Mammography utilization and male breast cancer in BRCA1/2 carriers.

Abstract

10563 Background: Males with pathogenic germline variants in BRCA1 /2 (BRCA+) have a 1-10% lifetime risk of developing breast cancer (MBC). NCCN guidelines recommend that BRCA+ males consider annual mammograms. We have prior shown low rates of mammography uptake in an academic cohort from Penn Medicine (PM). We sought to validate these findings about mammography in a national veteran (VA) cohort and to investigate the clinical characteristics of BRCA+ compared to nonBRCA+ MBC. Methods: We performed a retrospective analysis of 327 BRCA+ male veterans with no prior history of MBC. The electronic health record was reviewed to determine indication for and results of mammography episodes. A mammography episode was defined as all breast imaging studies obtained for asymptomatic screening or for symptoms within six months. The first mammogram episode identified was referred to as the “initial” mammogram and all other mammography episodes were “subsequent”. To determine BI-RADS PPV, data for 85 PM and 68 VA BRCA+ males were combined and compared to 1819 nonBRCA+ males. To determine clinical characteristics of MBC, data for 30 PM and 18 VA BRCA+ MBC were combined and compared to 104 PM and 122 VA nonBRCA+ MBC. Results: Sixty-eight (20%) of VA BRCA+ males underwent an initial mammogram, 57% of which were ordered for screening. Among patients ≥50 without mammography, 31% of individuals had no discussion documented and 66% had a shared decision-making discussion against screening with an ordering provider. BI-RADS 4 and 5 findings occurred in six and five mammograms, respectively. MBC was diagnosed in 13% (9/68) after initial and 13% (3/23) after subsequent mammography pooled VA and PM data showed that 95% (21/22) of MBC diagnoses in BRCA+ males were after a symptom-prompted mammogram. BI-RADS 4 PPV was higher in BRCA+ compared to non-BRCA+ men (75% vs 5%, p < 0.0001), and BI-RADS 5 PPV was similar (100% vs 67%, p = 0.0661). In an expanded cohort of 48 BRCA+ MBC compared to 226 nonBRCA+ MBC, median (IQR) age of diagnosis was 66 (56-73) vs 66 (59-74) (p = 0.52). The majority of BRCA+ and nonBRCA+ MBC were ER+Her2- (85% and 90%, respectively, p = 0.70). Among those with Oncotype testing, 93% BRCA+ BC had intermediate or high-risk recurrence scores compared to 50% of non-BRCA+ (p = 0.002). However, BRCA+ and nonBRCA+ male patients had similar rates of node positivity (40% vs 41%, p = 0.87) and progression to metastatic disease (19% vs 16%, p = 0.67). Conclusions: Analysis of a Veteran cohort of BRCA+ males confirms low rates of mammography as we prior reported in an academic cohort. Counseling and SDM were inconsistently documented, highlighting gaps in guideline implementation. Both BRCA+ and nonBRCA+ MBC were nearly always diagnosed based on symptoms. Both BRCA+ and nonBRCA+ MBC were often node-positive and nearly 20% progressed to metastatic disease. These characteristics suggest the need for prospective evaluation of mammography in high-risk males to reduce rates of advanced disease.