Routine Breast Cancer Screening in Asymptomatic Men
No, an asymptomatic male in his late 60s with no significant medical history should not undergo routine mammography or ultrasound for breast cancer screening. There are no established screening guidelines for breast cancer in asymptomatic men, and imaging should only be performed when clinical findings cannot distinguish between benign disease and breast cancer, or when the presentation is suspicious. 1, 2
Why Screening Is Not Recommended
Clinical Diagnosis Is Sufficient
- Most men with breast symptoms can be diagnosed based on clinical findings alone without imaging. 1
- For men with clinical findings consistent with gynecomastia or pseudogynecomastia (the most common breast conditions in males), no imaging is routinely recommended. 1
- Unnecessary imaging in clear cases of gynecomastia can lead to additional unnecessary benign biopsies. 1, 2
Male Breast Cancer Epidemiology
- Male breast cancer is extremely rare, accounting for less than 1% of all breast cancers. 1
- While the median age of male breast cancer is 63 years (making your patient's age group relevant), the extremely low incidence does not justify population-based screening in asymptomatic men. 3, 1
When Imaging IS Indicated
Imaging should only be pursued if any of the following clinical features are present:
Suspicious Clinical Findings
- Unilateral breast mass (especially if hard, fixed, or eccentric to the nipple) 1
- Bloody nipple discharge 1
- Skin or nipple retraction 1
- Any presentation where differentiation between benign disease and breast cancer cannot be made clinically 1, 2
Age-Appropriate Imaging Algorithm (If Needed)
For men 25 years and older with suspicious findings:
- Bilateral diagnostic mammography or digital breast tomosynthesis (DBT) is the initial imaging study of choice. 3, 1, 2, 4
- Mammography demonstrates high sensitivity (92-100%), specificity (90-96%), and negative predictive value (99-100%) in distinguishing benign from malignant disease. 3, 2, 4
- If mammography is indeterminate or suspicious, ultrasound should follow to further characterize the mass and guide potential biopsy. 3, 4
Important Clinical Pearls
What to Look for on Physical Examination
- True gynecomastia: Soft, rubbery, or firm mobile mass directly under the nipple, often painful (especially if present <6 months), bilateral in approximately 50% of cases. 1
- Pseudogynecomastia: Fatty tissue deposition rather than glandular tissue enlargement, especially in patients with elevated BMI. 1
Common Pitfall to Avoid
- Do not order screening imaging in asymptomatic men simply because of age. Unlike breast cancer screening recommendations for women aged 40 and older 5, there is no evidence base or guideline support for routine screening in asymptomatic men of any age. The approach to male breast evaluation is fundamentally symptom-driven and clinical examination-based. 3, 1, 2