September 17, 2019
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Breast cancer screening for high-risk men may detect disease early, improve survival

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Yiming Gao, MD
Yiming Gao

Men at high risk for breast cancer may benefit from screening for the disease, according to results of a retrospective study published in Radiology.

“Mammographic screening has helped improve the prognosis for women with breast cancer,” Yiming Gao, MD, assistant professor in the department of radiology at New York University Langone Health, said in a press release. “But men don’t have any formalized screening guidelines, so they are more likely to be diagnosed at a more advanced stage and often don’t do as well as women.”

Incidence of breast cancer among men is rising, from 900 cases diagnosed in 1991 to an estimated 2,670 new cases in 2019, according to researchers. Although rare, male breast cancer often is deadly, with 500 men projected to die of the disease this year.

Gao and colleagues analyzed breast imaging use and screening outcomes among 1,869 men (median age, 55 years; range, 18-96) who had a personal or family history of breast cancer and/or genetic mutations and underwent 2,052 examinations between 2005 and 2017.

All exams included mammography, and 1,004 included sonography.

The exams detected 2,304 breast lesions that led to 149 biopsies among 133 men. Results showed 41 (27.5%) of the lesions were malignant.

Screening revealed five node-negative cancers, for a cancer detection rate of 18 per 1,000 exams (95% CI, 7-41) with diagnosis on average after 4 person-years of screening (range, 1-10). The average detection rate among average-risk women is three to five per 1,000 exams.

Researchers calculated mammographic screening sensitivity of 100% (95% CI, 50-100), specificity of 95% (95% CI, 93.1-98) and positive predictive value of biopsy of 50% (95% CI, 22.2-77.8). Researchers attributed this strong performance to the lower amount of breast tissue in men compared with women.

Old age (P = .001), Ashkenazi Jewish ancestry (P = .001), genetic mutations (P = .006), personal history (P = .001) and first-degree family history (P = .03) all appeared associated with a higher risk for breast cancer among men. In particular, men who had an immediate relative with breast cancer appeared three times more likely to develop the disease.

Researchers observed no significant association between nonfirst-degree family history and cancer.

More research must be conducted to determine the age at which men with higher risk for breast cancer should begin screening and how often it should occur, according to researchers. They noted that current National Comprehensive Cancer Network guidelines recommend annual clinical breast examinations, and not mammography, starting at age 35 years for men with BRCA mutations.

“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. “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.” – by John DeRosier

Disclosures: Gao reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.