If a man is found to have brca1 or brca2 mutations, what should his next step be?

Genetic counseling. The penetrance of a mutation defines the risk of developing the disease that one is at risk for. The penetrance of the brca mutations varies between 40-80% for women and less than 10% for men, depending on the specific mutation and patient factors. The best method to prevent breast cancer at this time is to have a prophylactic bilateral mastectomy.
Medical Oncologist. One experienced with brca assoc risks. Men that are carriers have an approx. 8% risk of developing breast cancer (compared to less than 1% for the general population) this usually does not justify prophylactic surgery in men, but there are surveillance recommendations that can be followed. Also the risk of prostate and pancreatic cancer are higher. Genetic counselor will not help with surveillance.
Surgical consult. I would recommend any patient who tests positive for brca 1 or 2 meet with a genetic counselor and breast surgeon to discuss their risk of developing breast cancer as well as treatment options available. This should be followed by a consultation with a plastic surgeon to discuss reconstruction of the breast.

Related Questions

Do brca1 and brca2 mutations affect men the same way they affect women?

No. The penetrance of a mutation defines the risk of developing the disease in those that carry a particular mutation. Women with brca mutations have lifetime risks estimated between 40-80%; men's risks are much less-studied but are probably in the range of 10% or less. Read more...
Male breast cancer. Men with a brca mutation have a dramatically elevated relative risk of developing breast cancer, but because the overall incidence of breast cancer in men is so low, the absolute risk is equal to or lower than the risk for women without a brca mutation. Approximately 1% to 2% of men with a brca1 mutation will develop breast cancer by age 70 and 6% of men with a brca2 mutation will develop cancer. Read more...