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Breast cancer

24 September 2019

At-risk men may also benefit from regular mammograms

Mammography screening has helped detect breast cancer early in women, and now it has been shown it can do the same for 'high-risk' men.

Mammography has saved hundreds of thousands of lives by detecting breast cancer early in women.

Could such regular X-ray screening also help men?

Genetics, race or ethnicity

A new study argues there's potential benefit in regular mammograms for men who are at high risk of breast cancer.

Mammography accurately detected dozens of cases of breast cancer in nearly 1 900 men screened during a 12-year period, results show.

These men were at increased risk of breast cancer due to their genetics, race or ethnicity, prior radiation exposure, hormone imbalances or other medical factors, said lead researcher Dr Yiming Gao, an assistant professor of radiology at NYU Langone Medical Center in New York City.

"Mammography screening has helped detect breast cancer early in women, and we have shown it can do the same for men," Gao said.

The study also found that men who already had breast cancer were 84 times more likely than others to get it again. And men with an immediate relative such as a sister or mother who had breast cancer had triple the risk.

Breast cancer is much rarer in men than women. About 2 670 breast cancers will be diagnosed in men this year, compared with 268 600 new cases diagnosed in women, said Robert Smith, vice president of cancer screening for the American Cancer Society.

Men don't do as well

But because men aren't regularly screened, male breast cancer tends to be diagnosed when it's reached a more advanced stage, Gao said.

"For this reason, men with breast cancer often do not do as well as women," she said. "More men die from breast cancer than from testicular cancer according to American Cancer Society estimates, although the latter is more common."

To see whether mammograms might help detect breast cancer in men, Gao and her team studied 1 869 male patients who had more than 2 000 X-ray screenings between 2005 and 2017.

The men sought testing either because they felt a lump in their breast or because a family member had recently been diagnosed with the disease.

The exams found about 2 300 breast lesions, which resulted in 149 biopsies in 133 men. In all, 41 malignant breast tumours were detected.

That might not sound like much, but mammography actually proved more accurate for men than for women, researchers said.

More research needed

For every 1 000 exams in high-risk men, 18 had breast cancer. The detection rate for women is roughly 5 for every 1 000 exams.

Men have less breast tissue than women, and more breast tissue can mask small tumours, researchers said.

Although this study showed the promise of mammography for high-risk men, more research is needed before any guidelines can be issued, Gao said.

Right now, there's no way to know when these men should start having mammograms, and how often they should undergo screening, she said.

"Our available data allows us to determine that targeted mammography screening in high-risk men is worthwhile," Gao said. "However, a lot more data are needed to get to more nuanced information before we are able to make meaningful recommendations."

Very, very low risk

Smith agreed that the findings suggest that "serious consideration be given to recommending regular breast imaging for men at very high risk".

However, it wouldn't make sense to have all men receive regular mammograms, he added.

"While the average woman can be judged to be at high enough risk – about 12% over her lifetime – of breast cancer to undergo regular screening after age 40 or 45, it would be very unproductive to screen average-risk men, who have a very, very low risk of breast cancer," Smith said.

The new study was published in the journal Radiology.

Image credit: iStock

 

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Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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