, research over the last decade has shown that small amounts of gadolinium can be retained in the body after contrast-enhanced MRIs, even in people with normal kidney function. The long-term clinical significance of this retention is still being studied.

---

Why This Is Relevant for Male Breast Cancer Patients

Male breast cancer is often diagnosed later than female breast cancer due to lower awareness and delayed screening. As a result, men may undergo intensive imaging during diagnosis, treatment planning, and follow-up. Survivors may continue surveillance imaging for years.

Repeated exposure does not automatically translate into harm. However, cumulative exposure raises reasonable questions about long-term safety, especially for individuals who later develop unexplained symptoms that overlap with neurological, musculoskeletal, dermatologic, or systemic complaints. For survivors already managing the effects of surgery, chemotherapy, radiation, endocrine therapy, or targeted treatments, new symptoms can be confusing and stressful.

The goal is not to create fear—but to support informed consent, transparent dialogue with your care team, and thoughtful use of imaging tools when they are clinically necessary.

---

What Is Known About Gadolinium Retention

Research has documented that trace amounts of gadolinium can remain in tissues after MRI contrast administration. This has been observed in areas such as the brain, bones, and soft tissues. Scientists are actively studying:

·        How long gadolinium may persist in the body

·        Whether certain people retain more than others

·        How different contrast agents compare

·        Whether cumulative exposure has clinical relevance

Regulatory agencies and professional radiology societies have updated guidelines over time to reflect these findings. In current practice, contrast use is increasingly individualized, with attention to kidney function, imaging necessity, and alternative imaging strategies when appropriate.

---

Reported Symptom Patterns: What Patients Have Described

Some patients across cancer and non-cancer populations have reported persistent symptoms following contrast-enhanced MRI. These reports are part of an evolving conversation and do not establish direct cause-and-effect in every case. Symptoms described in patient registries and clinical observations include concerns involving:

·        Skin and connective tissue changes

·        Neurological or cognitive complaints

·        Musculoskeletal discomfort

·        Fatigue and exercise intolerance

·        Cardiorespiratory sensations

·        Renal or urinary changes

·        Gastrointestinal or swallowing discomfort

·        Eye, hair, or metabolic shifts

·        Immune or inflammatory patterns

Many of these symptoms also occur commonly in cancer survivors due to treatment effects, aging, hormonal therapies, nerve injury, vascular changes, or chronic inflammation. This overlap is why careful clinical evaluation is essential before attributing symptoms to any single factor.

---

Immediate Reactions vs. Long-Term Concerns

Acute Reactions

Some individuals experience short-term allergic-type reactions to contrast agents at the time of imaging. These reactions are uncommon and are typically managed safely in imaging centers with standard protocols.

 

Long-Term, Non-Specific Symptoms

Longer-term symptoms, when reported, are more difficult to interpret because they may appear weeks or months later and overlap with cancer-related side effects. This is where survivorship care becomes especially important: tracking symptom timelines, documenting imaging history, and coordinating across specialties.

---

Special Consideration: Kidney Health

A rare but serious condition called nephrogenic systemic fibrosis (NSF) has been linked to gadolinium exposure in patients with advanced kidney disease. Today, kidney screening and safer contrast selection have made NSF extremely uncommon in routine oncology imaging. This progress demonstrates how evidence-based protocols can meaningfully improve patient safety.

For male breast cancer patients, particularly older survivors or those with comorbid conditions such as diabetes or hypertension, kidney health remains an important part of imaging decision-making.

---

What Male Breast Cancer Survivors Can Do

1. Ask Informed Questions

You have the right to understand why contrast is being used and whether it is essential for your specific scan. Consider asking:

·        Is contrast necessary for this MRI?

·        Are there alternative imaging options?

·        Which contrast agent is being used and why?

·        How does my kidney function factor into this decision?

2. Keep a Personal Imaging Record

Maintaining a simple log of past imaging studies (dates, type of scan, whether contrast was used) can support informed discussions with your care team over time.

 

3. Track New or Persistent Symptoms

If you experience new neurological, musculoskeletal, skin, or systemic symptoms after imaging, document timing and progression. This helps clinicians assess patterns and determine appropriate next steps.

