High-risk men might benefit from breast-cancer screening, research suggests

By Will Boggs MD

NEW YORK (Reuters Health) - 17/9/2019

Men at high risk of developing breast cancer might benefit from screening, a 12-year longitudinal study hints.

"Our findings suggest that targeted screening in men with personal history of breast cancer or in men with genetic predispositions, particularly in conjunction with other risk factors, such as family history or certain ethnic origin, may be warranted," Dr. Yiming Gao of New York University Langone Medical Center told Reuters Health by email.

The number of new cases of invasive breast cancer diagnosed in men has nearly tripled since 1991, and the median breast cancer survival is shorter in men than in women (7 vs. 9.8 years). The low prevalence of male breast cancer argues against general screening, and it remains unclear which men, if any, should undergo breast cancer screening.

Dr. Gao's team evaluated patterns of the male-breast-imaging utilization in their effort to determine high-risk screening outcomes and to delineate risk factors associated with cancer diagnosis.

They identified 1,781 diagnostic and 271 screening studies in 1,869 men (median age, 55 years). Over the 12 years of the study, the number of examinations in men increased significantly relative to the number of examinations in women.

All men undergoing screening had personal or family history of breast cancer and/or genetic mutations.

Overall, 133 men underwent 149 biopsies, 41 of which were malignant. Five of these breast cancers were diagnosed at screening and 36 were diagnosed at diagnostic examinations, the researchers report in Radiology, online September 17.

The cancer-diagnosis rate at screening was 18 cases per 1,000 examinations, with cancer diagnosed on average after four person-years of screening. In comparison, the cancer diagnosis rate at diagnostic evaluations was 20 cases per 1,000 examinations.

Older age, Ashkenazi descent, genetic mutations, personal history and first-degree family history were significantly associated with breast cancer.

For men who presented for screening, mammography was 100.0% sensitive and 95.0% specific for breast-cancer detection. The positive predictive values were 26.3% after one screening, 45.5% after two screenings and 50% after three screenings.

For men who presented for diagnostic evaluation, sensitivity was 94.7%, specificity was 92.4% and the negative predictive value was 99.9%.

"Remember to also discuss breast-cancer risk in the appropriate male patients, who may benefit from genetic counseling and possible mammography screening," Dr. Gao said. "Breast cancer in men is usually diagnosed late when symptomatic (and) therefore associated with worse prognosis. Mammography is highly sensitive for male breast cancer and has the potential to improve individual outcomes for high-risk men."

Dr. Alain M. Mukendi from Baragwanath Academic Hospital, University of the Witwatersrand, in Johannesburg, South Africa, recently reported that men with prostate cancer might benefit from screening for breast cancer and vice versa. He told Reuters Health by email, "I recommend (breast cancer) screening in men with family history of hereditary breast and ovarian cancer (HBOC) syndrome, family history of BRCA1 and 2 mutations, men with prostate cancer with or without estrogen therapy, patients with androgen deficiency or excess estrogen, particularly with a history of testicular injury, mumps orchitis, undescended testes, or Klinefelter's syndrome."

"Careful selection of patients who are at high risk is a very crucial step in male breast cancer screening, and mammography is able to detect clinically occult breast malignancy," said Dr. Mukendi, who was not involved in the new study.

SOURCE: http://bit.ly/31tIcSh

Radiology 2019.

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