Men and Women and the Risk of BRCA-positive Breast Cancer

Although breast cancer is more common in women, during October, Breast Cancer Awareness Month, experts from Cedars-Sinai Cancer are reminding men that they are also at risk.

According to the Centers for Disease Control and Prevention (CDC), one in every 100 breast cancers in the United States is diagnosed in a man, which means that the disease represents approximately 1% of cancers that occur in men. But available statistics show that the incidence of breast cancer in males is rising, reaching 15% in some patient groups.

According to the CDC, the most common kinds of breast cancer in menace the same as breast cancer in women, including:

• Invasive ductal carcinoma. This type of breast cancer begins in the ducts and then grow outside these ducts into other parts of the breast tissue. Invasive cancer cells can also metastasize.
• Invasive lobular carcinoma. This type of breast cancer begin in the lobules and then metastasize from the lobules to the breast tissues that are close by. However, these invasive cancer cells can also metastasize to other parts of the body.
• Ductal carcinoma in situ (DCIS) is a form of breast disease that may lead to invasive breast cancer. However, in the early stage, the cancer cells are only found in the lining of the ducts, and have not spread to other tissues in the breast.

Early diagnosis and treatment
Breast cancer is most common in older men, it can, however, occur at any age. Other risk factors include hormonal imbalance, radiation exposure, and a family history of breast cancer, liver disease (cirrhosis of the liver can lower androgen levels and raise estrogen levels in men, increasing the risk of breast cancer) and overweight and obesity.

Another risk factor for male breast cancer is Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome. This can lead to the body making higher levels of estrogen and lower levels of androgens.

In any case, early diagnoses and treatment is important. And men diagnosed with male breast cancer at an early stage have a good chance for a cure.

Because male breast cancer is rare, treatment recommendations are generally extrapolated from data available from clinical trials enrolling female breast cancer patients. [1]. Such treatments typically involves surgery to remove the breast tissue. Other treatments, such as chemotherapy and radiation therapy, may be recommended based on your particular situation.

Understanding genetic risk
Genetic predisposition is an important part of cancer risk and an important area of cancer care.

“Some people have damage to their DNA-their hereditary genetic material-that makes them more likely to get cancer,” explained Dan Theodorescu, MD, Ph.D., director of Cedars-Sinai Cancer and the PHASE ONE Distinguished Chair.

“As genetic sequencing of patients with cancer becomes more common, we are discovering an increasing number of patients with this hereditary genetic damage, so our genetic counselors are an important part of the Cedars-Sinai Cancer team,” Theodorescu added.

Men and Women
“Both men and women should be aware of their family history of breast cancer,” noted John E. Lee, MS, LCGC, associate director of the Genetic Counseling Program at Cedars-Sinai Cancer.

Lee added that “both sides of the family need to be checked, because mutations in the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes that increase risk for breast cancer can be passed from the mother or the father-or both.”

Lee recently sat down with the Onco’Zine share additional breast cancer awareness tips for men in the hope of diagnosing more of these cancers at early stages, when they are most treatable.

Onco’Zine: “What factors increase a man’s risk of developing breast cancer?”

Lee: “The first is family history on either side. There’s a misconception that breast cancer can’t be inherited from the father’s side. But that’s absolutely not true. You inherit half your genes from your mother, half your genes from your father, and for cancer-related genes, they are really quite equal.”

Other risk factors include age-as most male breast cancers are diagnosed in those over age 60-as well as obesity and certain medical conditions. Those include liver disease and testicular disease.

Onco’Zine: “When should males consider undergoing genetic testing?”

Lee: “Any male with a personal or family history of male breast cancer, regardless of age of diagnosis, should consider undergoing genetic testing. Other clinical indications include personal history of metastatic, high- or very high-risk prostate cancer. Males should also consider genetic testing if they have a family history of early onset female breast cancer, multiple family members with female breast cancer, or Ashkenazi Jewish ancestry.”

Onco’Zine: “Why do you think many of these men fail to come in for genetic testing?”

Lee: “First, they aren’t always referred for testing because a lot of healthcare providers hold an outdated view that family history of breast cancer only matters for women. Second, most people think genes like BRCA1 and BRCA2 only affect female risk. The risk of cancer for BRCA-positive females is much higher than the risk for BRCA-positive males, but the risk still exists. There is also a stigma surrounding testing for men. Even when providers refer high-risk male patients, many of those patients never schedule appointments, and among those who do come in for a consultation, some opt to forgo testing.”

Onco’Zine: “How does being BRCA1 or BRCA2 positive affect a man’s risk of developing breast cancer?”

Lee: “Being BRCA2 positive raises a man’s risk of developing breast cancer from 0.1% to approximately 7%. When you look at absolute numbers, I can see why some people dismiss it, because it isn’t nearly as large an increase as the risk for women, which rises from 13% in the general population to as much as 70% for BRCA-positive women. But being BRCA positive also increases a man’s risk for developing prostate and pancreatic cancer. Another factor is that BRCA-positive men can pass that gene on to their children. And I think that’s important for them to know as well.”

Onco’Zine: “What are the breast cancer screening recommendations for BRCA-positive men?”

Lee: “We recommend annual clinical breast exams starting at age 35. We also recommend evaluation for gynecomastia, which often means a man has enough breast tissue to make routine mammograms feasible. We also recommend general breast self-awareness-being familiar with their breasts and watching for signs such as a lump or any sort of nipple discharge-for both men and women.”

Reference
[1] Gucalp A, Traina TA, Eisner JR, Parker JS, Selitsky SR, Park BH, Elias AD, Baskin-Bey ES, Cardoso F. Male breast cancer: a disease distinct from female breast cancer. Breast Cancer Res Treat. 2019 Jan;173(1):37-48. doi: 10.1007/s10549-018-4921-9. Epub 2018 Sep 28. PMID: 30267249; PMCID: PMC7513797.
[2] Abdelwahab Yousef AJ. Male Breast Cancer: Epidemiology and Risk Factors. Semin Oncol. 2017 Aug;44(4):267-272. doi: 10.1053/j.seminoncol.2017.11.002. Epub 2017 Nov 9. PMID: 29526255.

Featured image: Cedars-Sinai Cancer experts caution that one in every 100 breast cancers in the US is diagnosed in a man. Illustration by Getty, used with permission.