Conducting screening mammography on men with a genetic risk for breast cancer can increase early detection, but clinical guidance and recommendations remain inconsistent.
A targeted approach to screening mammography for men who have genetic risk factors for breast cancer can lead to earlier detection and better outcomes. But, the exam is infrequently – and inconsistently – recommended, according to industry experts.
Even though only 1 percent of all diagnosed breast cancers occur in men, the incidence rate in this group has risen by 20 percent to 25 percent over the past two decades, according to industry experts. Screening mammography is known to catch cancers earlier, but there is still no official guidance for implementing this exam with men. In fact, the direction itself is inconsistent – The American Society of Clinical Oncology supports mammography for any man with a personal breast cancer history regardless of genetic factors, but the National Comprehensive Cancer Network only endorses clinical examination beginning at age 35 for men with a genetic mutation.
According to researchers from the New York University School of Medicine, very little consistency exists for when a clinician recommends screening for a man with a genetic mutation, such as BRCA 1 or BRCA 2. The team, led by Sushma Gaddam, M.D., clinical radiology instructor, presented their findings during this year’s Radiological Society of North America (RSNA) annual meeting.
“Although the absolute lifetime risk of breast cancer in men is relatively low, multiple concurrent risk factors can compound the actual risk for certain individuals,” the team said. “Given often delayed diagnosis in men due to lack of screening and worse prognosis as compared to women, optimizing early detection via screening in high-risk men is desirable.”
To assess how many at-risk men are screened, Gaddam’s team reviewed patient data and imaging studies from 414 men who had undergone genetic counseling, as well as multi-genetic panel testing. All the men had either a personal history, family history, or a combination of factors that put them at greater risk for developing the disease. According to the team’s analysis, 27.1 percent of men had a breast cancer-related genetic mutation – more than half of which were either BRCA 1 or BRCA 2.
Despite knowing the genetic mutation status of these men, though, Gaddam’s team discovered that physicians recommended only a clinical exam in 81 percent of BRCA carriers and suggested screening in only 50 percent of men who had a personal history of breast cancer. Additionally, among men who had both a personal history of the disease and a genetic mutation, only 40 percent received a recommendation for either a screening mammogram or a clinical exam – 60 percent were given neither suggestion.
But, when given the opportunity to pursue screening mammography, the team said, the majority of men complied. The 71.4 percent of men who adhered to a schedule indicate that men who are affected by a genetic mutation or who have a personal history of breast cancer are willing to undergo screening for early detection. And, the results can have a positive impact on patient health, the team said. Within their study population, screening mammography pinpointed two node-negative cancers.
Based on these findings, the team said, additional research is needed to create greater consensus on and standardization of risk management and screening.
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