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You X, Dong Y, Wang J, Cheng Y, Jia Y, Zhang X, Wang J. The comparison of pure uterine serous carcinoma and mixed tumor with serous component: a single-institution review of 91 cases. BMC Cancer 2024; 24:99. [PMID: 38233757 PMCID: PMC10795214 DOI: 10.1186/s12885-023-11793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/23/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Pure uterine serous carcinoma (p-USC) and mixed tumors with serous component (m-USC) are aggressive subtypes of endometrial cancer associated with high mortality rates. This retrospective study aimed to compare clinicopathologic features and outcomes of p-USC and m-USC in a single center. METHODS This study retrospectively reviewed patients diagnosed with USC at Peking University People's Hospital between 2008 and 2022. T-tests and chi-square tests were used to compare clinicopathological characteristics between p-USC and m-USC. Kaplan-Meier survival curve and Cox regression analysis were used to analyze the impact of clinical and pathological variables on OS and PFS. RESULTS Among the 91 patients who underwent surgery, 65.9% (n = 60) were p-USC, and 34.1% (n = 31) were m-USC. Patients with p-USC had earlier menopause (P = 0.0217), a lower rate of progesterone receptor(PR) expression (P < 0.001), and were more likely to have positive peritoneal cytology (P = 0.0464). After a median follow-up time of 40 months, 28 (46.7%) p-USC and 9 (29%) m-USC patients had progression disease, 18 (30%) and 8 (25.8%) patients died of their disease. 5-year PFSR were 51.2% and 75.3%, respectively, and 5-year OS rates were 66% and 67.4%. Kaplan-Meier survival analysis showed that p-USC was more likely to relapse than m-USC (P = 0.034), but there was no significant difference in OS. Cox regression analysis showed that lymph node metastasis and surgical approach were risk factors for OS, and myoinvasion depth ≥ 1/2 was an independent risk factor for PFS. CONCLUSIONS p-USC was more likely to relapse than m-USC, but there was no significant difference in OS between the two subtypes.
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Affiliation(s)
- Xuewu You
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, P. R. China
| | - Yangyang Dong
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, P. R. China
| | - Jiaqi Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, P. R. China
| | - Yuan Cheng
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, P. R. China
| | - Yuanyuan Jia
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, P. R. China
| | - Xiaobo Zhang
- Department of Pathology, Peking University People's Hospital, Beijing, 100044, P. R. China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, P. R. China.
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Endometrial Cancer and BRCA Mutations: A Systematic Review. J Clin Med 2022; 11:jcm11113114. [PMID: 35683509 PMCID: PMC9181458 DOI: 10.3390/jcm11113114] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022] Open
Abstract
This systematic review identifies, evaluates, and summarises the findings of all relevant individual studies on the prevalence of BRCA mutation (BRCAm) in endometrial cancer patients and the incidence of endometrial cancer in BRCAm women patients. Consequently, the benefits and limits of a prophylactic hysterectomy at the time of the risk-reducing salpingo-oophorectomy are analysed and discussed. A systematic literature search was performed in the databases of PubMed, Cochrane, and Web of Science until May 2022; 13 studies met the eligibility criteria. Overall, 1613 endometrial cancer patients from 11 cohorts were tested for BRCA1/2 mutation. BRCA1/2m were identified in 4.3% of women with endometrial cancer (70/1613). BRCA1m was the most represented (71.4%) pathogenic variant. Alongside, a total of 209 BRCAm carriers from 14 studies were diagnosed with endometrial cancer. Only 5 out of 14 studies found a correlation between BRCAm and an increased risk of endometrial cancer. Nevertheless, two studies found a statistical difference only for BRCA1m women. The present systematic review does not provide strong evidence in favour of performing routine hysterectomy at the time of risk-reducing salpingo-oophorectomy; however, it provides epidemiological data that can be useful for counselling patients in order to offer a tailored approach.
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Abstract
Although endometrial cancer management remains challenging, a deeper understanding of the genetic diversity as well as the drivers of the various pathogenic states of this disease has led to development of divergent management approaches in an effort to improve therapeutic precision in this complex malignancy. This comprehensive review provides an update on the epidemiology, pathophysiology, diagnosis and molecular classification, recent advancements in disease management, as well as important patient quality-of-life considerations and emerging developments in the rapidly evolving therapeutic landscape of endometrial cancers.
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Sekine M, Nishino K, Enomoto T. Differences in Ovarian and Other Cancers Risks by Population and BRCA Mutation Location. Genes (Basel) 2021; 12:genes12071050. [PMID: 34356066 PMCID: PMC8303997 DOI: 10.3390/genes12071050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022] Open
Abstract
Hereditary breast and ovarian cancer is caused by a germline mutation in BRCA1 or BRCA2 genes. The frequency of germline BRCA1/2 gene mutation carriers and the ratio of germline BRCA1 to BRCA2 mutations in BRCA-related cancer patients vary depending on the population. Genotype and phenotype correlations have been reported in BRCA mutant families, however, the correlations are rarely used for individual risk assessment and management. BRCA genetic testing has become a companion diagnostic for PARP inhibitors, and the number of families with germline BRCA mutation identified is growing rapidly. Therefore, it is expected that analysis of the risk of developing cancer will be possible in a large number of BRCA mutant carriers, and there is a possibility that personal and precision medicine for the carriers with specific common founder mutations will be realized. In this review, we investigated the association of ovarian cancer risk and BRCA mutation location, and differences of other BRCA-related cancer risks by BRCA1/2 mutation, and furthermore, we discussed the difference in the prevalence of germline BRCA mutation in ovarian cancer patients. As a result, although there are various discussions, there appear to be differences in ovarian cancer risk by population and BRCA mutation location. If it becomes possible to estimate the risk of developing BRCA-related cancer for each BRCA mutation type, the age at risk-reducing salpingo-oophorectomy can be determined individually. The decision would bring great benefits to young women with germline BRCA mutations.
