A painful reminder that men can get breast cancer too

A 28-year-old British man died Friday from breast cancer. He was diagnosed with breast cancer at age 24 and is reported to be the youngest male victim of this disease in Britain. Nickey Avery's death is a painful reminder that men also get breast cancer.

The breast cancer ribbon is pink, a feminine color. Both the ribbon and much of the public discussion of breast cancer seemingly excludes men. But it shouldn't. Men need to be aware that they are also at risk for breast cancer. And men in families with known BRCA mutations need to be especially aware of this danger as these men are at greater risk for breast cancer than men in the average population.

We dedicated an entire chapter of Positive Results to men with BRCA mutations and the cancer risks faced by such men. As we discuss in greater detail in Positive Results, BRCA-positive men are at greater risk for developing breast cancer than are men in the general population. And men with BRCA2 mutations face the highest risk.

A new study on the breast cancer risk of BRCA2-positive men in the Journal of Medical Genetics reinforces the risk estimates found in earlier studies. Specifically, this new study found that breast cancer risk for men withBRCA2 mutations is 7.1 percent to age 70 and 8.4 percent to age 80. While these numbers are relatively modest when compared with the breast cancer risk of aBRCA2-positive woman (whose breast cancer risk is from 45 to 87 percent by age 70), they are actually not much below the average woman's risk of breast cancer and are certainly in the range that should require men to pay attention to their bodies and think about surveillance and early detection. As with breast cancer in women, early detection of breast cancer in men can save lives. Having a family history of male breast cancer is a very compelling reason to undergo BRCA testing, but remember that there are also several other known genetic causes of male breast cancer so for those who test negative, additional medical investigation is important.

Fortunately, Positive Results seems to be having a positive impact on the men in at least one BRCA2family. Joi recently attended a FORCE meeting that included several BRCA2-positive cousins, several of whom had already battled breast cancer. One of these women assumed that she had inherited her mutation through her father, although he would not test for the mutation. Positive Results has the stories of a BRCA-positive father and daughter as well as the story of a BRCA2-positive man who has had breast cancer. The father talks not only about his mother's and daughter's battles with breast cancer but also about his experience as the only man in a breast cancer screening clinic. This woman highlighted these stories and sent the book to her father. These stories changed his mind not only about genetic testing but also about surveillance. He agreed to be tested and not surprisingly tested positive for the family BRCA2mutation. Then he went a step further and enrolled in a high risk screening program. Like Steve, who is profiled in the book, this man is overcoming his discomfort with being the "only man in a breast cancer screening clinic" and being proactive about protecting his health.

Dr. Gordon notes that male patients are often uncomfortable at first thinking about breast cancer, as it is so ingrained in our collective psyches as a female disease. The hard facts are that men are often diagnosed at more advanced stages of breast cancer, despite the exam and detection being easier, because they ignore the signs, since "that lump can't be anything". Clinical and self examination are the mainstay of screening, though mammograms are helpful if the man's particular build allows for them to fit in a mammogram machine. Yes, the wives often suppress a little smile and think "ah ha, finally, the guys get to know what we put up with!" I stress the importance of becoming part of a breast care center and reassure them that there will be plenty of men in the waiting room, though the other men might not actually be patients it will not be uncomfortable to be sitting there. I also make sure to let them know that even if they get a mammogram, no one will ever make them wear pantyhose. So to all the men who are BRCA mutation carriers or at other genetic risk, man up and take care of yourselves!