NEW YORK (Reuters Health) – Although BRCA1/2 mutations put men at increased risk of breast, prostate and other cancers, they are significantly less likely than women to undergo genetic testing for these variants, researchers say.
“We often hear about the risk of breast and ovarian cancer in women with BRCA1/2 mutations, but what is less often appreciated are the cancer risks to men with BRCA1/2 mutations,” Dr. Christopher Childers of the University of California, Los Angeles and Kimberly Childers of Providence Health and Services Southern California told Reuters Health in a joint email.
“Men with BRCA1/2 mutations – primarily BRCA2 – have a 100-fold higher risk of breast cancer than average; they are also at increased risk of often aggressive, early-onset, prostate cancers, as well as pancreatic cancer and melanoma,” they said.
“Once a mutation carrier is identified, an important next step is to help identify other individuals in the family who may have the mutation and encourage them to get tested,” they note. “Male relatives are equally as likely to carry a mutation as are their female relatives.”
The two researchers and their colleagues analyzed data from the 2015 U.S. National Health Interview Survey, which involved a representative sample of adults age 18 or over. Those who received genetic testing were asked if their test was for breast, ovarian, colon, rectal or other cancer.
As reported online April 26 in JAMA Oncology, 378 adults reported a history of genetic testing for cancer, representing 2,498,842 people in the weighted subsample.
Compared to the overall sample, the genetic testing subsample included a lower proportion of Hispanics (10% vs. 16%), uninsured individuals (2% vs 10%), and subjects with only high school or General Educational Development diplomas (30% vs. 44%).
Close to three times as many women were tested as men (73% vs. 27%). The disparity persisted for unaffected men, who tested at half the rate of unaffected women (relative risk, 0.51).
Three-quarters of genetic testing was for BRCA-related cancers, 24% for colorectal cancer, and 22% for other cancers. Among the unaffected population, men underwent testing for BRCA mutations at one-tenth the rate of women (RR, 0.10). However, there were no gender disparities for colorectal or other cancer testing.
“This latter point suggested to us that it is not that men are overall less likely to obtain genetic testing, but rather that men are getting tested specifically for (BRCA mutations) much less often,” the Childers said.
“Future research needs to focus on why men are not getting genetic testing, and more importantly, to find ways to increase testing in men,” they conclude. “Previous studies have shown that men don’t necessarily understand the importance of a breast/ovarian cancer gene mutation – that it is more of a ‘feminine’ issue – but this couldn’t be further from the truth.”
Dr. Marleen Meyers, director of the Perlmutter Cancer Center Survivorship Program at NYU Langone Health in New York City, told Reuters Health, “Men with genetic mutations may have a higher than average lifetime risk for breast, colon and prostate cancer among others. Their children may also have a significantly increased risk of carrying the gene and having an increased risk of cancer.”
“There are National Comprehensive Cancer Network guidelines for genetic testing that include men, and coverage for testing is often linked to these guidelines,” she noted.
“At this time,” she added, “not all men need genetic testing, but it is always important to take a detailed family history, review guidelines and consider genetic testing particularly in multiple cancer families with younger onset of cancer, families with Ashkenazi heritage, and families with male breast cancer.”
“Clinicians should be evaluating and screening any male with the above history and referring him to a genetic counselor, as discussion of mutations may be complex. As more men are screened, we will learn more about their risk and prevention options,” Dr. Meyers concluded.
SOURCE: http://bit.ly/2jmC7mx
JAMA Oncol 2018.
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