Clinical factors used to support prophylactic mastectomy for a male BRCA2 mutation carrier

Abstract

Male breast cancer accounts for less than 1% of male cancers and of all diagnosed breast cancers in the United States. Male breast cancer is treated with mastectomy and, more recently, mastectomy combined with sentinel node surgery. For female BRCA gene mutation carriers requiring mastectomy, the use of prophylactic mastectomy for the contralateral breast is well supported. Whether this should be done for male BRCA mutation carriers has not yet been established. This case report describes the treatment of a male with a known BRCA2 mutation who was found to have breast cancer and had an opposite side prophylactic mastectomy at the time of his breast cancer surgery. His tumor was strongly estrogen receptor positive and moderately progesterone receptor positive, and his estradiol level was elevated. Increased estrogen exposure is a probable risk factor for breast cancer in men and women. Examples of conditions leading to hyperestrogenism in males include cirrhosis of the liver and genetic syndromes such as Klinefelter Syndrome. Some studies support the use of a single measurement of bioavailable estradiol to stratify women into risk categories for breast cancer, although not all re-