 

4. Build a Trusted Care Team

Male breast cancer survivors benefit from multidisciplinary care that may include oncology, primary care, cardiology, neurology, endocrinology, rehabilitation, and integrative specialists. Complex symptoms often require collaborative evaluation.

 

5. Balance Vigilance with Perspective

Imaging remains a cornerstone of cancer care and surveillance. The goal is not avoidance, but thoughtful use—ensuring each scan serves a clear clinical purpose.

---

Why MBCGA Is Sharing This Information

The Male Breast Cancer Global Alliance assembled this educational overview to support transparency, patient empowerment, and survivorship awareness. Men with breast cancer are often underrepresented in research and education. Providing balanced, clinically grounded information helps survivors participate more actively in their care, ask better questions, and reduce uncertainty around unexplained symptoms.

This conversation is not about rejecting MRI technology or contrast agents. It is about advancing informed consent, continued safety research, and patient-centered imaging practices that evolve with emerging evidence.

---

A Supportive Closing for Survivors

Living beyond male breast cancer involves navigating uncertainty, long-term monitoring, and the cumulative effects of treatment. Imaging is part of that journey—and so is your right to understand how it fits into your overall health picture. If something does not feel right, speak up. If you have concerns, ask questions. Your experience matters, and your voice contributes to improving care for the next generation of men facing breast cancer.

 

Epilogue

BE INFORMED, NOT AFRAID; Doing Your Homework as a Cancer Patient

By Cheri Ambrose, Founder, Male Breast Cancer Global Alliance

One of the most important lessons I’ve learned through advocacy is that empowerment begins with information. As patients and caregivers, we are asked to trust complex systems of care, powerful technologies, and treatment decisions that can feel overwhelming in the moment. Imaging, medications, and therapies are essential tools in modern cancer care—and they save lives every day. At the same time, each tool has a profile of benefits, limitations, and potential side effects that deserve thoughtful consideration and open conversation.

Gadolinium-based contrast agents, used in some MRI scans, are one example of a technology that is both valuable and worthy of informed discussion. For many patients, contrast-enhanced imaging plays a critical role in diagnosis, treatment planning, and follow-up. Yet, as with many aspects of cancer care, individuals may respond differently, and some patients report symptoms or sensitivities that deserve to be taken seriously. This is not about rejecting medical imaging—it is about understanding what you are receiving, why it is being recommended, and what questions to ask if something does not feel right afterward.

Doing your homework as a patient does not mean becoming fearful or distrustful. It means participating in your care with curiosity and confidence. Ask your care team why a test is needed. Ask whether alternatives exist. Ask how your personal health history—especially kidney health, allergies, and prior reactions—factors into the decision. Keep a simple record of the treatments and imaging you receive. If you notice new or persistent symptoms after any procedure or therapy, document them and bring them into the conversation. Your lived experience is part of your medical story.

It is also important to rely on credible, balanced sources of information. Not everything online is accurate, and extreme narratives can create unnecessary anxiety. Patients and survivors deserve access to trustworthy education that respects both the value of medical technology and the importance of patient safety. Some reliable places to learn more include:

·        Your oncology and radiology care team – the first and most important resource

·        Major cancer organizations (e.g., American Cancer Society, National Cancer Institute)

·        Professional radiology societies (e.g., Radiological Society of North America – RSNA)

·        Patient advocacy organizations focused on education and survivorship

·        Peer-reviewed medical literature when discussed with your clinician

At the Male Breast Cancer Global Alliance, we believe that informed patients are stronger patients. Knowledge helps reduce fear, improve communication with clinicians, and support better long-term outcomes. You deserve transparency. You deserve to understand your options. And you deserve to be an active participant in the decisions that shape your care and survivorship.

 

MBC Educational Series

Feeling the Burn: Neuropathy in Cancer Patients and the Overlooked Burden in Male Breast Cancer

Written by: Lennard M. Goetze, Ed.D  |  Phil Hoekstra, Ph.D

This article is an original work prepared for publication exclusively for the Male Breast Cancer Global Alliance. No copyrighted sources were reproduced or paraphrased. All content is intended for educational purposes.

