University of Virginia Health System

BRCA Gene Mutation a Cancer Risk for Men

Men who are biologically related to family members who have the BRCA1 and 2 gene mutations typically avoid genetic counseling or testing, a new study finds.

Women who have mutations in the BRCA1 or 2 genes have an increased risk of breast and ovarian cancer. The findings were published in the Journal of Genetic Counseling.

When men do get counseling or testing, they are less likely than women to pass on the information or to discuss it thoroughly with their family members, according to study author Dr. Mary Daly of Fox Chase Cancer Center.

She says this is true even though men who carry these mutations have a 50 percent chance of passing them on to their children as well as an increased risk for getting certain cancers themselves.

Most cancers associated with BRCA1 and 2 mutations are seen in women, but men with these mutations are at higher risk for male breast cancer, prostate cancer, pancreatic cancer and melanoma.

Awareness of Genetics is Low

Consider a daughter with BRCA1 or 2 mutations: she has an estimated risk of 56 percent to 87 percent of developing breast cancer by age 70, says Daly, and half of these cancers occur before age 50.

The risk is especially high for people of Ashkenazi Jewish descent, she adds. BRCA mutations have been detected in more than 2 percent of this population.

Daly decided to do the research after finding that most men were not interested in getting genetic counseling or testing, even when family members tested positive for genetic mutations.

"In our experience, counseling family members [with genetic mutations], we deal primarily with women," she notes.

Many men, explains Daly, are simply unaware of how genetic mutations in the family can affect them and their offspring. Women are also unaware of the importance of men knowing.

"Women [who test positive for genetic mutations] are less likely to tell brothers than sisters," she says. "Even if they tell their brothers, they don't tell them as much."

Susan Jones, MS, CGC, a genetic counselor at the University of Virginia Cancer Center, says women may talk about their genetic testing results more often with female relatives because of their perception that the burden of diseases associated with BRCA mutations falls primarily on women. "It may also have to do with sociological roles, i.e., that discussions of illness and caring for ill people is a female role," she says.

Jones also notes that researchers have found many physicians are unaware that men can inherit and carry BRCA mutations. "Therefore, the significance of a male patient's family history of breast and ovarian cancer may go unrecognized by that man's physician," she says.

Counseling for Men, Too

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, called Daly's research "an important study" that "highlights what is a significant issue. I agree men need to know their family history - not just their mother's and father's, but aunts, uncles and cousins."

If men discover that the family includes many cases of breast cancer, especially at a young age, "they should be asking their doctors if they should be tested as well," says Lichtenfeld.

So, which men should consider genetic counseling? UVA's Jones says men should consider genetic counseling when one or more of these risk factors is present in their family:

• Early-onset breast cancer, especially when ovarian cancer is also present in their family.
• Several cases of breast cancer, especially when ovarian cancer is also present in their family.
• Early-onset ovarian cancer.
• Male breast cancer.
• Breast or ovarian cancer in a family of Ashkenazi Jewish ancestry.
• A BRCA mutation in a relative.

Steve Keiles, president of the National Society of Genetic Counselors, stresses that counseling should be the first step, followed by the decision of whether actual testing is needed. "Maybe a consultation will relieve some anxiety," Keiles says.

Most major medical centers now have genetic counseling services, says Daly. For more information about cancer genetic services at the UVA Cancer Center, call genetic counselors Susan Jones (243-6446) or Joanna Horn (982-6476).

To learn more about cancer, genetic counseling or other men's health issues, visit www.uvahealth.com.

Always consult your physician for more information.