September 23, 2021 by John Fernandez and Bethany Rundell
Men: Know Your Genetics to Lower Your Cancer Risk — and That of Your Family
A gene mutation that could put you at higher risk for cancer is just as likely to come from your father as your mother. Unfortunately, only 4 percent of those undergoing hereditary cancer gene testing are male, leaving a huge gap in the knowledge that could help you avoid cancer altogether or inform treatment decisions, according to a study published in the journal JAMA Oncology.
“Men do not often seek testing and many times do not understand the importance of the information,” says Louise Morrell, M.D., a genetics specialist and medical director of Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health. “The more accurate our information, the better our guidance on prevention. In genetics, unlike other areas, the benefit extends to family members and perhaps for generations to come.”
Today, up to 15 percent of cancers are tied to a hereditary link. Knowing about those links may help you and other members of your family prevent or reduce the risk of cancer.
Scientists have identified many mutations that increase the risk for breast and gynecologic cancers, some prostate cancers, colon cancer, gastro-intestinal cancers, kidney cancer and more. For example, a man with prostate cancer tied to a BRCA2 mutation, could pass that mutation to his son or daughter, increasing the risk of breast cancer in both children and of prostate cancer in the son.
Raising awareness of the value of genetic assessment and testing, particularly among men, is important to the experts at Lynn Cancer Institute and Miami Cancer Institute. Because the field of genetics moves at a rapid pace, discoveries may impact everything from guidelines for cancer screenings to treatment options for those who have cancer.
Although researchers have worked for decades on uncovering the links between genetic mutations and cancer, public knowledge grew when actress Angelina Jolie had her breasts removed in 2013, and then her ovaries in 2015, because she carried the BRCA1 gene mutation that is linked to a higher risk of breast and ovarian cancer. Ms. Jolie’s mother, grandmother and aunt had died from cancer, and her decision to prophylactically remove her breasts, ovaries and fallopian tubes to lower her cancer risk came after multiple tests and conversations with experts. The same BRCA1 and BRCA2 mutations that raise the risk of breast cancer in women, also raise the odds of breast cancer in men by eight times, according to the American Cancer Society.
Whether you are a man or a woman, your family’s health history may be the key to your future, says Arelis Mártir-Negrόn, M.D., medical geneticist and head of the Clinical Genetics program at Miami Cancer Institute. “Because as many men pass down mutations as women, you should be as aware of your father’s family’s cancer history as your mother’s. Know your family history. Ask questions.” In general, the earlier cancer is caught, the better the chance of survival.
Like Ms. Jolie, when Matthew Knowles, the father of artists Beyoncé and Solange, announced he had breast cancer in 2019, he put the spotlight on genetics. His mother, aunt and great aunt had died from breast cancer and he learned his rare male breast cancer was caused by a BRCA2 gene mutation. He understood that his daughters had a 50 percent chance of inheriting his mutation.
Genetic testing among Blacks is much lower than other races. Physicians would like that to change, particularly since some breast cancers that have a poorer prognosis also have a higher incidence in Black women. Fortunately, subsequent testing showed neither daughter had the mutation. Mr. Knowles underwent a mastectomy.
Thinking of genetics as a recipe may help some people better understand, genetic counselors say. All people inherit two copies of each gene: one from their mother and one from their father. Variations in genes are normal and are what give us our diversity. A slight change in the recipe may not make much of a difference but the wrong ingredient or too much or too little of something may cause the recipe to change drastically. In addition, not all mutations carry the same risk.
“A BRCA mutation might lead to an 80 percent risk of breast cancer but an ATM mutation might have a 20 percent lifetime risk,” Dr. Morrell says. “These are very different, which is why having this information is so valuable.”
It’s important to note that just because you carry a mutation doesn’t mean you will get cancer. “There are many things we take into account when we assess risk,” Dr. Mártir-Negrόn says. “We can suggest lifestyle modifications that could lower their chances of getting cancer. There are times when we might also suggest medications or present the idea of preventive surgery.”
The genetic teams at Lynn Cancer Institute and Miami Cancer Institute offer multidisciplinary care to patients ― and often their family members who may also be affected ― to better understand their risks, help them determine if genetic testing would be beneficial, and assist them with understanding the results, whether they are positive, negative or inconclusive. The team also develops personalized cancer prevention for “previvors,” the term used for those with a predisposition to cancer.
Fortunately, technological advances continue to make it possible to test for more genes. In recent years, improvements have sped up testing and made it less expensive. In addition, in someone already diagnosed with cancer, the answers from genetic testing can help drive treatment and surgery decisions.
Who Should Consider Cancer Genetic Assessment?
Men should consider assessment if they:
- Have had cancer themselves
- Have an early age of onset for cancer in their family
- Have a family member with multiple types of cancer
- Have a family tree with multiple cancers, especially on one side or the other
- Are a member of certain ancestry groups with higher rates of some genetic mutations, including those of Eastern European Jewish descent.
Couples who have a family history of cancer and are considering pregnancy also frequently take advantage of genetic assessment. “If you really want to be able to tell your children they are not at risk to have a particular mutation, you need to test both parents,” Dr. Morrell says. “The offspring can only inherit a mutation that the parents have. Mutations do not skip generations. The parent has to also inherit it.”
For more information on genetic assessment, testing and counseling at the Morgan Pressel Center for Cancer Genetics at Lynn Cancer Institute, click here; for information on Miami Cancer Institute’s Clinical Genetics program, click here.