Routine mammographic screening is not recommended in males with a BRCA1 or BRCA2 pathogenic variant. Although recent studies have demonstrated that mammography can detect clinically occult breast cancers in high-risk men, further research is needed to assess the value of this screening strategy.r There have been no trials to evaluate the effectiveness of manual palpation. Other factors such as obesity, chest wall radiation and gynaecomastia can increase the risk of male breast cancer.r BRCA-related (especially BRCA2) male breast cancer is known to be more aggressive and have a more unfavourable prognosis than male breast cancer occurring in individuals without a BRCA pathogenic variant.r
Pathogenic variants in the BRCA1 and BRCA2 genes have been widely linked with increased prostate cancer risk. The evidence for increased risk is stronger for males with pathogenic variants in BRCA2.rrr A recent study did not find an elevated prostate cancer risk in BRCA1 pathogenic variant carriers.r
In the general population surveillance can be associated with overdiagnosis and overtreatment with no evidence for improved short-term survival (10-year period). There is evidence for value in surveillance of men with BRCA pathogenic variants,r as data suggests that BRCA-related prostate cancer is aggressive and occurs at a younger age than sporadic prostate cancer.rr
Some studies suggest offering surveillance from age 50 years in BRCA1 or BRCA2 germline pathogenic variant carriers with a first- or second-degree relative with pancreatic cancer. Studies suggest surveillance can achieve ‘downstaging’ at diagnosis, although advanced interval cancers are common, and there is no evidence for improved survival. However, in one recently published screening study of patients at high risk of developing pancreatic cancer, most screen-detected pancreatic cancers were stage I with favourable long-term outcomes.r
If surveillance is offered it should be undertaken in an experienced high-volume centre after detailed discussion regarding limitations of screening including cost, high incidence of benign or indeterminate pancreatic abnormalities and uncertainties about the benefit. Most small cystic lesions found on screening will not warrant biopsy, surgical resection, or any other intervention.