Men and Mammography—Addressing Breast Cancer in Men

Breast cancer incidence in men, though rare, is on the rise.^[1] According to breastcancer.org, the lifetime risk for men to get breast cancer is one in 833.^[2] Although there are currently no image-based screening recommendations for asymptomatic men,^[3] a considerable effort is being made to increase awareness of male breast cancer, its warning signs and risk factors so that men who may be at higher risk can better monitor their breast health and cancers can be diagnosed at the earliest possible stages.

Improving awareness about risk factors and what they mean, as well as generating collaborative industry support on the benefits of breast cancer screening in men, could result not only in earlier detection but also in downstaging at diagnoses and potentially improving survival rates.

Understanding risks for breast cancer in men

Certain risk factors such as family history, several genetic factors, and environmental risk factors such as radiation exposure make up some of the similarities between men and women’s breast cancer, but industry experts are beginning to recommend screening for men who are at increased risk of breast cancer due to a breast cancer (BRCA)2 or BRCA1 inherited gene mutation and family history of breast cancer.^[4]  The incidence of male breast cancer has risen over the past few decades and new studies are exploring the data that connects genetic profile information to breast cancer in men.

Men with positive tests for a BRCA 1 or 2 pathogenic, for example, or likely pathogenic variants have an increased risk for the development of breast cancer.^[5] Studies demonstrate that up to four percent of men diagnosed with breast cancer have BRCA 1 mutations, and four to 16 percent have BRCA 2 mutations. And despite the low incidence of the disease, the relative increase in risk from the baseline is higher in men than women, from a 20-fold increase in risk for BRCA 1 carriers, and an 80-fold increased risk in BRCA 2 carriers, versus an approximate 7-fold increase for women carrying either BRCA 1 or 2^.[6]

Multiple factors can increase the risk of breast cancer in men beyond increased age, including these genetic factors, and others such as: family history, demographic, hormonal, and environmental influences. Family history is one of the strongest risk factors in female breast cancer and a family history of breast cancer also extends to an increased risk for breast cancer for men in the same family. According to the American Society of Clinical Oncologists (ASCO), about one in five men (in the US) who are diagnosed with breast cancer have a close relative who has also had breast cancer.^[7]

The case for image-based screening for breast cancer in men

Unfortunately, male breast cancer is primarily diagnosed after clinical presentation, as screening is not performed.[8] Screening has already been shown to improve breast cancer detection rates in women and has the potential to be beneficial for men as well. Several studies have explored the potential for breast cancer screening in males with elevated risk. Men diagnosed with breast cancer are typically older and have more advanced cancers, with poorer stage for stage overall survival compared to women.[9] Data reveals that there is a disparity between the male and female breast cancer survivor rate due to these delayed diagnoses and despite the similarity in treatment options.^[10] These statistics underscore the need for earlier and more timely diagnosis of breast cancer in men whenever possible.

Though there are no current image-based screening guidelines for men, the National Comprehensive Cancer Network (NCCN) recommends that men with positive tests for the BRCA 1 or 2 mutations get a clinical breast exam annually. Additionally, those men who also have gynecomastia, which is an enlargement of the breast caused by a hormone imbalance, should consider getting a mammogram every year, starting ten years before the earliest known breast cancer in a male family member or at the age of 50.^[11]

For men who proceed to image-based screening for breast cancer, studies have shown that because men have so little breast tissue, screening mammography is highly sensitive, with a high negative predictive value.^[12] Clinical experts believe that a screening program for subpopulations of high-risk men offer the best chances for early detection of a disease that disproportionately presents with advanced or metastatic disease.^[13]

Importance of patient-centric programs to navigate breast cancer screening and diagnosis for men

The adoption of screening recommendations and guidelines for breast cancer screening in women has had a positive effect on improving cancer detection as well as earlier diagnosis of cancers. Specialized initiatives, such as the one-stop clinic model, where women can move from screening exam to diagnostic exam, diagnosis and even biopsy in the same day simplifies the process and shortens the time to diagnosis.

The same care and concern are shown to men with respect to breast cancer screening.

“When I think about a man dealing with breast health issues, I think about how hard that must be for them. We use the same one-stop model for these patients, with a separate waiting area and changing rooms. It allows that man the privacy, the respect, and the dignity that he needs as he is going through this process, the same way we provide that for women.”

--Michele Brands, Network Director of Women’s Imaging at St. Luke’s Health Network

The One-Stop Clinic pilot at St. Luke’s formally began seeing female patients in January 2021 and has already shown positive results with a reduction of the delay between diagnostic imaging and pathology from 8.5 business days to 2 days or less, and between screening mammography to pathology from 13.44 days to 5 days. Most patients received results in 36 hours or less.^[15]

Programs like the one-stop clinic and others that already support male breast health issues are increasingly important as the healthcare industry continues to strive to improve awareness about risk factors and breast cancer in men. Collaborative support from health professionals, patient advocacy groups and industry has the potential to make significant progress in improving health outcomes for these patients.

To hear Michele Brands directly, click on this video here:  Men and Mammography: Myth or Reality?