Family health history matters. If diabetes, heart disease, or colon cancer runs in your family, you could be at higher risk of developing those conditions. But if you’re a man, there’s one part of your family health history that may feel easy to brush off: breast cancer. After all, breast cancer primarily impacts women. So even if you have relatives with a genetic link to the disease, like the BRCA1 or BRCA2 mutation, you’re in the clear, right? Wrong.
“Men think of BRCA1 and BRCA2 and they think of typically female diseases, so they assume it doesn’t matter to them,” says Jane Lowe Meisel, MD, a medical oncologist at Emory Winship Cancer Institute in Atlanta and an American Society of Clinical Oncology expert in breast cancer. “But men can have those genes too.” And these same gene changes that increase a woman’s risk of breast and ovarian cancers raise a man’s risk of prostate and male breast cancers (and both sexes’ risk for pancreatic cancer). So, at the risk of sounding like an after-school special, this is really a case where knowledge is power.
Here’s how to fully understand your family’s history of breast cancer and what it means for your well-being.
What to look for in your family
It’s not uncommon to have a relative with breast cancer—about one out of eight women in the U.S. will get it in their lifetime. “Breast cancer in women is so common, and the vast majority of men related to those women won’t have to deal with breast cancer,” says Dr. Meisel. It starts to be worrisome if you have what’s considered a strong family history of the disease. There are few signs that could point to that, according to Giacomo Montagna, MD, MPH, a breast surgeon and co-director of the Rare Breast Cancer Program at Memorial Sloan Kettering Cancer Center. Those include:
- Having one or more first-degree relatives, like your mom or sister, diagnosed with breast cancer or ovarian cancer before the age of 50.
- Having more than three relatives on either side of your family diagnosed with a combination of breast cancer, ovarian cancer, or prostate cancer at any point in their lives.
- Having a male relative who had breast cancer or prostate cancer that was very aggressive or metastatic.
- Having any relative with pancreatic cancer at any point in their life.
Dive deep into what’s going on
You and your doctors have a big question to answer: Could mutations in BRCA1, BRCA2, or one of the other 20+ genes researchers have discovered increase breast cancer susceptibility help explain why this disease and other cancers run in your family? Luckily you can find that out with a simple blood test—and some of the newest ones use just a saliva sample. “If your test is positive, you were born with a genetic predisposition to develop cancer,” says Dr. Montagna.
Let’s say you have a relative—male or female—who has already tested positive for a BRCA mutation. You should still get tested because it’s not a guarantee you’ll also have it. The odds that a parent will pass on the mutation to their child are actually 50-50, and you have the same odds of testing positive if one of your siblings or kids does.
This is true no matter your sex. “There’s a misconception that the BRCA gene only affects women, but it’s not true at all,” says Dr. Montagna. “Males have the exact same risk of acquiring the mutation from their parents.”
A quick side note about the BRCA mutations: Everyone is born with both BRCA genes, which help fix DNA mistakes that occur during your body’s normal processes. “They are DNA repair mechanisms,” Dr. Montagna says. Though BRCA genes can have variations that don't impact your health, certain mutations stop the DNA repair work from happening the way it should. “At the end of the day, a cancer cell is one with a lot of DNA mistakes,” says Dr. Montagna. The two genes—BRCA1 and BRCA2—are different, and their respective mutations affect cancer risk in different ways.
Here’s what that means for male breast cancer: “Male breast cancer is very uncommon, and in men without the genetic predisposition, about 1 in 1,000 will develop breast cancer,” says Dr. Montagna. “If you have the BRCA1 mutation, the risk is about 1/100, or 1%, and if you carry the BRCA2 change, the risk goes up to 7%. It really significantly increases.”
You have a BRCA mutation—now what?
First, take a deep breath. Having the mutation doesn’t guarantee you’re going to get male breast cancer. But it does mean you need to be more cognizant of your body and try to catch changes quickly. “Men aren’t screened for breast cancer, so they tend to present with more advanced cancer,” says Dr. Montagna. “They’ll say they had a lump for years by the time they see a breast cancer specialist, so the tumors are more advanced.”
So what should you watch for? “The most common symptom is a painless mass behind your nipple,” says Dr. Montagna. “Most breast cancer in men is behind the nipple because that’s where the milk-duct structures are.” In addition to a lump, you may notice some discharge or nipple retraction. “Prevention is mostly monthly self-awareness exams,” says Dr. Meisel. “Know what your chest feels like so you can bring up changes to your doctor.”
As mentioned above pancreatic and prostate cancers are also more likely to impact men with BRCA mutations, so talk with your doctor about how to be proactive in screening for those diseases as well. “All men should be aware of their body,” says Dr. Meisel. “Something odd might be nothing, but if it is something, you’ll be glad you caught it early.”
Another quick tip: If you have additional questions about your gene-related risk after going over your test results with your doctor, consider scheduling an appointment with a genetic counselor. They can translate your test results and explain what they mean for you, your relatives, and any future children.