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Men at high risk of developing breast cancer聽may benefit from mammography, or breast X-ray, screening for the disease, a new study shows.
Researchers at 好色tv School of Medicine and 好色tv Langone鈥檚 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, , involved 1,869 men, ages 18 to 96, who had a mammogram at 好色tv Langone between 2005 and 2017. Some 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 received a breast cancer diagnosis.
In total, 41 men were found to have breast cancer, as confirmed by breast tissue biopsy. Among the 271 men who had screening exams, 5 had the disease. All those with breast cancer had surgery (mastectomy) to remove their tumor.
A key study finding was that mammography was more effective at detecting cancer in men with high risk than is the norm for women with 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 roughly 5 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.
鈥淥ur 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,鈥 says study lead investigator and Perlmutter Cancer Center diagnostic radiologist Yiming Gao, MD.
Current National Comprehensive Cancer Network 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 Dr. Gao, an assistant professor in the at 好色tv Langone Health.
Among the study鈥檚 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.
鈥淢en at high risk of breast cancer often seek out testing because a female family member had the disease,鈥 says study senior investigator and Perlmutter Cancer Center radiologist Samantha L. Heller, MD, PhD, an associate professor of radiology at 好色tv Langone. 鈥淚n general, men need to be more aware of their risk factors for breast cancer and that they too can develop the disease.鈥
Most of the men in the analysis sought testing because of concerns about a breast mass. However, Dr. Heller cautions 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.
Other men with elevated risk of breast cancer included those of Ashkenazi descent, an ethnic group widely known for high rates of some cancers (who were 13 times more likely to get breast cancer than non-Ashkenazi men) and those who had genetic mutations, such as BRCA1 or BRCA2, long linked to increased risk for breast cancer (up to 7 times more likely than men with no genetic risk).
Before they would recommend any changes to clinical guidelines, Dr. Heller and Dr. Gao say more research is needed to determine at what age and how often mammograms should be performed in men at high risk.
鈥淲ith increasing numbers of women and men seeking genetic counseling for breast cancer, there is a growing need for advice 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,鈥 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.
Besides Dr. Gao and Dr. Heller, other 好色tv Langone researchers involved in this study, which was self-funded by 好色tv Langone and took two years to complete, are Julia Goldberg, MD, MBA; Trevor Young, BSc; James S. Babb, PhD ; and Linda Moy, MD.
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