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Affiliation(s)
- Masayuki Sekine
- Correspondence: ; Tel.: +81-25-227-2320; Fax: +81-25-227-0789
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5
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Dasanu CA, Lerner J, Ocampo MM, Iskandar AS, Kaur J, Tuler S, Codreanu I, Farrell S, Plaxe SC. Advanced uterine papillary serous cancer: Could there be a role for newer targeted therapeutic approaches or immune checkpoint inhibitors? J Oncol Pharm Pract 2021; 27:1181-1185. [PMID: 33983075 DOI: 10.1177/10781552211015769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although now available in oncology clinics, comprehensive germline mutation testing is being performed only in a minority of patients with advanced uterine papillary serous cancer (UPSC). Some of these patients might harbor various targetable mutations, either heritable or acquired.Data sources: We conducted a retrospective cohort study involving all consecutive patients with UPSC treated at our institution from 2009-2019. Data on epidemiology, with an accent on personal and family history of cancer, clinical presentation, disease stage, employed treatment modalities and cancer-specific survival (CSS) was sought. FINDINGS Thirteen patients were seventy years of age or younger (≤70) while 15 were older than seventy (>70), and the two arbitrary patient cohorts were well-balanced for the TNM stage. Four UPSC patients >70 had a personal history of metachronous breast cancer. We also identified five cases of breast cancer, two cases of colon cancer, and one of each ovarian and uterine cancer in the first-degree relatives of UPSC patients >70. More than 90% of patients had surgical excision/debulking, and nearly half of the patients in each group received systemic chemotherapy. The most common chemotherapy regimen was carboplatin-paclitaxel every three weeks. Compared to patients ≤70, the UPSC patients >70 were less likely to undergo postoperative radiation therapy (6% vs 61.5%; p = 0.001) and had a worse CSS (21.8 vs. 27.4 months; HR 0.61, p = 0.03). CONCLUSIONS Personal and family history in a cohort of older UPSC patients identified an excess of second primary cancers, and these patients displayed a shorter CSS. Comprehensive germline and tumor mutation analysis might identify optimal candidates for various targeted agents and immune checkpoint inhibitors, and ultimately improve survival. This may represent an unmet need in the UPSC patients, and further studies are needed to confirm the significance of our findings.
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Affiliation(s)
- Constantin A Dasanu
- Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA USA.,University of California San Diego Health, San Diego, CA, USA
| | - Jaren Lerner
- Department of Medicine, Eisenhower Health, Rancho Mirage, CA USA
| | | | | | - Jaspreet Kaur
- Department of Medicine, Eisenhower Health, Rancho Mirage, CA USA
| | - Shahat Tuler
- Department of Medicine, Eisenhower Health, Rancho Mirage, CA USA
| | - Ion Codreanu
- Department of Radiology and Medical Imaging, State University of Medicine and Pharmacy "Nicolae Testemitanu," Chisinau, Republic of Moldova
| | | | - Steven C Plaxe
- Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA USA.,University of California San Diego Health, San Diego, CA, USA
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Mejia-Gomez J, Gronwald J, Senter L, Karlan BY, Tung N, Wolfman W, Demsky R, Sun P, Narod SA, Kotsopoulos J. Factors associated with use of hormone therapy after preventive oophorectomy in BRCA mutation carriers. ACTA ACUST UNITED AC 2021; 27:1396-1402. [PMID: 32796289 DOI: 10.1097/gme.0000000000001629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Bilateral salpingo-oophorectomy (oophorectomy) is recommended to women with a germline BRCA1 or BRCA2 mutation before natural menopause to prevent ovarian and fallopian tube cancer. The adverse effects of early surgical menopause are well established. Although many of the side effects can be ameliorated by the use of hormone therapy (HT); use of HT in this group of predominantly young patients remains suboptimal. The goal of this study was to identify the frequency of HT use, as well as predictors of HT uptake in BRCA mutation carriers who underwent preventive oophorectomy before natural menopause. METHODS Eligible participants were identified from a longitudinal study of BRCA mutation carriers. We included premenopausal women with no personal history of cancer who underwent oophorectomy before age 50 and who had a minimum of 2 years of follow-up. Detailed information on HT use and other important variables was collected by a research questionnaire every 2 years. Descriptive statistics were used to evaluate the use of HT in various subgroups. RESULTS A total of 793 women with a BRCA1 or BRCA2 mutation were included in this analysis. The mean age at oophorectomy was 42 years (range 28-49). Sixty-one percent of the women reported using HT after oophorectomy. Factors associated with HT use included young age at surgery, a high level of education and preventive mastectomy. CONCLUSIONS The uptake of HT after oophorectomy in women with a BRCA1 or BRCA2 mutation varies by age, education, and surgical history. Clinician and patient awareness may lead to better utilization of HT in women who undergo oophorectomy at an early age to help mitigate the adverse effects associated with surgical menopause.
