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Men at High Risk for Breast Cancer Benefit From Mammograms

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Mammography screening offers benefits to men with a high risk of developing breast cancer, according to a study.

The mammograms help find any breast cancer early, when it is most treatable.

The research was published online on Sept. 17, 2019, by the journal Radiology. Read Breast Cancer Screening in High-Risk Men: A 12-Year Longitudinal Observational Study of Male Breast Imaging Utilization and Outcomes (PDF).

Risk factors for male breast cancer

While breast cancer in men is rare, it does happen. Fewer than 1% of all breast cancers are diagnosed in men. In 2019, about 2,670 new cases of invasive breast cancer will be diagnosed in men. For men, the lifetime risk of getting breast cancer is about 1 in 833.

Like breast cancer in women, breast cancer in men can be hormone-receptor-positive or hormone-receptor-negative, as well as HER2-positive or HER2-negative.

It's important to understand the risk factors for male breast cancer — particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

Current National Comprehensive Cancer Network guidelines only recommend checking for breast cancer as part of annual physical exams, not using more sensitive imaging tests — such as a mammogram — for men age 35 and older with a BRCA genetic mutation, according to the study’s lead investigator Yiming Gao, M.D., assistant professor of radiology at NYU Langone Health.

Risk factors for male breast cancer include:

  • Growing older: Just as in women, risk increases as age increases.
  • High estrogen levels: Estrogen stimulates the growth of breast cells, both normal and abnormal. Men can have high estrogen levels as a result of being overweight, taking hormonal medicines, being exposed to estrogen in the environment, having liver disease, or drinking large amounts of alcohol.
  • Klinefelter syndrome: Men with Klinefelter syndrome have lower androgen levels and higher estrogen levels.
  • Family history: A strong family history of breast cancer or a known genetic mutation linked to breast cancer in the family increases the risk of breast cancer.
  • Radiation exposure: Radiation treatment to the chest increases the risk of breast cancer.

About the study

Because rates of male breast cancer, while still low, are increasing, the researchers wanted to know if screening men at high risk for the disease could help improve outcomes.

The study included 1,869 men, age 18 to 96, who had at least one mammogram at New York University Langone between 2005 and 2017. Most of the men had a mammogram because they felt a lump in their breast. Other men had no symptoms but wanted to be screened because a family member recently had been diagnosed with breast cancer.

The men had:

  • 1,781 diagnostic mammograms (86.8%)
  • 271 screening mammograms (13.2%)

Overall, 41 men were diagnosed with breast cancer, which was confirmed with a biopsy. The 271 screening mammograms found five breast cancers.

All the men diagnosed with breast cancer had mastectomy.

The men diagnosed with breast cancer were older (65 years) than men who were not diagnosed with breast cancer (50 years).

Certain factors were linked to a higher risk of a man developing breast cancer, including:

  • having been previously diagnosed with breast cancer (84 times more likely)
  • being of Ashkenazi Jewish (Eastern European) descent (13 times more likely)
  • having a genetic mutation linked to breast cancer (7 times more likely)
  • having a first-degree family member (mother, father, sibling) who had been diagnosed with breast cancer (3 times more likely)
  • having a family history of breast cancer (2 times more likely)

The researchers noted that mammography was more effective at finding breast cancer in high-risk men than in women at average risk of breast cancer. For every 1,000 mammograms done in high-risk men, 18 breast cancers were found. In comparison, five breast cancers are found for every 1,000 mammograms in average-risk women.

"Our findings show the potential of mammography in screening men at high risk for breast cancer and in detecting the disease well before it has spread to other parts of the body," Gao said.

"Men at high risk of breast cancer often seek out testing because a female family member had the disease," said study senior investigator Samantha Heller, M.D., associate professor of radiology at NYU Langone Health. "In general, men need to be more aware of their risk factors for breast cancer and that they, too, can develop the disease."

The study investigators said that more research is needed to determine at what age and how often mammograms should be performed in men at high risk before they would recommend any changes to clinical guidelines.

"With increasing numbers of women and men seeking genetic counseling for breast cancer, there is a need for advice to both men and women about their actual risk and guidance about the best screening practices to make sure if they do get the disease, that it is detected and treated early," said Gao.

To better understand and define the risk relationships among family members, the team plans to look at data from other cancer centers.

What this means for you

If you’re a man who has a high risk of breast cancer because of personal or family history, your ethnicity, or a genetic mutation, it makes sense to talk to your doctor about this study.

While clinical guidelines don’t recommend regular mammograms for high-risk men at this time, you and your doctor can work to develop a screening plan that makes sense for you and your unique situation.

It’s also important to talk to your doctor right away about any changes in your breasts, including:

  • nipple pain
  • inverted nipple
  • nipple discharge
  • sores on the nipple and/or areola area
  • enlarged lymph nodes under the arm

Because many men don’t consider the possibility that they may develop breast cancer, they may wait a year or longer to talk to their doctor after noticing a breast symptom. According to the researchers who did this study, that is why men have a higher risk of dying from breast cancer, even though the disease is much more common in women.

For more information, visit the pages on Male Breast Cancer.

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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