Men and BRCA: what you need to know

We all have BRCA genes. And men are just as likely as women to inherit a fault in those genes and pass them on to any children they have. So what do men and their families need to know when it comes to BRCA? 

Demetra Georgiou is a Principal Genetic Counsellor at Imperial College Healthcare (Charing Cross Hospital). She answers our top questions about men and BRCA – covering the advantages of testing, and family planning, and how everybody is different when it comes to making decisions around genetic risk. 

Q. What cancers are men with a BRCA1/2 mutation at risk of?

Men with BRCA2 alterations have an increased risk of breast, prostate, and pancreatic cancer. 

Men with BRCA1 alterations have an increased risk of breast cancer. Data on prostate cancer risk is not very clear, but it is not thought to be very much higher than population risk.

Q. Do men only need to worry about cases of cancer on their dad's side when looking for signs of a hereditary BRCA mutation?

Cancer from both paternal and maternal sides is important to note when discussing your family history with your GP or other clinician.

Q. What are the chances a son will have inherited a BRCA mutation from his mum if she's a carrier?

Any person who has a parent with a pathogenic BRCA alteration (also known as a mutation), has a 50% chance of inheriting this; regardless of whether they are a man or a woman.

Q. At what age can eligible men get a BRCA test?

Generally, testing is only done once a person turns 18. It is a personal decision and one may feel differently about this when they are 18 compared to when they are 50. Discussing the pros and cons based on your personal circumstances can help you make the best possible decision.

Q. Why is most of the conversation around genetic testing and cancer risk centred on women?

The alterations in the BRCA genes (causing an increased risk of breast, ovarian, and prostate cancer) are the most known in popular culture out of all cancer susceptibilities. These alterations are more likely to affect women's risk than men's even though both men and women can carry them equally. This is because men have less breast tissue, so their risk of breast cancer is much lower. 

There have also been more female carriers discussing their genetic testing journey in the media (think Angelina Jolie), which may affect how people think about cancer genetics. 

Q. What are the advantages of getting a BRCA test if it's likely a man has inherited one?

Men with BRCA2 gene alterations have an increased risk of prostate cancer and may benefit from extra screening through ongoing research trials. This can help detect prostate cancer early and treat it successfully. If a man has not inherited this gene alteration, they would not need to be worried about a high cancer risk linked to BRCA.

Once someone knows about their genetic status, they may inform their children (if they have any) so that they can also make their own informed decisions. If a man hasn’t already had children, there are fertility options available that almost eliminate the chances of passing on the faulty gene. 

Genetic testing has advantages and disadvantages. Not one decision is good for all, as it depends on personal circumstances. It may be beneficial to discuss these circumstances with a genetics clinician before one decides to have a test. 

Q. What extra screening can men get if they test positive for a BRCA mutation?

Men with BRCA2 alterations can get increased prostate screening through relevant research studies.

Q. I’m a man in my early 30s and I have had genetic testing, and know I carry a faulty gene. When I’m ready to start a family, can my partner and I access fertility treatment or is this only available for women?

Family planning options are available to couples affected with cancer susceptibilities; regardless of whether this affects a female or male partner. A discussion with a genetics clinician would be helpful to understand the options available and make an informed decision.

Q. I’m a woman with a BRCA mutation. My brothers aren’t interested in talking about their risk, but I’m concerned about their children. Is it ok to give the children information about genetic testing once they are adults?

Brothers and sisters need to have conversations about a genetic condition in the family. Sometimes, members of the family may not understand the consequences of such a condition and may need help accessing information. It is also important to understand that someone may have made a conscious choice to not inform their children. 

Sometimes, people find it difficult to talk about these complex subjects with their children and may need some support. Instead of speaking to a sibling's children directly, it would be best to have a conversation with your sibling first and then consult with a genetics clinician; as they may help you and the family with advice and guidance.

It is important to note that by BRCA alteration, we mean pathogenic (or disease-causing) alterations. Some alterations in the BRCA genes are considered benign or unknown, which do not need to be managed the same as the pathogenic alterations. You must have a report from a verified lab to ensure the genetic analysis and interpretation of your test result is of good quality.