- Researchers say mammograms for men at high risk of breast cancer can save lives.
- About 2,600 men in the United States will be diagnosed with breast cancer this year. About 500 will die from the disease.
- Some experts say more research is needed before guidelines can be adopted for when men should get mammogram screenings.
- The FDA has recommended that more men be included in breast cancer clinical trials.
When men are diagnosed with breast cancer, it’s usually at a later stage than women.
That’s a problem because early treatment for breast cancer increases treatment options and improves prognosis.
That’s why the U.S. Preventive Services Task Force recommends screening mammograms for women at high risk of breast cancer as well as most women aged 50 to 74.
But there are no formal screening guidelines for men at high risk of breast cancer.
A study published in the journal Radiology suggests a potentially lifesaving benefit of screening high-risk men.
The researchers reviewed mammography screening outcomes of 1,869 men over a 12-year period between 2005 and 2017.
In that time, 2,304 breast lesions were detected through mammography.
Of the 149 lesions that were biopsied, 41 were cancerous. Most of these cancers were detected before they had the chance to spread to lymph nodes, making them easier to treat and improving the chances of survival.
“These results show that it is possible to detect male breast cancer early and it appears that mammography is effective in targeted screening of high-risk men,” said Dr. Yiming Gao, the study’s lead author and an assistant professor in the department of radiology at New York University Langone Medical Center.
“We’ve shown that male breast cancer doesn’t have to be diagnosed only when symptomatic,” said Gao.
The researchers acknowledge several limitations of the study, including its retrospective design, single institution, and possible selection bias.
They note the need for larger studies to validate the results and provide more definitive recommendations.
Dr. Therese Bartholomew Bevers is a professor of clinical cancer prevention and the medical director of the Cancer Prevention Center and prevention outreach programs at MD Anderson Cancer Center in Texas.
Bevers told Healthline that we currently don’t have the data to be able to establish recommendations, so she sees the need for this type of research.
“Having said that, I don’t think this study gets us too much closer to any kind of understanding,” said Bevers.
“The total analysis was 1,869 men, but only 165 were ‘screening exams.’ The vast majority of these men were coming in because of a breast problem. That’s not a screening population. That’s a diagnostic population. You’ll always have a higher yield of cancers in a diagnostic population,” she explained.
Bevers defines a screening exam differently than the researchers do.
“I agree with family history or genetic mutation, but men with a personal history of breast cancer — that is a surveillance population, not a screening population. It’s a whole different group,” she said.
Once you remove the 47 men with a personal history of breast cancer, you’re left with 118 men getting true screening, said Bevers.
“That’s simply too small of a population to really get a handle on the benefits and harms of screening in this population especially when doing a retrospective study that could be fraught with biases. That’s not to say they’re not on the right track. We need to understand this,” she continued.
She also notes that the study does not address potential harms of screening mammography in men.
Bevers chairs the National Comprehensive Cancer Network (NCCN) Breast Cancer Screening and Diagnostic Guidelines Panel.
“I can say with 99 percent certainty my panel would not make recommendations based on this level of data,” she said.
The American Cancer Society estimates that about 2,670 men in the United States will be diagnosed with breast cancer in 2019.
About 500 of those men will die from the disease.
In the study, the most significant risk factor for men was a personal history of breast cancer. Other significant risk factors were Ashkenazi Jewish ancestry, genetic mutations associated with breast cancer, and first-degree family history of breast cancer.
Kellie Bedenbaugh is lead technologist at the Augusta University Health Breast Health Center in Georgia.
Bedenbaugh told Healthline it’s important for men to know their family history, do self-breast exams, and report changes to their doctors.
“They also need to understand that mammography is not just for women, it’s relatively painless, and can help save your life,” she said.
Mammography is often more accurate in men than in women.
That’s because men don’t have dense breasts or other changes that can lead to unclear results.
Bedenbaugh said there’s no difference in the way mammograms are performed on men.
“Here at Augusta University Health, we perform 3D mammograms on all of our patients. Therefore, the radiologist has the standard four images, plus the 3D images that construct the tissue into millimeter thick slices. The radiologist can scan through the breast tissue and better determine densities versus masses versus summated tissue,” she explained.
Some men might be reluctant to get a mammogram because they think breast cancer is a “woman’s disease,” or they hear stories that it’s painful, said Bedenbaugh.
“Thankfully, new technology has allowed us to perform mammograms that are not painful for the majority of patients and only last about 5 seconds per image,” she said.
“Mammography is not perfect, but it is able to detect calcifications, tiny lesions, and changes to the tissue that ultrasound and MRI may not be able to detect. Those studies are done in accordance with mammography if the radiologist requires such,” said Bedenbaugh.
Bevers’ male patients with symptoms or personal history of breast cancer have not expressed reluctance to have mammograms as needed.
“But we still have limited data to support making a recommendation for imaging in men. We recommend they get breast exams on a 6- to 12-month basis. There’s a low threshold to pursue diagnostic evaluation if they have symptoms,” said Bevers.