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Affiliation(s)
- Javier Mejia-Gomez
- Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jacek Gronwald
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Leigha Senter
- Division of Human Genetics, the Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH
| | - Beth Y Karlan
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Wendy Wolfman
- Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, ON, Canada
| | - Rochelle Demsky
- Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Ping Sun
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Endometrial Cancer in Germline BRCA Mutation Carriers: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:947-956. [PMID: 33249269 DOI: 10.1016/j.jmig.2020.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Risk-reducing salpingo-oophorectomy (RRSO) is standard treatment among women with BRCA mutations. The aim of this meta-analysis is to evaluate the risk of endometrial cancer (EC) in BRCA1 or BRCA2 germline mutation carriers and to examine the justifiability of prophylactic hysterectomy at the time of RRSO. DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.gov, and Google Scholar were searched. Eleven articles were selected and analyzed using the OpenMetaAnalyst 2012 software. METHODS OF STUDY SELECTION Randomized controlled studies, cohort studies, and case-control studies evaluating the risk of EC and specifically uterine papillary serous carcinoma (UPSC) in germline BRCA1/2 mutation carriers were included. Articles were excluded if they did not meet the inclusion criteria, or if data were not reported and the authors did not respond to inquiries. We assessed the methodological quality of the included studies on the basis of the Newcastle-Ottawa scale. Dichotomous results from each of the studies eligible for the meta-analysis were expressed as the proportion of patients with EC or UPSC per total number of BRCA mutation carriers, with 95% confidence interval (CI). The Mantel-Haenszel statistical method was used. TABULATION, INTEGRATION, AND RESULTS Eleven studies reported the outcome of interest and were included in the final meta-analysis. In total, 13 871 carriers of BRCA1 and BRCA2 mutations were identified. The pooled prevalence rates of EC and UPSC in BRCA1/2 mutation carriers were 82/13 827 (0.59%) and 19/11 582 (0.16%), respectively. The EC prevalence was 46/7429 (0.62%) in BRCA1 mutation carriers and 17/3546 (0.47%) in BRCA2 mutation carriers, with relative risk of 1.18 (95% CI, 0.7-2.0). For UPSC, the prevalence was 15/7429 (0.2%) and 3/3546 (0.08%) among BRCA1 and BRCA2 mutation carriers, respectively, (relative risk 1.39; 95% CI, 0.5-3.7). CONCLUSION Most studies in this meta-analysis suggest a slightly increased risk of EC in BRCA mutation carriers, mainly for BRCA1. The decision regarding concurrent hysterectomy should be tailored individually to each patient on the basis of the patient's age, type of mutation, future need for hormone replacement treatment, history of breast cancer, tamoxifen use, and personal operative risks.
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8
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Association between BRCA mutations and endometrial carcinoma: a systematic review with meta-analysis. Arch Gynecol Obstet 2020; 303:1569-1579. [PMID: 33215232 DOI: 10.1007/s00404-020-05887-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To first investigate on the association between BRCA mutations and endometrial carcinoma. To first evaluate the contribution of tamoxifen use and risk-reducing bilateral salping-oophenrectomy (BSO) on endometrial carcinoma in BRCA carriers. METHODS A systematic search of electronic databases including the PubMed and EMBASE was conducted to identify publications exploring the association between BRCA mutations and endometrial carcinoma. Finally, single rate meta-analysis and diagnostic meta-analysis were performed. RESULTS 11 retrospective studies and 3 prospective studies were included in the meta-analysis, single rate meta-analysis was performed on retrospective studies and prospective studies respectively. We got that incidence of BRCA mutations in patients with endometrial carcinoma is about 0.035, the incidence of endometrial carcinoma in BRCA carriers is about 0.004. Diagnostic meta-analysis performed on prospective studies found that tamoxifen increased incidence of endometrial carcinoma in BRCA carriers. CONCLUSIONS The incidence of BRCA mutations in patients with endometrial carcinoma is about 0.035 according to present studies, the incidence of endometrial carcinoma in BRCA carriers is about 0.004. Tamoxifen use is a certain risk factor for subsequent endometrial carcinoma, while history of breast cancer or risk-reducing BSO is not associated with incidence of follow-up endometrial carcinoma. The necessity and rationality of prophylactic hysterectomy for BRCA carriers remained to be discussed.
