While there are no formal recommendations as to mammography screening for high-risk men, a recently released 12-year study by Dr. Gao, published in the journal, Radiology, suggests that men at high-risk for breast cancer would benefit from mammography screening.
What characteristics define a man as being at high risk for breast cancer?
There are several reasons that a man would be considered at high risk of developing breast cancer.
- Family history. 1 out of every 5 men diagnosed with breast cancer has a family history of breast cancer — one or more first-or-second degree relatives (either male or female) who had breast cancer. The presence of ovarian cancer within a family may cause a man to be at higher risk.
- Genetic mutations. The presence of the BRCA2 mutation increases a man’s risk of developing breast cancer to about 6 out of 100. Some men have the BRCA2 mutation without a strong family history of breast cancer. CHEK2, PTEN and PALB2 mutations may also be responsible for male breast cancer.
- Klinefelter syndrome. 1 in every 1,000 men has Klinefelter syndrome, a genetic mutation that affects the number of X and Y chromosomes. Men typically have an X chromosome and a Y chromosome. Men with Klinefelter’s syndrome have two (or more) X chromosomes and a Y chromosome. Men with Klinefelter’s syndrome are 20-to-60 times more likely to develop breast cancer.
- Estrogen exposure. Men treated with estrogen-therapy for prostate cancer are at increased risk for breast cancer. Cattle farmers who utilize estrogen to help fatten up cattle may also be at increased risk.
- Chest radiation. Men who received chest radiation for lymphoma are at increased risk for breast cancer.
Because breast cancer is rare in men and there is no formalized screening recommendation, men may be diagnosed at a later stage and experience worse outcomes.
What does this new study show?
Dr. Gao and his team did a retrospective study of 1,869 men (median age 55) who had mammography screenings over 12 years (2005-2017). The results are compelling.
- Mammography detected 2,304 breast lesions.
- Doctors biopsied 149 of these lesions. 41 lesions (27.5 percent) were confirmed as cancer.
- For every 1,000 mammography screenings, 18 men at high risk were diagnosed with breast cancer — in contrast to just 3-to-5 average risk women diagnosed with breast cancer for every 1,000 mammograms.
- Every man diagnosed in this man was detected at an early stage, before their cancer had spread to their lymph nodes.
- Personal history of prior breast cancer proved to be the most significant risk — these men are 84 times more likely to develop breast cancer again.
- Men of Ashkenazi were 13 times like to develop breast cancer. Men with the BRCA1 and BRCA2 mutations were 7 times more likely to have breast cancer. Men with a first-degree relative were three times more likely to develop breast cancer.
Making recommendations
The National Comprehensive Cancer Network (NCCN) does not recommend mammography screenings for high-risk men … due to lack of evidence. Dr. Gao and his team plan on additional studies, pulling in more data from other cancer centers. Until then, clinicians should consider this new study when counselling high-risk men. More higher-risk men are seeking guidance, and this newly-released study suggests that mammographic screenings of high-risk men are beneficial and will save lives.