Most people would flinch if I told them that breast cancer is a rare cancer, so prepare to flinch because I am now saying that breast cancer is a rare cancer!
Breast cancer has the highest level of awareness of any cancer and it is the most common cancer in women. For men the story is very different. Most people don’t even know that men can get breast cancer, but they can and they do get it. Male breast cancer counts for only 1% of all breast cancers, so it is a rare cancer, but one that men need to become more aware that they are at risk.
Men need to know that:
1- The risk of developing male breast cancer is increased by exposure to elevated levels of estrogen, prior exposure to radiation and a family history of breast cancer.
2- Mutations in specific genes including BRCA1 and BRCA2 have been shown to be associated with an increase in risk for breast cancer in men.
3- When men are diagnosed with breast cancer most commonly they are diagnosed with infiltrating ductal carcinoma.
4- The most common clinical symptom of male breast cancer is a lump beneath the nipple.
5- When male breast cancer is staged it is staged identically to breast cancer in women.
In this post I want to concentrate on point 2, specifically the BRACA mutations.
As a result of all the awareness around breast cancer there has been a lot of attention focused on the risks posed by the BRCA gene mutation, but the attention has been focused on women. Men are just as likely as women to have a BRCA mutation
Women are often tested for the BRACA mutation, but men are rarely tested so those men with the mutation often do not know they have it. It is important that men learn their BRACA status for two reasons.
1- Men are a potential carrier of the mutation and can pass the mutations onto their children. Fathers pass down the altered BRCA gene at the same 50% rate as mothers.
2- BRCA mutations have been linked to a higher incidence of cancers in men, including male breast cancer, pancreatic cancer, melanoma, as well as prostate cancer.
It is important for men to know their BRACA status, however being positive for the mutation does not mean that you will get cancer, but it greatly increases your risk of developing the disease.
If you think back, it was concerns about the increased risk from her family history and the fact that she had the BRACA mutation that motivated actress Angel Jolie to have her breasts and ovaries removed as a prophylactic approach to lower her risk factors for developing cancer.
Since her very public action there has been a lot of public conversation about women and genetic testing for hereditary cancers. However, this discussion has not carried over to how the BRACA mutation might also impact men.
Being BRCA positive also raises a man’s risk for developing cancers. About 12 percent of men with metastatic prostate cancer—roughly one in eight—carry a BRCA mutation. This is a higher rate than the percentage of women with breast cancer who carry a BRCA mutation.
Having a BRCA mutation has additional testing and treatment implications for men. Men with the mutation should be screened for prostate and breast cancers at an earlier age than men with average risk factors. The National Comprehensive Cancer Network (NCCN) recommends men with BRCA mutations begin breast self-exams and annual clinical breast exams at age 35. NCCN also recommends prostate cancer screening for BRCA mutation carriers beginning at age 40.
“There's a possibility that someone could undergo prostate cancer screening in his 30s, especially if he has a family history of prostate cancer,” says Altovise Ewing, a Genetic Counselor. “It would be appropriate for that person to start his screenings 10 years before the age of the earliest onset of prostate cancer in his family.”
So, if you are a male you should consider making an appointment with a genetic counselor to understand your risks. If you have a number of risk factors then you should consider seeing if you also carry a BRACA mutation. The genetic counselor can help you understand your overall risk factor and if additional BRACA testing should be performed.
Joel T. Nowak, MA, MSW wrote this Post. Joel is the CEO/Executive Director of Cancer ABCs. He is a Cancer Thriver diagnosed with 5 primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma and a rare cancer, and Appendiceal Cancer.
