Screening mammography isn’t just for women. While we tend to think of breast cancer as a woman’s disease– other populations – including men and transgender people – can be at risk too.
While male breast cancer is rare – it represents just one percent of all breast cancers in the United States – its incidence has increased by an estimated 20 to 25 percent over the past few decades. Nearly 20 percent of men diagnosed with breast cancer have a family history of breast and ovarian cancer, and about 10 percent have a BRCA 2 mutation. Of approximately 2620 men diagnosed with breast cancer in the US annually, roughly 500 die from the disease, and they are often diagnosed later than their female counterparts.
Men with Klinefelter syndrome – a genetic condition that only affects males and is characterized by the addition of at least one X chromosome to the normal XY karyotype (XXY) – have a 50-fold increase in the relative risk of developing breast cancer, as well as a 60-fold higher breast cancer–specific mortality. These men face the highest risk for developing breast cancer and would benefit from mammographic screening.
Yet screening mammography has no role in the general screening of men. In fact – no general guidelines exist for breast cancer screening in men. However, the current National Comprehensive Cancer Network guidelines (v 1, 2018) for male carriers of BRCA1 or BRCA2 mutations include (a) annual clinical breast examination and self-examination to begin at 35 years old and (b) prostate cancer screening to begin at 45 years old.
Mammography screening is not currently recommended for men – though male carriers of BRCA 1 or BRCA 2 mutations may pursue mammographic screening if it is recommended by their physicians.
New research indicates that as genetic testing becomes more accessible – and we are better able to identify men at risk for breast cancer – screening mammography may offer benefits to these groups.
This brief focuses on mammography guidelines for men, but we will focus on transgender screening guidelines in an upcoming article.