Should men get screening mammograms (mammography) for breast cancer?

Screening Mammography Recommendations for Men

Routine screening mammography is not recommended for average-risk men without genetic predisposition to breast cancer. 1

Risk Stratification for Male Breast Cancer Screening

High-Risk Men Who Should Consider Mammography:

• Men with a genetic predisposition to breast cancer, particularly BRCA2 mutation carriers (6.8% lifetime risk by age 70) and BRCA1 mutation carriers (1.2% lifetime risk by age 70) 1
• Men with a personal history of breast cancer and a genetic predisposing mutation 1
• Men with gynecomastia may be considered for annual mammogram screening beginning at age 50 or 10 years before the earliest known breast cancer in the family (whichever comes first) 1

Average-Risk Men:

• No screening mammography is recommended for men without genetic predisposition or significant risk factors 1
• The Expert Panel did not reach consensus on recommending contralateral annual mammography for men with a history of breast cancer but without a predisposing genetic mutation 1

Evidence Supporting Mammography in High-Risk Men

• A 12-year longitudinal observational study of 1,869 high-risk men found mammography detected node-negative breast cancer with a cancer detection rate of 18 per 1,000 examinations 2
• This detection rate is higher than that seen in both average-risk and high-risk women undergoing breast screening 1
• Harboring a genetic mutation was significantly associated with breast cancer (OR 7; 95% CI 2-29; p=0.006) 1
• Another study found a cancer detection rate of 4.9 cancers per 1,000 examinations in high-risk men, similar to detection rates in average-risk women 3

Recommendations for Men with BRCA1/2 Mutations

• Annual clinical breast examination starting at age 35 1
• Training in breast self-examination with regular monthly practice starting at age 35 1
• Contralateral annual mammogram may be offered to men with a history of breast cancer and a genetic predisposing mutation 1
• Breast MRI is not recommended routinely in men with a history of breast cancer 1

Rationale Against Routine MRI in Men

• Relatively small amount of breast tissue present in most men 1
• Lack of data demonstrating improvement in survival for this screening test 1
• Potential for false positives 1

Genetic Testing Recommendations

• All male patients with breast cancer should be offered genetic counseling and genetic testing for germline mutations 1
• Approximately 20% of male breast cancer patients may carry an identifiable inherited risk factor 1
• Previous studies have found 0-4% of men with breast cancer have mutations of BRCA1 gene, and 4-16% have mutations of BRCA2 gene 1

Clinical Pitfalls and Caveats

• Screening recommendations for men at elevated risk currently vary widely among practitioners, leading to inconsistent care 4
• Despite evidence of benefit in high-risk men, many BRCA carriers (80.9% in one study) were only recommended clinical breast examination without mammography 4
• Male breast cancer incidence is rising, suggesting potential need for more structured screening approaches in high-risk populations 2, 5
• The small amount of breast tissue in most men makes mammography technically feasible but requires appropriate positioning and technique 1