Breast cancer screening helps ID men at risk for the disease

Men at high risk of developing breast cancer may benefit from mammography screening for the disease, a new study shows.

Researchers at NYU School of Medicine and its Perlmutter Cancer Center conducted what they say is the largest review in the United States of the medical records of men who have had a screening mammogram. The study, publishing in the journal Radiology online this week, involved 1,869 men who had a mammogram at NYU Langone between 2005 and 2017. Some sought diagnostic mammogram testing 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.

A total of 41 men were found to have breast cancer, as confirmed by breast tissue biopsy. Among the 271 men who had screening exams, five had the disease. All with breast cancer had surgery (mastectomy) to remove their tumor.

A key study finding was that mammography was more effective at detecting cancer in high-risk men than is the norm for women at average risk of breast cancer. For every 1,000 exams in these men, 18 had breast cancer. By contrast, the detection rate for women is about 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.

"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," says Yiming Gao, MD, a radiologist and the lead investigator for the study.

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Current National Cancer Care Guidelines only recommend checking for breast cancer as part of annual physical exams, not using more sensitive imaging tests like a mammogram, for men age 35 and older with BRCA mutations, says Gao, an assistant professor in the Department of Radiology at NYU Langone Health.

Among the study's other main findings was 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, were three times more likely to develop the disease.

Most of the men in the analysis sought testing because of concerns about a breast mass, cautions study senior investigator and Perlmutter radiologist Samantha Heller, MD, an associate professor of radiology at NYU Langone Health. However, that 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.

Before they would recommend any changes to clinical guidelines, Heller and Gao say more research is needed to determine at what age and how often mammograms should be performed in men at high risk. The team plans to expand their analyses to include data from other cancer centers and to better define the risk relationships among family members.

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