Men and Breast Cancer
It's not just girl talk: Including men in breast cancer genetic counseling
Contributed by Lauren E. Hipp, M.S., Breast and Ovarian Cancer Risk Evaluation Clinic
There is no question that breast cancer disproportionately affects women -- but we shouldn't be so quick to dismiss the risk to men. As we continue to learn more about the ways our genes influence our cancer risk, involvement of male relatives in genetic counseling and genetic testing can provide important information for your family's breast cancer risk evaluation. So why are men often forgotten?
Myth One: Men don’t carry mutations in breast cancer genes
It is a common misconception that only women need to be tested for genetic factors that can increase breast cancer risk. In fact, both men and women are at risk to carry gene changes, called mutations, that predispose them to cancer. Gene mutations can be passed on from generation to generation in families through both men and women, which means that it is important to look for a history of breast cancer on both your mother and your father’s side of the family when thinking about your risk.
Myth Two: Men are not at risk for breast cancer.
Men have less breast tissue than women and it is true that breast cancer among men in the general population is very rare. Less than 0.1% of men (1 in 1000) will have a diagnosis of breast cancer in their lifetime. For men that have a mutation in their BRCA1 or BRCA2 genes, however, that risk is much higher. For example, men with a BRCA1 mutation have a 1% lifetime (1 in 100) risk for breast cancer while men with a BRCA2 mutation have about a 5-8% (1 in 20) risk to develop a breast cancer.
In addition to that risk, male carriers of a BRCA1/2 gene mutation are at increased risk for prostate cancer, which can develop at earlier ages and be more aggressive than prostate cancers in men without a gene mutation. Both men and women with BRCA2 mutations may be at increased risk for pancreatic cancer and melanoma (both ocular and cutaneous), and researchers are continuing to look into risks for other cancers as well.
A family history of breast cancer in a male relative is often a clue that a BRCA1/2 mutation may be being passed on through the family. However, many men (and women) with a BRCA1/2 mutation never develop cancer, so a gene mutation in the family can sometimes remain hidden for many generations. As we continue to learn more about cancer genetics, it is possible that we will find other genes besides BRCA1 and BRCA2 that can increase breast cancer risk for men.
What can men do to reduce their risk?
National guidelines are available to guide men with a BRCA1/2 mutation, along with their physicians, in developing a cancer screening program to help minimize their risk to develop a cancer. This screening may include monthly breast self-exams, a breast examination by a physician twice a year, and earlier and more frequent screening for prostate cancer. Some men may benefit from additional screening with breast imaging, like a mammogram.
Even if they don’t have cancer themselves, men can play a huge part in a family's genetics evaluation. By staying up to date on their family's health history, men can provide important information that can be used to determine which family members may be at risk and who may need genetic testing. Once a gene mutation is identified in a family member, open communication on both maternal and paternal sides of the family can help alert additional family members to receive testing and can help spread information regarding what is known about the family's risk.