It's not surprising that awareness efforts for hereditary breast cancer focus on the women in the family, but it's important not to leave the men out. Not only can men get breast cancer, their family health history holds important information to help relatives determine their cancer risk.
This Breast Cancer Awareness Month, I encourage people to have discussions with their relatives – both male and female – about their health history to help determine if breast cancer runs in the family. If it does, genetic counseling and testing may provide a better understanding of the risks to you and your family members and what to do about them. Recognizing patterns of breast cancer and other related cancers can help the entire family.
Genetic Testing for Hereditary Cancer
The criteria for considering genetic testing for hereditary breast and ovarian cancer now includes men with aggressive forms of prostate cancer. A man who is diagnosed with prostate cancer should ask his doctor about his Gleason score, which indicates how aggressive the tumor is; a score of 7 or higher is considered aggressive. Genetic testing is a reasonable option to consider if a relative has been diagnosed with an aggressive prostate cancer and one relative in the family has had breast, ovarian or pancreatic cancer. Testing guidelines were recently updated to include all men with metastatic prostate cancer regardless of their age at the time of their diagnosis or their family history. Knowing whether a BRCA1 or BRCA2 mutation contributed to the development of prostate cancer is important as it would likely influence the treatment plan recommended by your doctor.
The genetic testing criteria for hereditary breast and ovarian cancer has also expanded to include pancreatic cancer. All individuals with pancreatic cancer, regardless of their age at the time of their diagnosis or their family history are candidates to pursue genetic testing as the results may be used to inform treatment decisions and to provide information for relatives regarding surveillance or risk reduction options. If a relative had pancreatic cancer and/or there is a family history of breast or ovarian cancer in a close relative, testing may be an option.
Family Health History
It's important to look at the health history on both sides of the family. Half of the families who have an inherited risk of developing cancers inherited it from their father's side of the family, but often the patterns are easier to see on their mother's side. The chances of men developing cancer as a result of a BRCA1 or BRCA2 gene mutation are lower than the chances for women. Therefore, it may look like the gene is skipping a generation if the men don't develop cancer. A man may inherit the mutation and not become sick, but his children and grandchildren remain at risk. Talking to a genetic counselor can help you determine your health risks.
Patterns in a family that should prompt a visit to a genetic counselor:
- Early onset breast cancer (under 50 years of age)
- An aggressive type of breast cancer called triple negative breast cancer, under 60 years of age
- Metastatic breast cancer regardless of the age at diagnosis or family history
- Cancer in both breasts or two separate breast cancers in the same breast
- Three or more close relatives* on the same side of the family with the same or related kind of cancer (breast, ovarian, prostate, pancreatic or colon cancers)
- Ashkenazi Jewish background with a personal or family history of breast, ovarian, colon, pancreatic or prostate cancer
- Aggressive and/or metastatic prostate cancer
- Male breast cancer
- Pancreatic cancer
- Ovarian cancer
- Gene mutation identified in the family
* Close relatives are defined as first degree: parents, siblings and children; second degree: nieces, nephews, grandparents, aunts and uncles; and third degree: first cousins, great aunts and uncles and great grandparents
Patterns can be hard to see if there are not many women in a branch of the family.
That's why a diagnosis of cancer at an early age alone may be enough to identify an inherited risk factor. As we approach the holiday season and you gather with your relatives, talk with them about this topic. Ask what kind of health problems run in your family, the ages of your family members at the time of diagnosis, the kind of cancer each relative has or had, and the types of surgeries they've had (i.e. hysterectomy with removal of ovaries) and their age at the time of the surgery. Knowing the current ages of your relatives or the age that your relative passed away and the cause of death is also quite useful. It's also important to ask if your relatives have already had genetic testing.
As a genetic counselor, I encourage you to share this information with your relatives. Family history is a valuable tool to help protect your health and the health of your relatives and may suggest that earlier screening or prevention is reasonable to consider.
Genetic counselors can help explain your family history, determine your chance of developing cancer, explore your testing options and help you decide whether testing is right for you. Find a genetic counselor in your area by using NSGC's “ Find a Genetic Counselor ” tool.
Joy Larsen Haidle , MS, CGC, is president of the National Society of Genetic Counselors and a genetic counselor at the Humphrey Cancer Center in Minneapolis.