Breast cancer in a BRCA2 mutation carrier with a history of prostate cancer
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BACKGROUND: A 49-year-old patient with high-risk prostate cancer presented to a specialist. He was treated with neoadjuvant hormonal therapy for 6 months, followed by conformal radiotherapy. Three years later, he had a biochemical recurrence and commenced continuous luteinizing hormone-releasing hormone analog and antiandrogen therapy as part of a clinical trial. Aside from notable gynecomastia, he remained asymptomatic. He has a strong family history of breast cancer with multiple sisters affected. INVESTIGATIONS: At 58 years of age, the patient underwent BRCA2 germline testing and was found to be a mutation carrier. Following post-test counseling, he was offered clinical breast examination, which was unremarkable except for gynecomastia. Baseline screening mammography identified a 4 mm cluster of microcalcifications and ductal carcinoma in situ (DCIS) was confirmed by stereotactic biopsy. DIAGNOSIS: DCIS in a male BRCA2 mutation carrier undergoing androgen deprivation therapy for prostate cancer. MANAGEMENT: The patient was treated with bilateral mastectomy and no additional systemic therapy was recommended. This case report illustrates the importance of implementing screening mammography in male BRCA mutation carriers, particularly in those with a BRCA2 mutation.
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