High-risk men may benefit from breast cancer screening too

A novel observational study has determined that men at high risk of developing breast cancer may benefit from selective mammography screening.

Researchers from New York University’s (NYU) School of Medicine and Langone’s Perlmutter Cancer Center (both NY, USA) have conducted the largest, most inclusive medical records review of men who have received mammograms in the USA. The results of the study, published in Radiology, suggest that mammography screening may confer significant benefits for early disease detection in men at high risk of developing breast cancer.

The study evaluated the medical records of 1869 men, aged 18—96, who underwent breast cancer examinations at NYU Langone Health (NY, USA) between 2005 and 2007. Of these, 165 men had undergone screening examinations. Patients’ reasoning for seeking such screening varied; some sought testing following their feeling a mass in their breast, whilst others were driven by familial disease history.

Researchers sought to evaluate the patterns of breast imaging in men to determine high-risk screening outcomes and whether such risked-based screening improves the early detection of male breast cancers.

In the study, researchers observed that mammography screening was more effective at detecting breast cancer in high-risk men compared with women at average disease risk. Breast cancer detection rate by mammography in high-risk men was 18 per 1000 screens performed. By contrast, this detection rate in average-risk women is only five per 1000 exams performed.

Mammographic screening was also able to detect breast malignancies in men that were not otherwise clinically detectable; all of these malignancies were Stages 0 or I and node negative.

These results demonstrate that, for high-risk men, mammogram screening may improve disease prognosis due to earlier detection.

Further, the study revealed that men who had an immediate female family member – sister or mother – with breast cancer were three times more likely to suffer the disease themselves, compared with men who did not have immediate relatives with breast cancer.

Senior study author Samantha Heller, an associate professor of radiology at NYU Langone Health and a Perlmutter radiologist, commented: “Men at high risk of breast cancer often seek out testing because a female family member had the disease. In general, men need to be more aware of their risk factors for breast cancer and that they, too, can develop the disease.”

Lead study investigator Yiming Gao, a Perlmutter diagnostic radiologist, stated: “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.”

Currently, checking for breast cancer is only recommended as part of annual physical exams for men age 35 or older with BRCA mutations. Employing more sensitive imaging tests, such as mammograms, is not routinely advised, however, use of these tests for men has significantly increased in recent years.

Before they would recommend any clinical guideline changes, Heller and Gao insist further research is required to determine at what age, and how often, mammograms should be ideally performed in high-risk men.

Sources:

Gao Y, Goldberg JE, Young TK, Babb JS, Moy L, Heller SL. Breast cancer screening in high-risk men: a 12-year longitudinal observational study of male breast imaging utilization and outcomes. Radiology. doi.org/10.1148/radiol.2019190971 (Epub ahead of print) (2019); https://nyulangone.org/news/breast-cancer-screening-found-effective-men-high-risk-disease