Routine mammography for men?

Breast cancer screening found effective in men at high risk for the disease

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NEW YORK—Researchers at NYU School of Medicine and its Perlmutter Cancer Center have conducted what they say is the largest review in the U.S. of medical records of men who have had a screening mammogram. And according to the study, men at high risk of developing breast cancer may benefit from mammography screening for the disease.
The article, published today in the journal Radiology, involved 1,869 men aged 18 to 96 who had a mammogram at NYU Langone between 2005 and 2017. Some sought a 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 breast cancer.
In total, 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 men with breast cancer had a mastectomy to remove their tumor.
“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,” said Yiming Gao, M.D., study lead investigator, Perlmutter diagnostic radiologist and assistant professor in the department of Radiology at NYU Langone Health. 
The study found 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 roughly five for every 1,000 exams. Researchers attribute this in part to the lower amount of breast tissue in men. More tissue can mask the detection of small tumors.
“Mammographic sensitivity for cancer is excellent in men due to a relative lack of breast fibroglandular tissue. In our study, the first imaging modality of detection was mammography for all cancers, both at diagnostic and screen examinations. Although clinical breast examination is thought to be highly sensitive and negatively predictive, and currently serves as the norm of male breast cancer detection even among the high-risk population, our study yielded five clinically occult breast cancers at screening, three of which presented as calcifications alone,” the article states. “This potential for early disease detection in men is supported by the fact that 90% of male breast cancers are ductal in origin, and up to 98% of precursors to invasive male breast cancers are ductal carcinoma in situ, typically seen as calcifications at mammography.”
According to Gao, current National Cancer Care Guidelines recommend checking for breast cancer as part of annual physical exams, without using more sensitive imaging tests like a mammogram, for men age 35 and older with BRCA mutations.
The study also found that men who had a history of breast cancer were 84 times more likely to develop 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.
“Men at high risk of breast cancer often seek out testing because a female family member had the disease,” noted Samantha Heller, M.D., Ph.D., study senior investigator, Perlmutter radiologist and associate professor of radiology at NYU Langone Health. “In general, men need to be more aware of their risk factors for breast cancer and that they, too, can develop the disease.”
Most men in the analysis sought testing because of concerns about a breast mass. Heller pointed out that the lack of targeted screening in those at high risk and the tendency to wait to feel a lump before seeking care could explain why men have a higher risk of dying from breast cancer than women, even though the disease is more common in women.
“Selective screening appears beneficial in our study, particularly in men with a personal history of breast cancer, who represent the largest group in this cohort to undergo regular annual screening (56.4%, 22 of 39). Of the four cancers found in this group, except for one cancer identified at baseline screening following prior cancer treatment, the remaining three cancers were found following multiple years of screening,” the article continues. “These contralateral second cancers were identified on average after 5.5 person-years of screening (range, 1–10 person-years), which is consistent with the time frame of male breast cancer recurrence reported in prior data, suggesting routine screening may be of value in this group.”
Others with elevated risk of breast cancer included men 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, (up to seven times more likely than men with no genetic risk).
Heller and Gao said that before they would recommend any changes to clinical guidelines, 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 better define the risk relationships among family members.
“With 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,” added Gao.

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