Neuropathy is one of the most common and distressing complications faced by people undergoing cancer treatment—and one of the least adequately addressed in routine survivorship care. Characterized by numbness, tingling, burning pain, electric-shock sensations, temperature sensitivity, and loss of balance, neuropathy can profoundly disrupt mobility, sleep, work, and quality of life. While chemotherapy-induced peripheral neuropathy (CIPN) is widely recognized in oncology, the experience of neuropathy in male breast cancer (MBC) patients remains underrepresented in clinical discourse, research priorities, and survivorship resources.

Men diagnosed with breast cancer often enter care pathways designed primarily around female patients. As a result, side effects such as neuropathy may be under-screened, under-discussed, and under-treated in male survivors—despite the same exposure to neurotoxic chemotherapies, radiation, and adjunctive therapies. Advocacy groups in male breast cancer care have increasingly called attention to this gap, noting that lingering neuropathy becomes a silent burden that outlasts remission and shapes long-term recovery.

 

Why Does Neuropathy Happen in Cancer Care?

Neuropathy in cancer patients arises from multiple converging mechanisms:

1) Chemotherapy Neurotoxicity
Certain chemotherapeutic agents—such as taxanes, platinum compounds, and vinca alkaloids—directly damage peripheral nerves. These drugs interfere with axonal transport, mitochondrial function, and myelin integrity, leading to sensory loss and neuropathic pain that often begins in the toes and fingertips before ascending proximally. Because nerves regenerate slowly, symptoms may persist long after treatment ends.

2) Radiation-Induced Nerve Injury
Radiation can cause fibrosis and microvascular compromise around nerve bundles. While breast cancer radiation targets the chest wall and axillary region, downstream effects on autonomic regulation and microcirculation can alter distal nerve health, contributing to sensory disturbances and cold intolerance in the extremities.

3) Microcirculatory Injury
Cancer therapies can damage small blood vessels that nourish nerves. Reduced perfusion deprives peripheral nerves of oxygen and nutrients, compounding neurotoxicity. The feet—being the most distal tissues—often reveal these deficits first.

4) Inflammation and Immune Dysregulation
Targeted therapies and immunotherapies can trigger inflammatory cascades that affect small fibers and autonomic nerves. In susceptible individuals, this results in burning pain, hypersensitivity, and temperature dysregulation.

5) Compounding Risk Factors
Pre-existing diabetes, vitamin deficiencies, thyroid dysfunction, alcohol exposure, and occupational neurotoxin exposure can amplify neuropathic vulnerability—factors that may be overlooked in male breast cancer care pathways.

Why Male Breast Cancer Patients Are at Particular Risk

Male breast cancer patients frequently report feeling “out of place” in oncology settings, which can discourage proactive reporting of side effects. Neuropathy may be normalized as “expected discomfort” rather than recognized as a treatable condition. Additionally, men may delay reporting sensory changes until functional impairment—falls, gait instability, or sleep disruption—becomes unavoidable. This delay narrows the window for early intervention.

Furthermore, MBC survivors may lack access to gender-specific survivorship education and peer support where neuropathy management strategies are shared. The result is an unmet clinical demand: to screen, detect, identify, and treat neuropathy earlier and more systematically in men with breast cancer.

Screening and Detection: Moving Beyond Symptom Checklists

Traditional neuropathy screening relies heavily on patient-reported symptoms and bedside exams. While essential, these approaches can miss early physiologic changes. Modern survivorship care benefits from combining subjective reporting with functional and imaging-based tools:

·        Quantitative sensory testing to track vibration and thermal thresholds

·        Nerve conduction studies to evaluate large-fiber involvement

·        Thermal imaging to visualize microcirculatory and autonomic changes associated with neuropathic stress patterns in the feet and hands

·        Gait and balance assessments to identify functional risk

Thermal imaging, in particular, offers a non-invasive way to detect asymmetric temperature patterns and distal perfusion changes that often accompany neuropathic dysfunction. While not a standalone diagnostic, it complements neurologic testing by revealing functional changes that may precede overt nerve conduction abnormalities.

