BRCA1 and BRCA2 gene mutations were first connected to an increased risk for breast and ovarian cancer in women in 1994 and 1995 respectively. This was a big moment in medical genetics and oncology and after this discovery the floodgates of BRCA-related studies opened. Unfortunately, the amount of data on men was a trickle in comparison to data on women. It took about 10 years before studies on BRCA1 and BRCA2 gene mutations in men started being published. Men got the shaft. As a result, a lot of questions about a man’s risk remained unanswered. Not surprisingly this historical lack of information led to an increase in myths about the impact of BRCA mutation in men. Despite the fact that today our picture of what it means for a man to be a BRCA mutation carrier is clearer, these old myths are still alive and strong. Let’s see if we can bust a myth or five.
1. You cannot inherit a BRCA1 or BRCA2 gene mutation from your father
BUSTED – Just like a woman, if a man has a BRCA1 or BRCA2 gene mutation there is a 50% chance that he will pass that gene mutation on to each of his children; son or daughter. When it comes to the BRCA gene, your father’s family history of cancer is just as important as your mother’s. Men can still carry a BRCA1 or BRCA2 mutation and never develop cancer (you can jump ahead to myth 3 for more information).
2. Women are always the first in a family to be tested for a BRCA1 or BRCA2 mutation
BUSTED – Men most certainly can be the first in their family to be tested for a BRCA1 and BRCA2 gene mutation. Here are three common scenarios when men are the first in their family to be tested for a BRCA mutation:
- A man diagnosed with breast cancer, regardless of his family history of cancer.
- A man is of Ashkenazi Jewish ancestry and has a family history of breast or ovarian cancer on mom or dad’s side.
- A man with a family history strongly suggestive of hereditary breast and ovarian cancer with no living family member with cancer
3. Men are not at an increased risk for cancer if they have a BRCA1 or BRCA2 gene mutation
BUSTED – Men are at an increased risk for breast cancer and prostate cancer if they have a BRCA1 or BRCA2 gene mutation. Pancreatic cancer and skin cancer are at a slight increased risk for both men and women. The difference between having a BRCA1 and BRCA2 gene mutation comes into play a little here as well. Men with a BRCA1 gene mutation are at the lower end of the risk spectrum and men with a BRCA2 gene mutation are at the higher end. The lifetime risk for cancer is as follows:
| General Population | Male BRCA Carrier | |
| Prostate Cancer | 15% | 20-25% |
| Breast Cancer | much less than 1% | 6-8% |
| Melanoma (Skin Cancer) | 1-3% | slightly more than 1-3% |
| Pancreatic Cancer | less than 1% | slightly more than 1% |
It is important to note that although the risk for cancer is elevated, many men with a BRCA gene mutation will not develop cancer.
4. Prostate cancer in men with a BRCA1 or BRCA2 mutation is the same as prostate cancer in the general population
BUSTED – Prostate cancer in men with a BRCA1 or BRCA2 gene mutation is more aggressive than prostate cancer in the general population. In the general population prostate cancer tends to be slow-growing – lots of men never get treated and instead have their cancer monitored through active surveillance. In contrast, men with a BRCA2 mutation may develop aggressive prostate cancer that needs to be treated. The data on the aggressiveness of prostate cancer in men with a BRCA1 mutation is less clear. BRCA1 carriers tend to have prostate cancer that is less aggressive than BRCA2 carriers but more aggressive the general population. A man’s BRCA gene mutation should always be factored into his prostate cancer management.
5. There is no special cancer screening for men with a BRCA1 or BRCA2 mutation
PLAUSIBLE – Men with a BRCA1 or BRCA2 gene mutation are screened very similarly to men in the general population. The main difference is that screening starts sooner and that men with a BRCA gene mutation have clinical breast exams. Screening starts at 40 years of age as opposed to 50 years of age in the general population. Screening includes annual:
- PSA blood test
- Digital rectal exam
- Clinical breast exam
Mammograms are not commonly done but may be clinically indicated. It is best to talk to your doctor or oncologist regarding mammography.
Screening options for male BRCA carriers may change in the future as more research into alternative screening methods is completed. At Sunnybrook there is a Familial Prostate Cancer Clinic (FPCC) run by Dr. Danny Vesprini, an oncologist who screens male BRCA carriers annually. Some men who are part of the FPCC choose to participate in the Male Oncology Research and Education (MORE) program run by Dr. Vesprini and Justin Lorentz, a genetic counsellor. The MORE program has many research initiatives including investigating new screening options for male BRCA carriers.
If you are interested in more information about the FPCC or MORE program please don’t hesitate to contact me by phone at 416 480-5000 ext.83683 or by email at justin.lorentz@sunnybrook.ca
Very good article Justin.