Why Even Young Men Should Know Their Breast Cancer Risk

“Men don’t get breast cancer.” “You can only get breast cancer in October.” Those are just a couple of the dangerous myths people believe about breast cancer, said Bret Miller, a survivor of male breast cancer.

The reality is that breast cancer can happen to folks of any gender, said Madeline Deutsch, the clinical director for the Center of Excellence for Transgender Health at the University of California in San Francisco. And though it isn’t recommended that women get regular mammograms until they’re 50, breast cancer can happen to younger people, too.

What do genes have to do with it?

“All cancer is genetic, but not all cancer is hereditary,” said Brandi Preston, founder of the Kamie K. Preston Hereditary Cancer Foundation.

Illustration of female doctor talking to male patient. Breast Cancer Risk pbs rewire
If you have a family history of certain cancers, your doctor might recommend genetic testing for cancer.

Translation? All cancers involve gene mutations, but only some of those mutations are ones that are passed down from parents to their children. Also, a family history of breast or ovarian cancer doesn’t always mean hereditary genetic mutations are to blame, but it can still put folks at an elevated risk of developing those cancers.

Heredity results in 12 to 14 percent of breast cancer cases and about 24 percent of ovarian cancer cases, Preston said. In 2014, she launched the Heredity Cancer Foundation in memory of her mother, who died of breast cancer at age 40.

“My mom was a marathon runner, an Omaha police officer, never smoked, never drank — literally the picture of perfect health,” Preston said.

Her mother was first diagnosed with breast cancer at age 35, then again at age 38. After her second diagnosis, Kamie Preston was found to be a carrier of BRCA1. (Two genes – BRCA1 and BRCA2 – produce proteins that suppress tumors, according to the National Cancer Institute. Specific mutations of either of those genes, which can be inherited from either parent, significantly increase the likelihood that people will develop cancer.)

When Brandi Preston was just 19, genetic testing revealed that she also carried that faulty gene.

At first, she opted to have her doctors monitor her health through regular screenings, including breast MRIs. Three years later, after having her son, she had a nipple-sparing double mastectomy.

Now, she said, her risk of developing breast cancer has fallen to less than 2 percent. Women without a known predisposition for breast cancer have about a 12.5 percent chance of developing it.

How other cancers come into play

But a family history of breast cancer isn’t the only thing to look out for. Did you know that your grandpa’s prostate cancer, your aunt’s melanoma or your cousin’s colorectal cancer could be telling you something about your own risk for breast cancer?

There are eight types of cancer – breast, ovarian, prostate, pancreatic, gastric, colorectal, endometrial (cancer of the lining of the uterus, or the endometrium) and melanoma – that “go hand-in-hand,” Preston said.

Preston recommends checking out this table, which describes genes associated with hereditary cancer and the types of cancer linked to them. Let your family know you’re trying to gather family health history in order to make decisions about your own health.

Prostate cancer in older men isn’t necessarily a red flag, but if men in your family have developed it at a young age, that can be. When it comes to colorectal health, don’t just ask if anyone in your family has had the cancer. Since it’s possible to prevent colon cancer by removing polyps, also ask if anyone in your family has needed to have polyps removed, and if so, how many. Share all of this information with your doctor.

The possibility of hereditary breast cancer “can be very obvious coming from mom’s side,” Preston said. However, people tend to forget that hereditary breast cancer and ovarian cancers can also be passed down from the father’s side of the family.

Preston’s non-profit provides funding for cancer genetic testing when it’s denied (or is only partially covered) by Medicaid, Medicare or private health insurance.

Also, under the Affordable Care Act, women who meet certain screening guidelines, like not already having cancer, can receive cancer genetic testing “as a ‘preventative care service,’ meaning zero dollars out of pocket,” Preston said.

Getting tested

If you have a family history of certain cancers, your doctor might recommend genetic testing for cancer. However, if they don’t broach the topic, it’s a good idea to bring it up.

Your doctor can order the blood or saliva testing, the sample will be sent off to a lab and you’ll have the results within weeks, Preston said. Based on the results, your doctor can then work with you to develop a game plan.

If you’re scared to get tested, remember that “when you know, there’s something you can do,” Preston said said. “There are a lot of things you can do to stay healthy.”

Know your body – and see your doctor if you have concerns

While clinical guidelines used to recommend that people perform breast self-exams as an at-home screening tool, thinking on this has shifted, Deutsch said.

“We used to want to find as many things as possible,” she said.

However, when patients found lumps at home, “most of the time, they ended up being false positives,” putting the patient through worry and testing when nothing concerning was there.

However, both Preston and Miller, who see the benefit in self-examination as a way to get to know your body and learn what is – and isn’t – normal for you. It’s especially helpful if you aren’t getting regularly scheduled mammograms.

There are videos about male breast self-exams available through the Male Breast Cancer Coalition, an organization Miller co-founded. He also founded the Bret Miller 1T Foundation, which spreads awareness of breast cancer in men.

There currently aren’t universal guidelines for screening cisgender men for breast cancer, said Miller, who first noticed something wasn’t right on one side of his chest when he was 17.

For seven years, his doctors dismissed the lump as a calcium buildup. Ultimately, Miller had to have a mastectomy. He also underwent chemotherapy and has had to take a daily medicine to reduce the chances of the cancer returning.

When it comes to the transgender population’s risk for breast cancer, there’s still a need for scientific studies, Deutsch said. A variety of factors can affect when or if a transgender person might need screenings, such as how long a trans woman has been on estrogen or whether a trans man has had top surgery, which is a type of mastectomy.

If you find a lump, don’t panic

If you find a lump, keep an eye on it and see if it goes away, Preston advised; lumps can come and go with hormone fluctuations. If it lingers for, say, two weeks, see your doctor about it. If your concerns are brushed off and the lump remains, seek a second opinion.

“You know your body best and you are your own best advocate,” Miller said.

Rachel Crowell

Rachel Crowell is an Iowa-based writer exploring science and math. Rachel lives with Delilah, a golden retriever a stranger once called “the cutest thing in America.” Outside of STEM topics, Rachel also welcomes writing opportunities on everything from art to finance. Follow them on Twitter at @writesRCrowell.