Breast cancer screening among high-risk men proves to be effective in detecting the disease in its early stages
Breast cancer is as much a reality for men as it is for women. And now, studies have shown that breast cancer screening has been found to be effective in men at high risk of having the disease, showing it is possible to detect breast cancer early in males.
Since men do not have formal screening guidelines, they are more likely to be diagnosed at an advanced stage and often do not do as well as women. An analysis shows that mammography helped detect a total of 2,304 breast lesions, 149 of which were biopsied. Of those, 41 (27.5%) proved to be malignant.
Researchers say a significant finding of their analysis is that mammography was more effective in detecting cancer in high-risk men than is the norm for women at average risk of breast cancer.
For every 1,000 exams among these men, 18 had breast cancer. By contrast, the detection rate for women is roughly five for every 1,000 exams. Researchers attribute this result in part to the lower amount of breast tissue in men: more tissue can mask the detection of small tumors.
The researchers evaluated "breast imaging utilization patterns and screening outcomes" in 1,869 men in the median age of 55, who underwent mammography over a 12-year period.
According to the research team at NYU School of Medicine and its Perlmutter Cancer Center, the study is the largest review of medical records of men in the US who have had a screening mammogram.
The results, published in the journal Radiology, show that it is possible to detect male breast cancer early, and it appears that mammography is effective in the targeted screening of high-risk men, say researchers.
"Our findings show the potential for 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. Male breast cancer does not have to be diagnosed only when symptomatic," says Dr. Yiming Gao, lead investigator, and Perlmutter diagnostic radiologist.
Current estimates of breast cancer in men
Breast cancer in men is a rare but often deadly disease. According to the American Cancer Society projections, 2,670 new cases of invasive breast cancer will be diagnosed in men in 2019, and about 500 men will die from it.
Currently, there are no formal screening guidelines for men in high-risk groups such as those who have a personal history of the disease, breast-cancer-associated genetic mutations, Ashkenazi Jewish ancestry (ethnic group widely known for high rates of some cancers) or family members who had breast cancer.
According to researchers, the National Cancer Care Guidelines only recommends checking for breast cancer as part of annual physical exams, not using more sensitive imaging tests like a mammogram, for men aged 35 and older with genetic mutations, such as BRCA1 or BRCA2.
These mutations have long been linked to increased risk of breast cancer (up to seven times more likely than men with no genetic risk). Hence, men diagnosed with breast cancer tend to have worse outcomes than women, says the team.
"The lack of targeted screening in those at high risk and the tendency to wait to feel a lump before seeking care may explain why men have a higher risk of dying from breast cancer than women, even though the disease is much more common in women," says senior investigator of the study Dr. Samantha Heller, Perlmutter radiologist and an associate professor of radiology at NYU Langone Health.
The findings
The study involved 1,869 men, ages 18 to 96, who had a mammogram at NYU Langone between 2005 and 2017. Some of the men sought testing (diagnostic mammogram) because they felt a mass in their breast, while others had no symptoms and wanted to be screened because a family member had recently been diagnosed with the disease.
Overall, the analysis shows, 41 men were found to have breast cancer, as confirmed by breast tissue biopsy. All of them underwent surgery (mastectomy) to remove their tumor.
"The cancer detection rate of 18 per 1,000 exams in men at high risk of breast cancer was significantly higher than the average detection rate of three to five per 1,000 exams in average-risk women. In addition, the cancers in men detected were at an early stage, before they had spread to the lymph nodes, improving the prognosis for survival," says the study.
It further says, "In men, mammographic screening sensitivity, or the ability to detect cancer, was 100%, while specificity, or the ability to distinguish breast cancer from other findings, was 95%. This excellent performance is related to men having a relative lack of breast fibroglandular tissue that in women often masks abnormal results."
Researchers also found that men who had already had breast cancer were 84 times more likely to get it again than men who had no personal history of the disease. Men with an immediate relative who had breast cancer, such as a sister or mother, but not a cousin, were three times more likely to develop the disease.
Currently, the National Comprehensive Cancer Network (NCCN) does not support screening because of a lack of evidence, even in men with elevated risk, says the team. Earlier NCCN guidelines suggested consideration of baseline mammograms on an individual basis, an approach the new study results may support.
The team says more research is needed to determine at what age and how often mammograms should be performed in men at high risk.
"Rethinking our strategy toward male breast cancer diagnosis is necessary. We hope these results will provide a foundation for further investigations, and potentially help pave the way to standardizing screening for certain high-risk groups of men," says Dr. Gao.
The team plans to expand their analyses to include data from other cancer centers and to better define the risk relationships among family members.
"With increasing numbers of women and men seeking genetic counseling for breast cancer, there is a need for advice to both men and women about their actual risk and guidance about the best screening practices to make sure if they do get the disease, that it is detected and treated early," adds Dr. Gao.