Image-based screening for men at high risk for breast cancer: Benefits and drawbacks

doi:10.1016/j.clinimag.2019.11.005

Clinical Imaging

Volume 60, Issue 1, March 2020, Pages 84-89

https://doi.org/10.1016/j.clinimag.2019.11.005 Get rights and content

Highlights

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No guidelines exist for screening men at average risk for breast cancer
•
There are no image-based recommendations for screening high risk men
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Potential benefits of screening include high sensitivity, elevated lifetime risk in some subpopulations, and early detection

Abstract

Male breast cancer is a rare malignancy. Due to low prevalence and limited data to support male breast cancer screening, there are currently no recommendations for image-based screening in asymptomatic men and few recommendations for men at high risk for breast cancer. However, symptomatically diagnosed cancers in men are typically advanced, suggesting that earlier detection may improve outcomes. In this article we briefly review the risk factors for male breast cancer, and discuss the potential benefits and possible drawbacks of routine image-based screening for men at high risk for breast cancer.

Section snippets

Background

Male breast cancer is a rare malignancy representing approximately 1% of all breast cancer cases [1], with an estimated 2670 new cases and 500 deaths attributable to the disease in 2019 in the United States [2,3]. The incidence of male breast cancer has risen over the past few decades [[4], [5], [6]]. The lifetime risk for female breast cancer is 1 in 8 (12%) while the lifetime risk for male breast cancer is 1 in 833 (0.12%) [7]. Men are overwhelmingly diagnosed with ductal carcinomas because

Risk factors for male breast cancer

There are multiple factors that increase the risk of breast cancer in men beyond increased age, including genetic, demographic, hormonal, and environmental influences (Table 2). As with women, deleterious genetic mutations increase the risk for male breast cancer and are found in approximately 10% of men diagnosed with breast cancer [31]. Studies demonstrate that up to 4% of men with breast cancer have BRCA1 mutations, while 4 to 16% have BRCA2 mutations [1,[34], [35], [36]]. The absolute

Potential benefits of image-based screening of high risk men

There are several potential benefits for screening men at an elevated risk for male breast cancer (Table 3). First, the sensitivity of mammographic screening for men is expected to be high secondary to the predominantly fatty male breast tissue. The detection of malignancy in females is hampered by denser and more diffuse fibroglandular tissue [56,57]. In males, however, the diagnostic performance in the setting of clinical symptoms demonstrates mammography to be highly sensitive and specific,

Possible drawbacks of screening high risk men

There is no established screening regimen for males, and no research has been conducted to determine the optimal screening strategy in this population as men are not typically screened. Although there is interest in improving research to inform prevention, early detection and management of male breast cancer [24], there have been no studies evaluating the impact of image-based screening on survival or disease-specific mortality. In regards to mammography, one potential confounder of

Conclusion

Male breast cancer is a rare malignancy comprising a small proportion of the total number of new breast malignancies diagnosed annually. There are currently no guidelines or data supporting screening men of average risk for male breast cancer. Although clinical breast exam is promoted as a screening tool for men with BRCA mutations, there are no recommendations from any organization for routine image-based screening for high-risk men.

Based on this review of the current literature we believe

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Cited by (17)