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Musacchio L, Caruso G, Pisano C, Cecere SC, Di Napoli M, Attademo L, Tambaro R, Russo D, Califano D, Palaia I, Muzii L, Benedetti Panici P, Pignata S. PARP Inhibitors in Endometrial Cancer: Current Status and Perspectives. Cancer Manag Res 2020; 12:6123-6135. [PMID: 32801862 PMCID: PMC7383016 DOI: 10.2147/cmar.s221001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
Advanced, recurrent and metastatic endometrial cancer (EC) has a dismal prognosis due to poor response rates to conventional treatments. In the era of precision medicine, the improved understanding of cancer genetics and molecular biology has led to the development of targeted therapies, such as poly (ADP-ribose) polymerase (PARP) inhibitors. This class of drugs that inhibit PARP enzymes has been investigated in many different types of tumors and its use in the treatment of gynecological malignancies has rapidly increased over the past few years. Data from several clinical trials showed that PARP inhibitors have a beneficial role in cancers with a defect in the homologous DNA recombination system, regardless of the BRCA mutational status. Since EC frequently shows mutations in PTEN and TP53 genes, indirectly involved in the homologous DNA recombination pathway, several in vivo and in vitro studies investigated the efficacy of PARP inhibitors in EC, showing promising results. This review will discuss the use of PARP inhibitors in endometrial cancer, summarizing data from preclinical studies and providing an overview of the ongoing trials, with a special focus on the development of combined treatment strategies with PARP inhibitors and immune checkpoint inhibitors.
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Affiliation(s)
- Lucia Musacchio
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico Umberto I, Rome, Italy
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico Umberto I, Rome, Italy
| | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Laura Attademo
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Rosa Tambaro
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Daniela Russo
- Functional Genomic Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Daniela Califano
- Functional Genomic Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico Umberto I, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico Umberto I, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico Umberto I, Rome, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
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Shah PD, Domchek SM. The contemporary landscape of genetic testing and breast cancer: Emerging issues. Breast J 2020; 26:1549-1555. [DOI: 10.1111/tbj.13968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Payal D. Shah
- Basser Center for BRCA at the Abramson Cancer Center University of Pennsylvania Philadelphia Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Susan M. Domchek
- Basser Center for BRCA at the Abramson Cancer Center University of Pennsylvania Philadelphia Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
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Njoku K, Abiola J, Russell J, Crosbie EJ. Endometrial cancer prevention in high-risk women. Best Pract Res Clin Obstet Gynaecol 2019; 65:66-78. [PMID: 32107136 DOI: 10.1016/j.bpobgyn.2019.12.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/24/2022]
Abstract
Endometrial cancer (EC) is the most common gynaecological malignancy, and its incidence is rising alongside the growing prevalence of obesity. Effective risk-reducing interventions hijacking the key mechanisms driving endometrial carcinogenesis may affect EC diagnoses if aimed at those at greatest risk. An understanding of the key risk factors and their role in tumourigenesis is critical in developing such prevention strategies. In this review, we summarise the major risk factors for EC and the evidence for available risk-reducing interventions in high-risk women. We suggest potential prevention strategies and make a case for the need for risk prediction models that identify specific groups of women at a particularly high risk of EC for whom risk-reducing interventions are likely to have a significant impact.
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Affiliation(s)
- Kelechi Njoku
- Division of Cancer Sciences, University of Manchester, School of Medical Sciences, Faculty of Biology, Medicine and Health, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
| | - Joanna Abiola
- Department of Obstetrics and Gynaecology, Tameside General Hospital, Fountain St, Ashton-under-Lyne, OL6 9RW, UK.
| | - Johanna Russell
- University of Manchester Medical School, Oxford Road, Manchester, M13 9PL, UK.
| | - Emma J Crosbie
- Division of Cancer Sciences, University of Manchester, School of Medical Sciences, Faculty of Biology, Medicine and Health, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
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12
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Long B, Lilyquist J, Weaver A, Hu C, Gnanaolivu R, Lee KY, Hart SN, Polley EC, Bakkum-Gamez JN, Couch FJ, Dowdy SC. Cancer susceptibility gene mutations in type I and II endometrial cancer. Gynecol Oncol 2019; 152:20-25. [PMID: 30612635 PMCID: PMC6326093 DOI: 10.1016/j.ygyno.2018.10.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the incidence of germline cancer predisposition gene mutations in patients with endometrial cancer (EC) subtypes. METHODS Germline DNA was extracted from whole blood collected from consenting patients undergoing primary surgery for EC between 5/2005 and 11/2016. DNA samples were evaluated by product sequencing from a targeted multiplex PCR panel including 21 known/suspected cancer predisposition genes. Variants were classified as pathogenic/likely pathogenic based on allele frequency (<0.003), effects on protein function, and ClinVar assertions. RESULTS Germline panel testing was performed on 1170 cases of EC; 849 (72.6%) were type I, and 321 (27.4%) were type II EC, including 135 (11.5%) uterine serous cancers (USC). BRCA1 mutations were enriched in Type II EC compared to Type I EC (0.93% vs. 0.12%, p = 0.07). Lynch Syndrome (LS) mutations were identified in 1.4% of type I and 1.6% of type II EC (p = 0.79), including 1.5% for USC. In total, predisposition gene mutations were present in 4.2% of type I and 5.3% of type II EC, as well as 6.7% of patients with USC). CONCLUSIONS BRCA1/2 and Lynch mutations were rare in this cohort of unselected patients with type I and II EC, including USC. However, the presence of predisposition gene mutations in 4.2% of EC type I, 5.3% of EC type II, and 6.7% of USC suggests that somatic mutation testing should be considered for all EC patients.