Standard Solutions for Managing Cancer-Related Neuropathy

There is no single cure for CIPN, but a multimodal management strategy can significantly reduce suffering:

Pharmacologic Options

·        Neuropathic pain agents (e.g., duloxetine)

·        Topical analgesics for focal pain

·        Careful medication review to avoid neurotoxic overlaps

Rehabilitation and Physical Therapy

·        Balance training and proprioceptive exercises

·        Gait stabilization and fall-prevention programs

·        Strength training to reduce compensatory injury

Lifestyle and Supportive Interventions

·        Foot protection and proper footwear to prevent unnoticed injury

·        Nutritional assessment (B vitamins, metabolic support)

·        Sleep and pain hygiene strategies

Adjunctive Non-Invasive Modalities

·        Neuromodulation techniques

·        Image-guided monitoring of extremity health to track response to interventions

·        Education on daily foot checks to catch early skin or sensory changes

Neuropathy and Dermatomal Mapping

Peripheral neuropathy and radiculopathy often produce burning, tingling, or electric pain in specific distributions. Thermography can visualize these patterns along dermatomes—the “wiring diagram” of the skin mapped to spinal nerve roots. Dr. Hoekstra describes how thermal gradients trace neuropathic pathways, helping localize nerve impingement in the spine or peripheral nerves in the limbs. When combined with autonomic challenge testing, clinicians can differentiate acute inflammatory phases (often warmer) from chronic ischemic or denervated phases (often cooler).

 

This capability is especially valuable in pain management and personal injury contexts, where objective documentation of nerve-related dysfunction supports diagnosis, treatment planning, and medico-legal clarity.

The Case for Proactive Neuropathy Care in MBC Survivorship

For male breast cancer survivors, neuropathy is not merely a side effect—it is a quality-of-life determinant. Persistent numbness or burning pain undermines confidence in walking, returning to work, and re-engaging in daily life. When neuropathy is under-identified, survivors feel unseen; when it is proactively addressed, recovery becomes tangible.

Elevating neuropathy screening within male breast cancer survivorship reframes care from survival alone to functional restoration. By integrating early detection tools, imaging-informed surveillance, and multidisciplinary treatment pathways, clinicians can move from reactive pain management to proactive nerve protection. In doing so, the cancer community honors a simple truth voiced by patients themselves: relief from neuropathy is not optional—it is essential to healing.

 

 

Part 2 —

A Diagnostic Perspective on Neuropathy in Cancer Care

By: Robert L. Bard, MD, DABR, FAIUM, FASLMS

From a diagnostic imaging perspective, neuropathy in cancer patients is not a mysterious side effect—it is a predictable consequence of how modern oncology therapies interact with nerve biology, microcirculation, and tissue metabolism. Peripheral nerves are uniquely vulnerable structures. They rely on uninterrupted blood supply, intact mitochondrial function, and stable axonal transport to maintain sensory and motor signaling over long distances. Cancer treatments disrupt each of these systems in different ways, which explains why neuropathy often emerges first in the feet and hands.

Chemotherapeutic agents are designed to target rapidly dividing cells, but many also interfere with microtubule dynamics and mitochondrial integrity within neurons. This impairs axonal transport—the cellular “highway” that delivers nutrients and signaling molecules along nerve fibers. When transport fails, distal segments of long nerves become metabolically deprived, producing the classic stocking-and-glove distribution of numbness, burning pain, and temperature sensitivity. In parallel, treatment-related injury to the small vessels that nourish nerves reduces oxygen delivery, compounding neural stress in the most distal tissues.

Radiation therapy introduces a different pathway to neuropathy. By inducing endothelial injury and fibrotic change within irradiated fields and adjacent neurovascular bundles, radiation alters vascular regulation and autonomic signaling. Even when radiation is localized to the chest wall or axilla in breast cancer care, downstream effects on autonomic tone can influence distal circulation and nerve health. Over time, this dysregulation manifests as altered temperature control, color changes, edema, and sensory disturbances in the extremities.

Imaging provides a unique window into these processes because neuropathy is not solely a neural problem—it is a neurovascular and metabolic disorder with structural and functional signatures. High-resolution ultrasound can visualize peripheral nerves, revealing enlargement, altered echotexture, and perineural edema associated with inflammatory or compressive neuropathies. Doppler ultrasound adds physiologic context by assessing regional blood flow, highlighting areas of microcirculatory compromise that parallel sensory symptoms. When nerve irritation coexists with ischemic stress, imaging helps distinguish primary neural pathology from secondary vascular contributors—an important distinction for targeted intervention.

