A middle-aged man walks out of an old building at the Helen Joseph Hospital in Johannesburg. He pats his hands over his pockets, takes a few of steps away from the entrance and retrieves a small packet from his pocket.
It is a box of cigarettes.
He stops to light one and walks down a ramp away from the building. On the double glass doors leading into the building, in bold, bright pink print, are the words: Helen Joseph Hospital Breast Clinic.
Behind the glass doors patients fill the black plastic chairs, neatly lined up in rows in the waiting room. It is mid-morning on a Thursday, which means that most of the people are existing patients who are here for a follow-up visit. The clinic provides specialised breast healthcare services to people who do not have medical aid.
Almost everyone here is a woman.
That was the main thing that Thami Mabuza noticed when he first visited the breast clinic in March last year. The doctor at his local clinic in Lanseria had referred Mabuza to the hospital after finding a lump in his left breast.
Are South African men more at risk for breast cancer?
supports HTML5 video
Male breast cancer is the same as female breast cancer and men should be checking for lumps as well.
Warning sign"In 2013, I started bodybuilding for fun. In that first week I would get so excited, every day when I got home from the gym I would stand in front of the mirror and feel my muscles. It was at that point that I felt a small lump," he recalls.
But the lump was not painful so Mabuza did not think much of it.
"I thought it was a boil and that it would go away soon."
But it didn’t. Instead, the lump in Mabuza’s breast kept growing.
"After almost a year I decided to go to the clinic and get it checked out."
The doctor at the clinic referred him to the breast clinic for further tests. Mabuza, who works at a pharmaceutical plant, was diagnosed with breast cancer a month later.
"Before I went to the clinic, I spoke to my boss. He told me that it could possibly be breast cancer and that I should just get help as soon as possible," he says.
Breast cancer is the leading cancer in women globally, according to the World Health Organisation. The national cancer registry estimates that it accounts for over 20% of all cancers in South African women.
Less than 1%"Men can also get breast cancer although it is rare when compared to female breast cancer," says Carol Benn, a specialist breast surgeon.
"But male breast cancer is the same as breast cancer in women and the treatment is the same."
According to a 2016 article in the American Journal of Men’s Health, male breast cancer accounts for less than 1% of the global cancer incidence. But the figure is believed to be as high as 6% in Africa.
"In South Africa the incidence of male breast cancer is not well documented, but was recorded as 2.4% of all breast cancer cases," the study notes.
Although men of any age can develop breast cancer, it is more common in older men, according to the United States-based medical research organisation Mayo Clinic. Male breast cancer that is diagnosed early has "a good chance for a cure", the organisation says.
But many male cancers are only diagnosed at an advanced stage because men delay seeking medical advice.
Ntokozo Dludla, from the breast cancer advocacy organisation Breast Health Foundation, is a counsellor at the Helen Joseph Breast Clinic.
Delays in seeking careShe says many of the male breast cancer patients she sees present late because they are not aware that they can get breast cancer and often miss the symptoms.
Symptoms of breast cancer include a lump in the breast, a change in the shape or size of the breast and changes in skin over the breast, according to the Mayo Clinic.
"Breast cancer in the early stages is painless, so some patients would see a lump and think it is a boil. Or they would try to treat it with home remedies," she says. "Often they only come to the clinic when the pain starts and by then it might be too late."
Dludla says men, just like women, need to learn how to do breast self examinations to feel for lumps or abnormalities in their breasts.
"If they find any lumps or see discharge from the nipples they must go see a doctor," she says.
Coming to terms wit diagnosis Being diagnosed with breast cancer took Mabuza by surprise.
"I was hurt. I asked myself many questions. I asked myself why God would let this happen to me," he says.
That night when he called his mother to tell her about his diagnoses, Mabuza says he broke down.
"My stepdad also had cancer, but it wasn’t breast cancer. He got his treatment at this hospital. I watched him go through chemotherapy, so I knew what was waiting for me," he says. "I cried because of the pain I had seen him go through. I was thinking that is the very same pain that I’m headed towards."
Mabuza remembers sitting in the waiting room on a follow-up visit to the clinic. Once again he couldn’t help but notice how he was mainly surrounded by women.
But he had another concern on his mind.
"I was scared because I didn’t know if this thing could be treated or if it meant the end for me. But the doctor was great. She told me that she would try her best to make sure that I can get back to my life after operating on me to remove the lump," he says.
Carol Benn, a specialist surgeon, encourages men to check their breasts too
The 29-year-old decided to tell his friends and family about his cancer early on because he believed this would garner the support he would need while getting treatment.
"At first my friends at the gym didn’t understand what was going on. They didn’t know men can get breast cancer. But when I worked out topless and they saw the scar from my operation [they] started to understand that this thing is real."
An eye opening experienceMabuza says having breast cancer helped him to gain a deeper appreciation of how many women are faced with this situation on a daily basis.
The men surveyed in the American Journal of Men’s Health study were breast cancer patients at the Helen Joseph Breast Clinic and Netcare Breast Care Centre of Excellence at the privately owned Milpark hospital.
The study was the first to investigate the effect of male breast cancer on a patient’s "self-perceptions of masculinity in a Southern African patient population".
The researchers found no link between the delay in men presenting for breast cancer treatment and feelings of masculinity. A majority of the patients did not feel emasculated by having what is perceived to be a female illness.
But Mabuza’s own perception of masculinity was challenged in a way he never expected.
At the height of his illness while undergoing six months of chemotherapy, he was struggling to deal with the side effects of his treatment.
"I had diarrhoea, I couldn’t keep my food down and I had lost all my hair. I was so frustrated because when I started the treatment I was fine and now they were giving me medicine that was making me sick," he recalls.
One afternoon Mabuza, who is now in remission, got a visit from his neighbour and fellow bodybuilder.
"He was on his way to gym and had just stopped by to see how I was. That is when I told him that I wasn’t going to make it – I didn’t have the strength to fight anymore."
Hours later Mabuza’s friend returned, but this time he had brought with him the rest of men Mabuza used to train with. Mabuza couldn’t get out of bed so the six amateur bodybuilders all filed into his bedroom.
"They sang hymns and we prayed," he recalls. "I never thought that those guys knew how to pray. I couldn’t even imagine that they knew there is a God. But their prayers gave me the hope I needed to fight."
Have something to say? Tweet or Facebook us on @Bhekisisa_MG
Breasts: Five things to know about them and their care
In this township, alcohol makes violent men close to three times more likely to rape a woman.
As the death toll rises, we look at the people, the policies and the politicians at the centre of this national tragedy.
Finally capping its own medics, the country must now retain them and coax them into rural areas.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.