Clinical FeaturesMen’s HealthOncology

Management of BRCA in Men

BRCA stands for BReast CAncer gene. BRCA1 and BRCA2 are tumour suppressor genes which means that they stop the cells in our body from growing and dividing out of control and becoming cancer. People who inherit harmful variants in one of these genes have increased risks of several cancers—most notably breast and ovarian cancer, but also several additional types of cancer. People who have inherited a harmful variant in BRCA1 and BRCA2 also tend to develop cancer at younger ages than people who do not have such a variant.

A lot of people still think that this is a ‘Female or Woman’s’ gene, but the truth is that a BRCA1 or BRCA2 alteration/fault can be inherited from a person’s mother or father. If you carry a genetic alteration, each of your children (male or female), and each of your siblings (male or female) have a 50% (1 in 2) risk of inheriting the same alteration.

Faulty BRCA1 and BRCA2 genes are rare. Around 1 in every 400 people have a faulty BRCA1 or BRCA2 gene. Men who have inherited a fault in their BRCA1 or BRCA2 gene also have a higher risk of developing certain types of cancers, including prostate, pancreatic, and even breast cancers.

While breast cancer is rare in men, it can happen. The average male has a 0.1 percent lifetime risk of developing breast cancer, but in men with BRCA alteration, the risk is much higher: 1 to 5 percent lifetime risk for men with BRCA1 alteration and 5 to 10 percent lifetime risk for men with BRCA2 alteration.

However, most men are probably more worried about prostate cancer than breast cancer, with good reason: the lifetime risk for prostate cancer for an average male is 14 percent. In Ireland, after non-melanoma skin cancer, prostate cancer is the most common cancer in men. It accounts for almost one-third of all invasive cancers in men. 1:9 Irish men will develop prostate cancer (to the age of 75) and 1:6 in their life time. An average of 3,980 men are diagnosed each year in Ireland with prostate cancer and 623 deaths occur due to prostate cancer. However, the 5 year survival rate for prostate cancer is increasing all the time and it is now up to 93%!

For men with BRCA1/2 alterations, the risk of developing prostate cancer is higher than for the general public and if prostate cancer does develop, it may be more aggressive. The risk is higher for people born male with an alteration in the BRCA2 gene than in the BRCA1. Men who carry a BRCA2 alteration have a 27% risk of developing prostate cancer by the time they are 80 years old, more than double the rate compared to non-carriers and may be diagnosed at a younger age.

Men with BRCA alteration are also at increased risk for pancreatic cancer: 2 to 3 percent lifetime risk for those with BRCA1 alteration and 3 to 5 percent lifetime risk for those with BRCA2 alteration, compared to just 1 percent lifetime risk in the general population.

BRCA2 alteration are also associated with a higher risk of melanoma in males.

Patients should talk to their GP if they think they could have inherited any of these faulty genes or if they have a strong family history of cancer especially breast, ovarian and or prostate cancer. A strong family history of cancer means multiple close family members on the same side of the family who have the same cancer or related cancer types. Unfortunately, there’s currently no reliable screening test for prostate cancer. Some research suggests that perhaps annual PSA tests for prostate cancer may benefit men who carry the faulty BRCA2 gene.

BRCA: The Breast Cancer Gene – BRCA Mutations & Risks (nationalbreastcancer.org)

Predictive genetic tests for cancer risk genes – NHS (www.nhs.uk)

BRCA Gene Mutations: Cancer Risk and Genetic Testing Fact Sheet – NCI

What Men Need to Know About BRCA and Other Gene Mutations | Breast Cancer Research Foundation (bcrf.org)

Written by Bernie Carter, Assistant Director of Nursing, Marie Keating Foundation

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