Use of mammograms in men is rising

Many men have breast symptoms, including enlarged or painful breast tissue, but the majority do not need a mammogram, say researchers from Mayo Clinic Cancer Center. Mammograms are used to check for the presence of breast cancers, which are very rare in males.

Their study, presented Saturday, Dec. 16, at the 2006 meeting of the San Antonio Breast Cancer Symposium, suggests physicians should reconsider ordering mammograms for men, who are most often diagnosed with non-cancerous gynecomastia, a common condition which includes breast swelling, a tender mass or painful breast tissue.

"Mammography is being performed with increasing frequency in men with breast symptoms, but we found that breast cancer in men can be felt as a firm, discrete mass on a physical exam, or seen as changes in the skin or nipple," says the study's lead author, Stephanie Hines, M.D., of Mayo's Multidisciplinary Breast Clinic and Breast Cancer Program in Jacksonville, Fla. Male breast cancer is exceedingly rare -- fewer than 2,000 men in the United States are diagnosed with the condition annually, she says.

"But the problem is that there are no guidelines about the use of mammograms in male patients and few studies have been conducted to find out if they are helpful," says Dr. Hines.

Conversely, gynecomastia is found in 60 to 90 percent of male infants, in 30 to 60 percent of boys going through puberty, and in 24 to 65 percent of adult men, according to Dr. Hines. The condition has a number of causes, including hormonal imbalance, use of certain medications, organ failure, and alcohol use. Gynecomastia can be detected in a physical exam and can often be diagnosed solely based on the clinical evaluation.

"So, in the vast majority of cases, a mammogram is not necessary for confirming a diagnosis of gynecomastia. Breast cancer is rare and most often easily detected on physical examination," says Dr. Hines. "The bottom line is that most men don't need a mammogram, and that is good news for them."

In this study, researchers retrospectively reviewed the records of all men who had a mammogram at Mayo Clinic Jacksonville from 2001 to 2004. A total of 212 mammograms were performed on 198 patients. The researchers said only three men were diagnosed with breast cancer, and of these, all three men had an obvious mass in the breast that could be felt on physical exam, or had changes, such as retracted skin or nipple, that are associated with tumor development. In one of the three men, the mammogram showed a mass initially diagnosed as benign that was later discovered to be cancerous.

However, the researchers found that 83 percent of the men who had mammograms and had been diagnosed with gynecomastia were taking a medication, or had a medical condition, that could predispose them to developing breast swelling.

"Men who have gynecomastia rarely have a breast tumor," says Dr. Hines. "Physicians should be able to determine if their male patients have developed gynecomastia by performing a thorough examination and taking a good medical history," she says. "Mammography may still be necessary if there is uncertainty about the clinical diagnosis. But it is not necessary to confirm gynecomastia through a mammogram."