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Affiliation(s)
- Beverly Long
- Mayo Clinic, Division of Gynecologic Oncology, United States of America.
| | - Jenna Lilyquist
- Mayo Clinic, Department of Epidemiology, United States of America
| | - Amy Weaver
- Mayo Clinic, Department of Biostatistics, United States of America
| | - Chunling Hu
- Mayo Clinic, Department of Pathology, United States of America
| | - Rohan Gnanaolivu
- Mayo Clinic, Department of Biomedical Statistics and Informatics, United States of America
| | - Kun Y Lee
- Mayo Clinic, Department of Pathology, United States of America
| | - Steven N Hart
- Mayo Clinic, Department of Biomedical Statistics and Informatics, United States of America
| | - Eric C Polley
- Mayo Clinic, Department of Biomedical Statistics and Informatics, United States of America
| | | | - Fergus J Couch
- Mayo Clinic, Department of Epidemiology, United States of America
| | - Sean C Dowdy
- Mayo Clinic, Division of Gynecologic Oncology, United States of America
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13
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Laitman Y, Michaelson-Cohen R, Levi E, Chen-Shtoyerman R, Reish O, Josefsberg Ben-Yehoshua S, Bernstein-Molho R, Keinan-Boker L, Rosengarten O, Silverman BG, Perri T, Korach J, Mor P, Ephrat Ben-Baruch N, Levy Lahad E, Friedman E. Uterine cancer in Jewish Israeli BRCA1/2 mutation carriers. Cancer 2018; 125:698-703. [PMID: 30489631 DOI: 10.1002/cncr.31842] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND BRCA1/2 mutation carriers have an increased risk of developing ovarian cancer, leading to the recommendation of risk-reducing salpingo-oophorectomy (RRSO) at 35-40 years of age. The role, if any, that BRCA mutations play in conferring uterine cancer risk, is unresolved. METHOD Jewish Israeli women, carriers of one of the predominant Jewish mutations in BRCA1/2 from 1998 to 2016, were recruited. Cancer diagnoses were determined through the Israeli National Cancer Registry. Uterine cancer risk was assessed by computing the standardized incidence ratio of observed-to-expected number of cases, using the exact 2-sided P value of Poisson count. RESULTS Overall, 2627 eligible mutation carriers were recruited from 1998 to 2016, 2312 (88%) of whom were Ashkenazi Jews (1463 BRCA1, 1154 BRCA2 mutation carriers, 10 double mutation carriers). Among these participants, 1310 underwent RRSO without hysterectomy at a mean (± standard deviation) age of 43.6 years (± 4.4 years). During 32,774 women-years of follow up, 14 women developed uterine cancer, and the observed-to-expected rate of all histological subtypes was 3.98 (95% confidence interval [CI], 2.17-6.67; P < .001). For serous papillary (n = 5), the observed-to-expected ratio was 14.29 (95% CI, 4.64-33.34; P < .001), and for sarcoma (n = 4) it was 37.74 (95% CI, 10.28-96.62). These rates were also higher than those detected in a group of 1844 age- and ethnicity-matched women (53% with breast cancer). CONCLUSION Israeli BRCA1 or BRCA2 mutation carriers are at an increased risk for developing uterine cancer, especially serous papillary and sarcoma. These elevated risks of uterine cancer should be discussed with BRCA carriers.
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Affiliation(s)
- Yael Laitman
- Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Rachel Michaelson-Cohen
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Einat Levi
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Rakefet Chen-Shtoyerman
- Oncogenetics Clinic, Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Orit Reish
- Genetics Institute, Assaf Harofe Medical Center, Zerifin, Israel
| | - Sagi Josefsberg Ben-Yehoshua
- Oncogenetics Clinic, Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Rinat Bernstein-Molho
- Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- Israeli National Cancer Registry, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Ora Rosengarten
- Gyneco-Oncology Unit, Institute of Oncology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Barbara G Silverman
- Israeli National Cancer Registry, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Tamar Perri
- Department of Gyneco-Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Korach
- Department of Gyneco-Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pnina Mor
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Noa Ephrat Ben-Baruch
- Oncology Department, Kaplan Medical Center, Rehovot, Hebrew University School of Medicine, Jerusalem, Israel
| | - Ephrat Levy Lahad
- Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Eitan Friedman
- Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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14
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Nair N, Schwartz M, Guzzardi L, Durlester N, Pan S, Overbey J, Chuang L. Hysterectomy at the time of risk-reducing surgery in BRCA carriers. Gynecol Oncol Rep 2018; 26:71-74. [PMID: 30364812 PMCID: PMC6198097 DOI: 10.1016/j.gore.2018.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/02/2022] Open
Abstract
In this study, women at risk for BRCA were surveyed to understand their choice of prophylactic surgery and associated risk of uterine cancers. The study was conducted as an anonymous online web-based survey that assessed personal and family histories and choice of prophylactic surgery. Respondents were targeted through social media groups that bring awareness to hereditary breast and ovarian cancer. The study cohort included an international group of 601 respondents. The majority were female (99.3%), in their 40s (34.2%), and had completed college or graduate school (68.8%). 87% of respondents carry BRCA gene mutation. Of 339 respondents who underwent risk-reducing salpingo-oophorectomy (RRSO), 55.8% had a hysterectomy at time of RRSO. Most common reasons for hysterectomy at time of RRSO included: 39% provider recommendation, 27.6% personal desire, 9.7% benign indications, 1.6% cancer in uterus, 1.1% precancerous uterine lesion, and 21.1% other (N = 185). In this cohort, nine were diagnosed with uterine cancer. Three were diagnosed after risk-reducing surgery. Both patients with uterine serous carcinoma were BRCA1 carriers. Two thirds of BRCA carriers surveyed had undergone RRSO. Of these, more than half had hysterectomy at time of RRSO. One third chose to have hysterectomy based on surgeon recommendation. <1% (2 out of 258) of BRCA1 gene mutation carriers reported being diagnosed with uterine serous carcinomas. While this incidence is low, it may be an underestimate based on the limitations of this study. Additional studies are needed to select which patients will benefit from concurrent hysterectomy and RRSO.