Functional imaging modalities further extend diagnostic insight. Thermal imaging, for example, visualizes patterns of cutaneous temperature regulation that reflect autonomic control of microcirculation. In neuropathic states, asymmetry, distal cooling, or focal hotspots often parallel patient-reported burning or numbness. While not a standalone diagnostic tool, thermal imaging complements neurologic testing by revealing functional dysregulation that may precede structural nerve changes detectable by conduction studies. This functional perspective is particularly valuable in early survivorship, when symptoms are evolving and intervention windows are still open.

Imaging also supports longitudinal care. Neuropathy in cancer patients is dynamic: symptoms may worsen during therapy, plateau, or slowly recover afterward. Serial imaging—tracking nerve morphology, regional perfusion, and functional temperature patterns—provides objective markers of change over time. These markers inform clinical decisions about dose modification, rehabilitation strategies, protective footwear, and referral timing to neurology or pain management. In male breast cancer survivorship, where neuropathy may be underreported, objective imaging evidence helps validate patient experience and accelerates appropriate care pathways.

From a broader diagnostic standpoint, neuropathy rarely exists in isolation. Imaging frequently reveals concurrent contributors such as spinal degenerative changes, entrapment neuropathies, or vascular insufficiency that magnify treatment-related nerve injury. By integrating peripheral nerve imaging with regional vascular assessment, clinicians can address layered pathology rather than treating neuropathy as a single-cause phenomenon. This integrative approach aligns with precision survivorship—tailoring interventions to the dominant drivers of nerve dysfunction in each patient.

Ultimately, the value of imaging in cancer-related neuropathy lies in its ability to translate subjective symptoms into objective, trackable physiology. When patients say their feet burn, go numb, or feel “disconnected,” imaging provides clinicians with a map of where neurovascular stress is occurring and how it changes with time and therapy. This diagnostic clarity reframes neuropathy from an inevitable side effect to a monitorable condition—one that can be detected earlier, managed more precisely, and mitigated before it becomes a permanent barrier to recovery and quality of life.

 

References

1.     Argyriou, A. A., Bruna, J., Marmiroli, P., & Cavaletti, G. (2012). Chemotherapy-induced peripheral neurotoxicity (CIPN): An update. Critical Reviews in Oncology/Hematology, 82(1), 51–77. https://doi.org/10.1016/j.critrevonc.2011.04.012

2.     Cavaletti, G., & Marmiroli, P. (2010). Chemotherapy-induced peripheral neurotoxicity. Nature Reviews Neurology, 6(12), 657–666. https://doi.org/10.1038/nrneurol.2010.160

3.     Hershman, D. L., et al. (2014). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO clinical practice guideline. Journal of Clinical Oncology, 32(18), 1941–1967. https://doi.org/10.1200/JCO.2013.54.0914

4.     National Cancer Institute. (2024). Peripheral neuropathy (PDQ®)–Health professional version. https://www.cancer.gov/about-cancer/treatment/side-effects/nerve-problems/peripheral-neuropathy-pdq

5.     Staff, N. P., Grisold, A., Grisold, W., & Windebank, A. J. (2017). Chemotherapy-induced peripheral neuropathy: A current review. Annals of Neurology, 81(6), 772–781. https://doi.org/10.1002/ana.24951

6.     Giordano, S. H. (2018). Breast cancer in men. New England Journal of Medicine, 378(24), 2311–2320. https://doi.org/10.1056/NEJMra1707939

7.     Loprinzi, C. L., et al. (2020). Management of cancer treatment–related peripheral neuropathy. Journal of Clinical Oncology, 38(28), 3325–3348. https://doi.org/10.1200/JCO.20.01399

8.     Mols, F., Beijers, T., Vreugdenhil, G., & van de Poll-Franse, L. (2014). Chemotherapy-induced peripheral neuropathy and its association with quality of life among cancer survivors. Supportive Care in Cancer, 22(8), 2261–2269. https://doi.org/10.1007/s00520-014-2208-4