Men at High Risk for Breast Cancer May Benefit From Screening

Men at higher risk for breast cancer may benefit from mammography screening, according to new retrospective findings.

In a group of nearly 2000 men who consecutively underwent mammography over a 12-year period at New York University, 2304 breast lesions were detected. Of the 149 that were biopsied, 41 (27.5%) were malignant.

Everyone in the cohort had a personal or family history of breast cancer and/or genetic mutations.

The cancer detection rate was 18 per 1000 exams, which was significantly higher than the average detection rate of 3-5 per 1000 exams in women at average risk for disease.

Lead author Yiming Gao, MD, Department of Radiology, New York University Langone Medical Center, New York City, commented that she hopes this study will raise more awareness of male breast cancer.

"Currently, the typical presentation of breast cancer in men is only when someone feels a mass in their breast," she said. "Because there is no screening in men in general, since male breast cancer is uncommon, cancer only presents when it is palpated, which results in delayed diagnosis and worse prognosis."

"In comparison, mammography screening has helped detect cancers early in women before they become palpable, and in so doing, significantly improve prognosis for those with breast cancer," Gao told Medscape Medical News.

The study was published online September 17 in Radiology.

Breast cancer in men is rare, and the American Cancer Society projects that 2670 new cases of invasive breast cancer will be diagnosed in men in 2019. This rate, however, is almost three times the number of cases (900) diagnosed in 1991.

The authors note there is "persistent evidence" of disparities in survival between men and women because of delayed diagnosis and less individualized therapy in men (median survival, 7 vs 9.8 years; P < .005). The largest gender-based disparity for men versus women has been observed in stage I or II and node-negative disease (median survival, 6.1 years vs 14.6 years; P < .005), which highlights the need for earlier diagnosis in men.

Because of the low prevalence of breast cancer in men, general screening is not indicated and the usefulness of selective screening in those with identifiable risk factors remains unclear. However, the authors point out, even though screening of men is sporadic and inconsistent, anecdotal evidence has shown benefits in individual case studies.

But to date, there are no formal screening guidelines for men in high-risk groups such as those with a family or personal history of breast cancer or associated genetic mutations.

Targeted Screening Beneficial But Not Recommended Yet

Gao and colleagues hypothesized that selective screening could play a role among men at elevated risk for breast cancer and, in the first study of its kind, evaluated breast imaging utilization patterns and screening outcomes in 1869 men.

The median age of participants was 55 years (range, 18-96 years), and the men underwent screening in 2005-2017. A total of 2052 examinations were conducted; all exams included mammography and 1004 (48.9%) also included sonography.

The cohort included a subgroup with 165 identifiable genetic mutations or genetically related conditions. These included BRCA2 (n = 29), BRCA1 (n = 12), BARD1 (n = 1), BRCA2 variant of uncertain significance (n = 1), NBN variant of uncertain significance (n = 1), MLH1 (Lynch syndrome) (n = 1), and participants with Klinefelter syndrome (n = 2).

Of the 41 cancers diagnosed, five were detected at screening and 36 at diagnostic examination. On average, cancers were diagnosed after 4 person-years of screening (range, 1-10 person-years).

Mammographic screening sensitivity was 100% and specificity was 95%; the positive predictive value of biopsy was 50%.

Risk factors associated with male breast cancer were identified and included a personal history of breast cancer (odds ratio, 84), Ashkenazi ancestry (odds ratio, 13), genetic mutations (odds ratio, 7), and first-degree family history of breast cancer (odds ratio, 3). No associations were observed with non-first-degree family history.

"Although the National Comprehensive Cancer Network currently does not support screening in men, screening does happen sporadically in high-risk men," said Gao. "Our findings suggest that targeted screening in high-risk men is beneficial."

"Based on available data, however, we have centered our discussion primarily around the question of whether there is value in targeted screening in high-risk men," she added. "A lot more data are needed to get to more nuanced information before meaningful recommendations could be made or clinical guidelines could be altered. We hope to be able to expand our analysis to include data from other cancer centers to better delineate risk in men and evaluate how to best screen this patient population."

The authors have reported no relevant financial relationships.

Radiology. Published online September 17. Full text

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