News in breast oncology genetics for female and male population
2024, Gynecologie Obstetrique Fertilite et Senologie
La génétique oncologique mammaire a émergé il y a presque 30 ans avec la découverte des gènes BRCA1 et BRCA2. L’évolution des pratiques analytiques a progressivement permis d’accéder à des tests dont les résultats impactent désormais considérablement la prise en charge des cancers du sein, féminins et masculins. La Commission de sénologie du Collège national des gynécologues et obstétriciens français (CNGOF) a proposé à cinq spécialistes en chirurgie mammaire, oncologie et génétique oncologique d’établir une synthèse portant sur les critères de tests oncogénétiques retenus et les implications cliniques pour la population féminine et masculine des résultats d’analyse, avec ou sans variant causal identifié. Devant un risque génétique avéré, la surveillance, les stratégies de réduction de risque et les spécificités des prises en charge chirurgicales et médicales (avec en particulier les inhibiteurs de PARP) ont été actualisées.
Cette synthèse a été réalisée à partir des référentiels nationaux et internationaux portant sur la surveillance et la prise en charge thérapeutique du risque génétique et d’une revue récente de la littérature centrée sur les cinq dernières années.
Malgré les développements techniques successifs, la probabilité d’identifier un variant causal dans le cadre d’une situation évocatrice d’une prédisposition au cancer du sein et de l’ovaire reste de l’ordre de 10 % en France. Le risque de cancer du sein chez les femmes présentant un variant causal des gènes BRCA1, BRCA2, PALB2, TP53, CDH1 et PTEN est estimé entre 35 % et 85 % à l’âge de 70 ans. La présence d’un variant causal dans l’un de ces gènes fait l’objet de recommandations différentes pour les hommes et les femmes, concernant à fois la surveillance, dont l’âge de début et les modalités d’imagerie varient selon les gènes impliqués et également la chirurgie de réduction de risque, possible pour les femmes dès lors que leur niveau de risque dépasse 30 % et restant exceptionnellement indiquée chez l’homme. En cas de cancer du sein, les inhibiteurs de PARP constituent une nouvelle classe prometteuse en cas de mutation germinale BRCA.
Discipline résolument tournée vers la compréhension des mécanismes moléculaires, le dépistage et la médecine/chirurgie préventive, la génétique oncologique est à l’heure actuelle aussi impliquée dans de nouvelles approches médicochirurgicales dont il faudra suivre les bénéfices/risque à long terme.
Breast oncology genetics emerged almost 30 years ago with the discovery of the BRCA1 and BRCA2 genes. The evolution of analytical practices has progressively allowed access to tests whose results now have a considerable impact on the management of both female and male breast cancers. The Sénologie commission of the Collège national des gynécologues et obstétriciens français (CNGOF) asked five specialists in breast surgery, oncology and oncological genetics to draw up a summary of the oncogenetic testing criteria used and the clinical implications for the female and male population of the test results, with or without an identified causal variant. In the case of proven genetic risk, surveillance, risk-reduction strategies, and the specificities of surgical and medical management (with PARP inhibitors in particular) were updated.
This summary was based on national and international guidelines on the monitoring and therapeutic management of genetic risk, and a recent review of the literature covering the last five years.
Despite successive technical developments, the probability of identifying a causal variant in a situation suggestive of a predisposition to breast and ovarian cancer remains around 10% in France. The risk of breast cancer in women with a causal variant of the BRCA1, BRCA2, PALB2, TP53, CDH1 and PTEN genes is estimated at between 35% and 85% at age 70. The presence of a causal variant in one of these genes is the subject of different recommendations for men and women, concerning both surveillance, the age of onset and imaging modalities of which vary according to the genes involved, and risk-reduction surgery, which is possible for women as soon as their risk level exceeds 30% and remains exceptionally indicated for men. In the case of breast cancer, PARP inhibitors are a promising new class of treatment for BRCA germline mutations.
A discipline resolutely focused on understanding molecular mechanisms, screening and preventive medicine/surgery, oncology genetics is currently also involved in new medical/surgical approaches, the long-term benefits/risks of which will need to be monitored.
Knowledge and attitudes of male nursing students concerning male breast cancer and ways of prevention
2024, International Journal of Africa Nursing Sciences
Male breast cancer remains largely unfamiliar to students, the general public, and healthcare professionals. In stark contrast, female breast cancer, being more prevalent, has garnered significant awareness across various demographics.
This study aimed to assess knowledge and attitudes of male nursing students about male breast cancer and prevention measures.
A descriptive research design was employed for this study. The participant pool comprised 165 male nursing students enrolled in the nursing program at the College of Nursing, Prince Sattam Bin Abdulaziz University. Data collection involved utilizing a participant identification form and a questionnaire, encompassing three primary sections addressing sociodemographic data, knowledge, and attitudes of the participants regarding male breast cancer and ways of prevention.
The study revealed that the total mean score for knowledge among the participants regarding male breast cancer was 19.03±4.414. Additionally, the total mean score for their attitudes toward male breast cancer was 29.8±6.041. The analysis indicated a highly statistically significant association between the total knowledge scores and total attitude scores of the participants (P < 0.05). Furthermore, there was a notable and statistically significant relationship between the educational level of the participants and their total attitude scores.
Male nursing students lacked understanding about male breast cancer and had a poor attitude toward it.
These results provide a starting point for the creation of evidence-based, gender-specific health promotion and disease prevention strategies for men, while more research with bigger samples is required. Also, this study makes a significant contribution to the creation of an effective program meant to increase high nursing students' awareness of breast cancer and strategies to support their loved ones in the prevention and treatment of the disease.
Management of men with high genetic risk of breast cancer. Is there a place for screening or risk-reducing surgery? Case report and review.
2023, Current Problems in Cancer: Case Reports
Male breast cancer is uncommon, accounting for approximately 1% of breast cancer cases. Among its established risk factors, genetic etiology is recognized as predominant. While there is an abundant literature on surveillance and other risk-reduction strategies for women with high-risk breast cancer, only few studies are available on men with the same genetic condition.
We report the case of a 59-year-old man with a family history of four cases of breast cancer in first- and second-degree relatives, including two male cases. The genetic analysis revealed the presence of a pathogenic variant in the BRCA2 gene. Despite the normality of breast imaging, the patient requested bilateral breast risk-reducing surgery. This surgery consisting in bilateral mastectomy was performed after validation in a multidisciplinary meeting. The pathological examination revealed a ductal carcinoma in situ with intermediate grade in the right breast.
In families at high risk for breast cancer, pathogenic BRCA2 variants are responsible for 60–70% of male breast cancer cases and the cumulative risk is about 8% at 80 years of age. Breast cancers associated with a pathogenic BRCA2 variant have a poor prognosis, characterized by a lack of progesterone receptor, a more frequent overexpression of HER-2 and high grade. According to recent guidelines, education in breast self-examination is recommended from the age of 35, as well as annual clinical examination. Yearly screening by mammography is possible, only in men with gynecomastia, but there are disparities in screening recommendations. Risk-reducing breast surgery is not currently recommended. It is described occasionally in the literature, always for men with a pathogenic BRCA1 or 2 variant and a personal history of breast cancer, in the context of contralateral surgery. Our observation is, to our knowledge, the first risk-reducing surgery in a man, allowing the removal of an occult ductal carcinoma in situ.
Breast management in men does not necessarily involve imaging. Rare are the men requesting for bilateral risk-reducing surgery. In this context, health professionals have an important role in the patient's decision making. It can be accepted, as for our patient, only after discussion of the case in a multidisciplinary meeting, considering the personal and family history.
Male ductal carcinoma in situ: Diagnosis and management of a rare disease in men
2024, BMJ Case Reports
Gender-Specific Genetic Predisposition to Breast Cancer: BRCA Genes and Beyond
2024, Cancers
Male Breast Cancer: a Review on Diagnosis, Treatment, and Survivorship
2024, Current Oncology Reports