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Affiliation(s)
- Navya Nair
- Department of Obstetrics, Gynecology, and Reproductive Services, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Services, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa Guzzardi
- BRCA Advanced 101 & 102 Journal Club, New York, NY, USA
| | | | - Stephanie Pan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica Overbey
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Durable response in a woman with recurrent low-grade endometrioid endometrial cancer and a germline BRCA2 mutation treated with a PARP inhibitor. Gynecol Oncol 2018; 150:219-226. [DOI: 10.1016/j.ygyno.2018.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Kadan Y, Raviv O, Segev Y, Lavie O, Bruchim I, Fishman A, Michaelson R, Beller U, Helpman L. Impact of BRCA mutations on outcomes among patients with serous endometrial cancer. Int J Gynaecol Obstet 2018; 142:91-96. [PMID: 29572834 DOI: 10.1002/ijgo.12486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/19/2018] [Accepted: 03/15/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the outcome of patients with uterine papillary serous cancer (UPSC) carrying a BRCA mutation with that of patients with UPSC who are BRCA wild-type. METHODS The present retrospective, multicenter cohort study included women with UPSC who were diagnosed between January 1, 1993, and December 31, 2014, and were tested for the BRCA mutation at three Israeli medical centers. Data were collected from the medical records, and patient and tumor characteristics and disease outcomes were compared between BRCA mutation carriers and noncarriers. The primary outcome was overall survival. RESULTS In total, 14 BRCA mutation carriers and 50 noncarriers were included. Both groups had similar treatment modalities (P=0.530). A non-significant trend toward BRCA mutation carriers being diagnosed more frequently at an advanced stage compared with noncarriers was observed (P=0.090). Median overall survival (25 vs 37 months; P=0.442), progression-free survival (37 vs 29 months; P=0.536), and disease-specific survival (60 vs 39 months; P=0.316) were similar between the carrier and noncarrier groups. CONCLUSIONS Although not significant, BRCA mutation carriers tended to have more advanced disease at diagnosis. However, the survival was similar irrespective of the BRCA status in this small group. Further research is needed to confirm these findings in a larger cohort.
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Affiliation(s)
- Yfat Kadan
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Meir Medical Center, Kefar Sava, Israel
| | - Oshrat Raviv
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Meir Medical Center, Kefar Sava, Israel
| | - Yakir Segev
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
| | - Ilan Bruchim
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ami Fishman
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Meir Medical Center, Kefar Sava, Israel
| | - Rachel Michaelson
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel.,Department of Genetics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Uzi Beller
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Limor Helpman
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Meir Medical Center, Kefar Sava, Israel.,Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada
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17
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Naz S, Shahzad H, Ali A, Zia M. Nanomaterials as nanocarriers: a critical assessment why these are multi-chore vanquisher in breast cancer treatment. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2017; 46:899-916. [PMID: 28914553 DOI: 10.1080/21691401.2017.1375937] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Breast cancer is a group of diseases with various subtypes and leads to high mortality throughout the globe. Various conventional techniques are in practice to cure breast cancer but these techniques are linked with various shortcomings. Mostly these treatments are not site directed and cause toxicity towards normal cells. In order to overcome these issues, we need smart system that can deliver anticancer drugs to specific sites. Targeted drug delivery can be achieved via passive or active drug delivery using nanocarriers. This mode of drug delivery is more effective against breast cancer and may help in the reduction of mortality rate. Potentially used nanocarriers for targeted drug delivery belong to organic and inorganic molecules. Various FDA approved nano products are in use to cure breast cancer. However, body's defense system is main limitation for potential use of nano systems. However, this can be overcome by surface modification of nanocarriers. In this review, breast cancer and its types, targeted drug delivery and nanocarriers used to cure breast cancer are discussed. By progressing nanotechnology, we will be able to fight against this life threatening issue and serve the humanity, which is the basic aim of scientific knowledge.
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Affiliation(s)
- Sania Naz
- a Department of Biotechnology , Quaid-i-Azam University , Islamabad , Pakistan
| | - Hira Shahzad
- b Institute of Biochemistry and Biotechnology, PMAS Arid Agriculture , Rawalpindi , Pakistan
| | - Attarad Ali
- a Department of Biotechnology , Quaid-i-Azam University , Islamabad , Pakistan
| | - Muhammad Zia
- a Department of Biotechnology , Quaid-i-Azam University , Islamabad , Pakistan
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18
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Müllerian intra-abdominal carcinomatosis in hereditary breast ovarian cancer syndrome: implications for risk-reducing surgery. Fam Cancer 2017; 15:371-84. [PMID: 26875157 DOI: 10.1007/s10689-016-9878-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
More than 40 years ago Lynch et al. described several multigenerational breast cancer family pedigrees which demonstrated autosomal dominant inheritance of a trait(s) that increased risks for both breast and ovarian cancers. Mutation carriers in at least 90 % of these hereditary breast ovarian cancer (HBOC) syndrome families have been linked to cancer-associated mutations in the genes BRCA1 and BRCA2. This review focuses on the contributions of Lynch, colleagues and collaborators and pertinent literature, toward defining the HBOC syndrome, the cancer risks that the inherited adverse mutations convey, the gynecologic tissues and organs from which the malignancy may arise to disseminate throughout the pelvic and abdominal organs and peritoneum and how this information can be used to reduce the risk and morbidities of intra-abdominal carcinomatosis in effected individuals.
