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4 things every radiologist should know about male breast disease

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2. Risk factors associated with male breast cancer

In the study, Chesebro and colleagues detailed some of the many risk factors associated with the development of breast cancer.

“The well-established risk factors for breast cancer include age, race, family history/genetics, abnormal estrogen-to-androgen level, and radiation exposure,” the authors wrote. “Similar to female breast cancer, the incidence of male breast cancer increases with age. At all ages, black men have an increased incidence of breast cancer compared to white men, 1.8 per 100,000 versus 1.1 per 100,000.”

Also, approximately 10 percent of male breast cancer patients having a genetic predisposition, and patients with BRCA2 gene mutations are more likely to develop male breast cancer than patients with BRCA1 gene mutations. Klinefelter syndrome also significantly increases a man’s risk of developing breast cancer.

3. Treatment options for male breast cancer

The authors explained that treatment options for male breast cancer include surgery radiation therapy and systematic therapy. “Due to limited data, treatment recommendations are often extrapolated from studies of female breast cancer,” they wrote.

4. Imaging recommendations for transgender patients

“Radiologists and other physicians caring for transgender patients must be aware of the risk of breast cancer in this population and the appropriate breast cancer screening guidelines,” the authors wrote.

For female to male (FtM) transgender patients who have not undergone mastectomy, the mammographic screening recommendations remain unchanged. After the patient has undergone mastectomy, however, the authors explained that “medical providers should perform yearly chest and axillary examinations because residual breast tissue may be present.”

For male to female (MtF) transgender patients, mammographic screening is recommended for patients beginning at the age of 50 with more than five years of cross sex hormone therapy (CSHT).

CSHT results in the growth of breast tissue, and that tissue is often heterogeneously dense, Chesebro et al. added.

“The mammographic appearance of breast tissue in MtF transgender patients undergoing CSHT should not be called gynecomastia, as the breast tissue contains lobules and is similar to natal female breast tissue,” the authors wrote. “Therefore, development of lobular pathology rarely seen in natal males, such as cysts and fibroadenomata, can occur.”

In addition, if a MtF transgender patient chooses to get breast implants, “evaluation of implant integrity is the same as for natal female patients.”

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