Common Cancers in Men and People Assigned Male at Birth (AMAB)

Almost 490,000 men and people assigned male at birth (AMAB) in the United States are diagnosed with prostate, lung, and colorectal cancers each year, making them among the most common cancers. Screening may find these cancers before symptoms occur.

Xin Gao, MD, Jessica Lin, MD, and Aparna Parikh, MD, Mass General Cancer Center oncologists, review risk factors and screening recommendations for these common cancers.

Dr. Gao is a medical oncologist and clinical investigator at the Center for Genitourinary Cancers. Dr. Lin is an attending physician in the Center for Thoracic Cancers and the Henri and Belinda Termeer Center for Targeted Therapies. Dr. Parikh is medical director of the Center for Young Adult Colorectal Cancer.

“It’s important to discuss your risk factors and screening options with your primary care doctor because cancer is more treatable — and more curable — when it’s identified early,” says Dr. Gao.

Prostate cancer risk factors

The prostate gland helps produce semen in the male reproductive system. It’s located between the pubic bone and the rectum. Prostate cancer affects 1 in 8 men in their lifetimes, or more than 288,000 new cases each year.

Unlike some other cancers, the main risk factors for prostate cancer can’t be managed with lifestyle changes, says Dr. Gao. Those risk factors include:

• Age: Prostate cancer usually affects people ages 50 and older, although it can occur in younger men.
• Race: African Americans are more likely to get prostate cancer than people of other races. Mass General Brigham’s Prostate Cancer Outreach Clinic expands access to care to address health disparities.
• Family history: Men and people AMAB who have a blood relative with prostate, breast, ovarian, pancreatic, colorectal, or endometrial/uterine cancer have an increased risk of developing prostate cancer. In some cases, there may be an inherited gene that increases the risk for multiple types of these cancers.

But with routine screening, prostate cancer can be detected and treated early. The American Cancer Society (ACS) reports that the 5-year survival rate is greater than 99% for patients with prostate cancer that hasn’t spread beyond the prostate gland.

Prostate cancer screening

Prostate cancer often grows so slowly that it never becomes life-threatening. People may not have symptoms until the cancer becomes more advanced. “A lot of people with prostate cancer might never run into issues from it. However, screening can help find more aggressive forms of prostate cancer that require treatment,” says Dr. Gao.

Screening for prostate cancer involves a prostate-specific antigen (PSA) blood test to measure the amount of PSA protein made by the prostate gland and prostate cancer. A high PSA may indicate cancer. It’s important to know that noncancerous issues such as an enlarged prostate or urinary tract infection can also cause a high PSA level. For that reason, your doctor may repeat the PSA test before moving on to additional diagnostic testing, such as biopsy.

Because many prostate cancers progress slowly, routine screening of patients without symptoms can lead to unnecessary treatment. The United States Preventive Services Task Force (USPSTF) suggests that patients between 55 and 69 talk with their health care providers about whether PSA testing is right for them. For people older than 70, PSA testing isn’t recommended.

Lung cancer risk factors

One in 16 men develops lung cancer according to ACS. The vast majority of lung cancers (90%) occur in people who smoke, or who’ve smoked before, and people exposed to secondhand smoke. It’s important to be aware that lung cancers can affect anyone, including people who’ve never smoked before as well.

You also have a higher risk for lung cancer if it’s part of your family medical history, or if you were ever exposed to environmental toxins, such as:

• Radon, a radioactive gas
• Hazardous chemicals such as asbestos and cadmium
• Air pollution

Lung cancer screening

For people at high risk for lung cancer, getting screened offers the best chance to find and treat lung cancer early, when it’s most curable. Don’t wait for symptoms to develop to get tested because lung cancer can grow undetected for a long time. Talk to your doctor about screening if you have a history of smoking, a family history of lung cancer, or you’ve been exposed to toxins.

“Lung cancer screening enables lung cancers to be detected and diagnosed earlier, when they are likely easier to treat and cure than if diagnosed at more advanced stages,” says Dr. Lin. “Studies have shown that this translates into a lower risk of dying of lung cancer in those individuals at higher risk of developing lung cancer.”

A type of x-ray called low-dose computed tomography (LDCT) effectively screens for and detects lung cancer. The USPSTF recommends screening with LDCT for people who fit all of these criteria:

• 50 to 80 years old
• 20 pack-year smoking history (a pack year is the number of packs you smoked a day multiplied by the number of years you smoked)
• Current smoker or former smoker within the last 15 years

Colorectal cancer risk factors

One in 23 American men develop colorectal cancer. It often starts as noncancerous polyps in the colon or rectum that develop with age.

The major risk factors for colorectal cancer are:

• Family or personal history of colorectal cancer or polyps
• Alcohol and tobacco use
• Diet high in fats and processed meats and low in fiber
• Obesity
• Sedentary lifestyle
• Diagnosis of inflammatory bowel disease or certain genetic syndromes

Colorectal cancer screening

Like other cancers, colorectal cancer is most treatable when it’s detected early. The 5-year survival rate for colorectal cancer is at least 90% for cancer that is detected before it spreads beyond the colon or rectum.

The USPSTF recommends screening starting at age 45 and on a case-by-case basis for people older than 75. Talk to your doctor about the type of screening test and schedule that’s right for you.

Colorectal cancer is increasing in young adults. The majority of colorectal cancer cases are not tied to a family history of the cancer. However, up to 30% of all colorectal cancer diagnoses occur in patients that have a family history of colorectal cancer. “If you have a family history of colorectal cancer, you should get your first colonoscopy at 40 years old, or 10 years prior to when your immediate family member was diagnosed,” explains Dr. Parikh.

Screening may begin with a stool test to check for signs of cancer, such as the presence of blood or altered DNA. These screening tests allow your doctor to look at your colon and rectum to detect polyps or cancer:

• Colonoscopy using a device with a small camera to see the entire colon and rectum and remove any polyps for testing
• Flexible sigmoidoscopy using a camera to examine the rectum and part of the colon
• CT colonoscopy (virtual colonoscopy) using CT scans to view the colon
• Blood test. The Food and Drug Administration (FDA) recently approved a blood test for screening adults age 45 and older who are at average risk for the disease. The approval follows promising results from a clinical study of the blood test.

Screening for optimal treatment and prognosis

Mass General Brigham physician-scientists are leading the way in both clinical care and research to help people with cancer find out their diagnoses at the earliest possible stage.

The most important types of tools needed are those that can help point out which people are at risk for which cancers. Historically, understanding of cancer risk has been too simplistic and one-dimensional.

Risk calculators available to doctors often focus on tobacco use, alcohol use, and weight. But they donʻt incorporate important modern risk factors for cancer, like:

• Air quality
• Stress
• Poverty and other social determinants of health
• Effects of our changing food systems
• Occupational exposures
• Climate change

But technology is advancing, and by harnessing tools like advanced genetic testing, blood based biomarkers, and artificial intelligence (AI), doctors will be able to develop smarter strategies that provide truly personalized cancer screening and prevention recommendations.

Early Detection and Diagnostics Clinic

Mass General Cancer Center Early Detection and Diagnostics Clinic health care providers meet with patients to provide a cancer risk assessment consultation. At this in-depth visit, they learn about a person’s individual risk factors for cancer and customize recommendations for cancer screening. Patients also may take part in in a variety of clinical trials to help speed the delivery of novel technologies for finding cancer at the earliest stages.

In addition, for patients who have an abnormality on a lab test, or an x-ray that suggests they may have cancer, providers provide rapid and easy access to the latest diagnostic tests and personalized navigation into an appropriate cancer treatment group, if necessary.