Mammograms for Men: Who Should Be Screened and How It Works

Male breast cancer is rare compared to female breast cancer. About 1 in 100 U.S. breast cancer cases occur in people assigned male at birth.

A mammogram is an X-ray that helps determine signs of breast cancer. A screening mammogram (performed on a person without symptoms of breast cancer) is typically not recommended for people assigned male at birth with an average risk of breast cancer. However, people of any sex or gender with symptoms of breast cancer may be given a diagnostic mammogram.

Regular breast cancer screening mammograms may be performed for people assigned male at birth who have a strong family history of breast cancer or know they have a BRCA1 or BRCA2 inherited gene mutation. Transgender people may also get screening mammograms if they have breast tissue.

This article will discuss the risk of breast cancer in men, how a mammogram may be used and interpreted, and guidelines for people who are transgender.

Men at Risk for Breast Cancer

Some people assigned male at birth have a higher risk for breast cancer than others.

Genetic Link

Research shows that there is a strong biological link to male breast cancer. People assigned male at birth with a family history of breast cancer have a higher chance of developing breast cancer.

Many people with male breast cancer have been found to have BRCA or some other mutation. Up to 1 in 10 cases are linked to inherited BRCA1 or BRCA2 mutations. The overall lifetime risk of male breast cancer in people with BRCA1 and BRCA2 mutations is 1.2% and 6.8%.

PALB2 and CHEK2 mutations are also associated with a higher risk of male breast cancer. Still, limited research and the relatively rare nature of this condition means that there is much unknown about the genetic footprint of male breast cancer.

Other Risk Factors

The exact cause of male breast cancer remains a mystery, but there are some known risk factors, besides genetic mutations and family history, that may increase your likelihood of developing this condition. Risk factors include:

• Older age
• History of taking pro-estrogen medication (formerly a treatment for prostate cancer)
• Radiation therapy to the chest
• Overweight or obesity
• Liver disease
• Testicular injury or removal
• Klinefelter syndrome (having one Y chromosome and two or more X chromosomes)
• Gynecomastia (enlarged breast tissue in a person assigned male at birth)

Symptoms

A hard painless lump is a common symptom of male breast cancer. Changes to the skin of the breast, such as dimpling or puckering, may also occur.

Other symptoms can include:

• Nipple discharge
• Nipple retraction (inward turning of the nipple)
• Changes in skin color (usually darkening, but vary based on skin tone) of the nipple and surrounding area
• Lumps under the arm or along the collarbone (a sign that the breast cancer has begun to travel)

Mammogram for Men

It can be difficult to perform a mammogram on a person with little breast tissue. Screening mammograms are not routinely performed for people assigned male at birth who are of average risk. They might be performed for those at higher risk due to a genetic mutation, such as BRCA1 or BRCA2 inheritance.

A person of any sex or gender with symptoms of breast cancer may be given a diagnostic mammogram.

Who Does the Test?

A mammographer performs your mammogram. A radiologist (a healthcare provider specializing in medical imaging) interprets the report. You will usually get your results within two weeks, but waiting times may vary.

Preparation

On the day of your mammogram, it is recommended that you wear a loose fitting shirt that is easy to remove. It’s best to wear no deodorant, antiperspirant, powder, lotions, or perfumes that may compromise the integrity of your mammogram.

If you are experiencing breast or chest pain on the day of your mammogram, inform your mammographer. 

What to Expect During the Procedure

Mammograms use X-rays to help detect breast cancer. Each breast is visualized one at a time. Before your mammogram, a healthcare provider will discuss your health history and take your vitals, such as your weight and blood pressure. Tell the healthcare provider if you have breast implants.

Next, they will tell you about the procedure, what to expect, and post-care follow-up. After you consent to the procedure, the mammographer will ask you to remove your shirt so they can begin. The entire visit typically takes about 15 minutes.

You will stand in front of the mammography machine. The mammographer will position your chest on the machine. Two or more images are taken of each side of the chest, repositioning between each image. For each image, your chest will be compressed between two plates for 10 to 15 seconds while an X-ray is taken.

You will likely only have a sensation of pressure during the compression, but it might be painful. If it hurts, tell your mammographer, and they can try to adjust the pressure.

When complete, the mammographer may check to ensure the images are of good quality and repeat the imaging if needed. You can then put your shirt on and leave the imaging room.

Interpreting Results

When your results come back, a healthcare provider will call you or set up a follow-up appointment to explain the results. You will also receive a written report describing the findings after your procedure. 

The Breast Imaging Reporting and Data System (BI-RADS) is the standard system used to describe the findings in your mammogram report. Your report will include a score of 0 to 6, as well as a description of your breast density.

The following BI-RADS categories and descriptions can be found on your mammogram report:

• 0: Incomplete or inconclusive test
• 1: A negative or normal test result
• 2: Benign non-cancerous finding 
• 3: A likely benign finding with a very low risk of malignancy (cancer) that needs follow-up
• 4: Suspicious abnormality in need of biopsy (obtaining a sample of the suspicious tissue to analyze in the lab)
• 5: A highly suspicious (over 95%) finding of malignancy—immediate biopsy strongly recommended
• 6: Known biopsy-proven malignancy (cancer detected)—immediate treatment required
  

How Often Is a Mammogram Needed?

A diagnostic mammogram may be performed whenever a person of any sex or gender has symptoms of breast cancer.

The American Cancer Society and the National Comprehensive Cancer Network guidelines say an annual mammogram may be considered for a person assigned male at birth who has both:

• Gynecomastia
• A high risk of breast cancer due to having a family member with breast cancer or having a BRCA 1 or BRCA 2 mutation

Annual mammograms may start when you are 10 years before the age of cancer diagnosis in your relative (i.e., if they were diagnosed at 65, your yearly mammograms would begin at 55) or age 50, whichever comes first.

Guidelines for People Who Are Transgender 

Breast cancer screening guidelines are evolving for people who are transgender, especially as more research is being conducted around their risks. One rule of thumb is, "Screen for the body part you have."

A recommendation for transgender women is to begin mammogram screening every two years after the age of 50 and after a minimum of five years after completing feminizing hormone therapy.

Transgender men who have not undergone bilateral mastectomy (breast removal) or who have only undergone breast reduction should follow screening guidelines for people assigned female at birth.

Healthcare professionals must provide gender-affirming care and learn about the obstacles that might hinder transgender people from getting fair, high-quality care. 

Summary

A mammogram is an X-ray that takes images of the breast/chest to scan for signs of breast cancer. Male breast cancer is rare, so regular screening mammograms aren't typically recommended if you're at low risk. However, a person of any sex or gender may be given a diagnostic mammogram if they have symptoms of breast cancer.

People assigned male at birth who have gynecomastia and a high risk of breast cancer due to family history, or genetic mutation may have yearly screening mammograms. Transgender individuals may get screening mammograms if they have breast tissue.

A Word From Verywell 

Mammograms are potentially lifesaving in people of any sex or gender who have symptoms of breast cancer. They may also be beneficial in screening people assigned male at birth who have gynecomastia and a high risk of breast cancer. Check with your healthcare provider to determine the best time to start annual breast cancer screening if you are in that category.