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19
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Havrilesky LJ, Moss HA, Chino J, Myers ER, Kauff ND. Mortality reduction and cost-effectiveness of performing hysterectomy at the time of risk-reducing salpingo-oophorectomy for prophylaxis against serous/serous-like uterine cancers in BRCA1 mutation carriers. Gynecol Oncol 2017; 145:549-554. [DOI: 10.1016/j.ygyno.2017.03.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/25/2022]
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20
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Abstract
Endometrial cancer is the most common gynecologic malignancy in the United States, with yearly rates continuing to increase. Most women present with early stage disease; however, advanced disease carries a grave prognosis. As a result, novel therapies are currently under investigation for the treatment of endometrial cancer. These advances include a better understanding of the genetic basis surrounding the development of endometrial cancer, novel surgical therapies, and new molecular targets for the treatment of this disease. This review explores the literature regarding these advancements in endometrial cancer.
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Affiliation(s)
- Arthur-Quan Tran
- Gynecologic Oncology, University of North Carolina at Chapel Hill, NC, USA
| | - Paola Gehrig
- Gynecologic Oncology, University of North Carolina at Chapel Hill, NC, USA
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21
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Pierce SR, Stine JE, Gehrig PA, Havrilesky LJ, Secord AA, Nakayama J, Snavely AC, Moore DT, Kim KH. Prior breast cancer and tamoxifen exposure does not influence outcomes in women with uterine papillary serous carcinoma. Gynecol Oncol 2017; 144:531-535. [PMID: 28062116 DOI: 10.1016/j.ygyno.2016.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate progression-free survival (PFS) and overall survival (OS) outcomes in women diagnosed with uterine papillary serous carcinoma (UPSC) who have had (UPSCBR+) or have not had (UPSCBR-) an antecedent history of breast cancer and to correlate their outcomes to prior tamoxifen exposure. METHODS Data were collected for women diagnosed with UPSC at two academic institutions between January 1997 and July 2012. Patient demographics, tumor histology, stage, and treatments were recorded. Patients were divided into two groups: those with and without a personal history of breast cancer. Within the UPSCBR+ cohort, we identified those with a history of tamoxifen use. Cox regression modeling was used to explore associations between selected covariates of interest and the time-to-event outcomes of PFS and OS. RESULTS Of 323 patients with UPSC, 46 (14%) were UPSCBR+. Of these, 15 (33%) had a history of tamoxifen use. UPSCBR+ patients were older than UPSCBR- (median years, 72 vs. 68, p=0.004). UPSCBR+ women showed no significant difference in PFS or OS compared to UPSCBR- (p=0.64 and p=0.73 respectively), even after controlling for age (p=0.15 and p=0.48 respectively). Within the UPSCBR+ cohort, there was no difference in PFS or OS with or without tamoxifen exposure (p=0.98 and p=0.94 respectively). CONCLUSIONS There was no difference in PFS or OS between the UPSCBR+ and UPSCBR- cohorts. We did not demonstrate significant OS or PFS differences in women who took tamoxifen prior to their endometrial cancer diagnosis. These findings have implications for counseling, and should be encouraging to women who are facing their second cancer diagnosis.
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Affiliation(s)
- Stuart R Pierce
- University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States.
| | - Jessica E Stine
- University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States
| | - Paola A Gehrig
- University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States; Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Laura J Havrilesky
- Duke University, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Durham, NC, United States
| | - Angeles A Secord
- Duke University, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Durham, NC, United States
| | - John Nakayama
- Duke University, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Durham, NC, United States
| | - Anna C Snavely
- Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Dominic T Moore
- Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Kenneth H Kim
- University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States; Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, NC, United States
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22
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de Jonge MM, Mooyaart AL, Vreeswijk MPG, de Kroon CD, van Wezel T, van Asperen CJ, Smit VTHBM, Dekkers OM, Bosse T. Linking uterine serous carcinoma to BRCA1/2-associated cancer syndrome: A meta-analysis and case report. Eur J Cancer 2016; 72:215-225. [PMID: 28049106 DOI: 10.1016/j.ejca.2016.11.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/16/2016] [Accepted: 11/27/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Uterine serous carcinoma (USC) shows greater morphological, clinical and molecular similarities to high-grade ovarian tubal serous carcinoma than to other types of endometrial cancer. As high-grade ovarian tubal serous carcinoma is known to be associated with BRCA1/2 pathogenic germline mutations (PMs), we aimed to explore whether USC is also a constituent of hereditary breast and ovarian cancer syndrome. METHODS Pubmed, EMBASE and Web of Science were searched in July 2016 for articles assessing the association between USC and germline BRCA1/2-PMs. Pooled analysis and comparisons were performed using a random effects logistic model, stratifying for ethnicity (Ashkenazi versus non-Ashkenazi). In addition, tumour tissue from an USC case with a hereditary BRCA1-PM was analysed for loss of heterozygosity at the BRCA1 locus and was functionally analysed for homologous recombination proficiency. RESULTS The search yielded 1893 citations, 10 studies were included describing 345 USC patients. For Ashkenazi Jews, the pooled odds ratio of having a germline BRCA1/2-PM was increased in USC patients compared with the general Ashkenazi population: odds ratio 5.4 (95%confidence interval: 2.2-13.1). In the patient with USC, we identified the known germline BRCA1-PM in the tumour DNA. Furthermore, we showed both loss of heterozygosity of the wild-type allele and a deficiency of homologous recombination. CONCLUSION This study suggests that USC may be an overlooked component of BRCA1/2-associated hereditary breast and ovarian cancer syndrome. Screening for germline BRCA1/2-PMs should be considered in patients diagnosed with USC, especially in cases with a positive first-degree family history for breast and/or ovarian cancer.