View all citing articles on Scopus

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Breast ImagingImage-based screening for men at high risk for breast cancer: Benefits and drawbacks

Highlights

Abstract

Section snippets

Background

Risk factors for male breast cancer

Potential benefits of image-based screening of high risk men

Possible drawbacks of screening high risk men

Conclusion

Lancet

Eur J Radiol

Am J Surg

Clin Imaging

Biochim Biophys Acta

Breast

Breast

Mod Pathol

Mayo Clin Proc

Breast cancer in men

N Engl J Med

Cancer statistics, 2019

CA Cancer J Clin

Male breast cancer: an updated surveillance, epidemiology, and end results data analysis

Clin Breast Cancer

The rising incidence of male breast cancer

Breast Cancer Res Treat

Decline in breast cancer incidence in the United States: what about male breast cancer?

Breast Cancer Res Treat

Breast carcinoma in men: a population-based study

Cancer

Cancer facts & figures 2018

Gender differences in breast cancer: analysis of 13,000 breast cancers in men from the National Cancer Data Base

Ann Surg Oncol

Overall mortality after diagnosis of breast cancer in men vs women

JAMA Oncol

Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades

Radiology

Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort

Cancer

The significance of nipple discharge of the male breast

Breast J

Male breast cancer in the age of genetic testing: an opportunity for early detection, tailored therapy, and surveillance

Radiographics

ACR Appropriateness Criteria® evaluation of the symptomatic male breast

J Am Coll Radiol

Primary breast cancer in men: clinical, imaging, and pathologic findings in 57 patients

AJR Am J Roentgenol

Mammography and ultrasound in the evaluation of male breast disease

Eur Radiol

Imaging characteristics of malignant lesions of the male breast

Radiographics

Outcome of men presenting with clinical breast problems: the role of mammography and ultrasound

Breast J

Multidisciplinary meeting on male breast cancer: summary and research recommendations

J Clin Oncol

Male breast cancer

Breast cancer risk among male BRCA1 and BRCA2 mutation carriers

J Natl Cancer Inst

Genetic/familial high-risk assessment: breast and ovarian

Underdiagnosis of hereditary breast cancer: are genetic testing guidelines a tool or an obstacle?

J Clin Oncol

Consensus guideline on genetic testing for hereditary breast cancer

Screening mammography in men with BRCA mutations: is there a role?

Breast J

BRCA1 and BRCA2 mutations in a population-based study of male breast cancer

Breast Cancer Res

BRCA1 and BRCA2 mutation status and tumor characteristics in male breast cancer: a population-based study in Italy

Cancer Res

Breast Imaging
Image-based screening for men at high risk for breast cancer: Benefits and drawbacks