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Affiliation(s)
- M M de Jonge
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A L Mooyaart
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - M P G Vreeswijk
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - C D de Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - T van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - C J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - O M Dekkers
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
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23
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Ring KL, Bruegl AS, Allen BA, Elkin EP, Singh N, Hartman AR, Daniels MS, Broaddus RR. Germline multi-gene hereditary cancer panel testing in an unselected endometrial cancer cohort. Mod Pathol 2016; 29:1381-1389. [PMID: 27443514 PMCID: PMC5541389 DOI: 10.1038/modpathol.2016.135] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 01/06/2023]
Abstract
Hereditary endometrial carcinoma is associated with germline mutations in Lynch syndrome genes. The role of other cancer predisposition genes is unclear. We aimed to determine the prevalence of cancer predisposition gene mutations in an unselected endometrial carcinoma patient cohort. Mutations in 25 genes were identified using a next-generation sequencing-based panel applied in 381 endometrial carcinoma patients who had undergone tumor testing to screen for Lynch syndrome. Thirty-five patients (9.2%) had a deleterious mutation: 22 (5.8%) in Lynch syndrome genes (three MLH1, five MSH2, two EPCAM-MSH2, six MSH6, and six PMS2) and 13 (3.4%) in 10 non-Lynch syndrome genes (four CHEK2, one each in APC, ATM, BARD1, BRCA1, BRCA2, BRIP1, NBN, PTEN, and RAD51C). Of 21 patients with deleterious mutations in Lynch syndrome genes with tumor testing, 2 (9.5%) had tumor testing results suggestive of sporadic cancer. Of 12 patients with deleterious mutations in MSH6 and PMS2, 10 were diagnosed at age >50 and 8 did not have a family history of Lynch syndrome-associated cancers. Patients with deleterious mutations in non-Lynch syndrome genes were more likely to have serous tumor histology (23.1 vs 6.4%, P=0.02). The three patients with non-Lynch syndrome deleterious mutations and serous histology had mutations in BRCA2, BRIP1, and RAD51C. Current clinical criteria fail to identify a portion of actionable mutations in Lynch syndrome and other hereditary cancer syndromes. Performance characteristics of tumor testing are sufficiently robust to implement universal tumor testing to identify patients with Lynch syndrome. Germline multi-gene panel testing is feasible and informative, leading to the identification of additional actionable mutations.
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Affiliation(s)
- Kari L. Ring
- The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Gynecologic Oncology and Reproductive Medicine
| | - Amanda S. Bruegl
- Oregon Health & Science University, Portland, OR, Department of Obstetrics and Gynecology
| | | | | | | | | | - Molly S. Daniels
- The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Gynecologic Oncology and Reproductive Medicine
| | - Russell R. Broaddus
- The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Pathology
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24
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Shu CA, Pike MC, Jotwani AR, Friebel TM, Soslow RA, Levine DA, Nathanson KL, Konner JA, Arnold AG, Bogomolniy F, Dao F, Olvera N, Bancroft EK, Goldfrank DJ, Stadler ZK, Robson ME, Brown CL, Leitao MM, Abu-Rustum NR, Aghajanian CA, Blum JL, Neuhausen SL, Garber JE, Daly MB, Isaacs C, Eeles RA, Ganz PA, Barakat RR, Offit K, Domchek SM, Rebbeck TR, Kauff ND. Uterine Cancer After Risk-Reducing Salpingo-oophorectomy Without Hysterectomy in Women With BRCA Mutations. JAMA Oncol 2016; 2:1434-1440. [PMID: 27367496 PMCID: PMC5594920 DOI: 10.1001/jamaoncol.2016.1820] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE The link between BRCA mutations and uterine cancer is unclear. Therefore, although risk-reducing salpingo-oophorectomy (RRSO) is standard treatment among women with BRCA mutations (BRCA+ women), the role of concomitant hysterectomy is controversial. OBJECTIVE To determine the risk for uterine cancer and distribution of specific histologic subtypes in BRCA+ women after RRSO without hysterectomy. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective cohort study included 1083 women with a deleterious BRCA1 or BRCA2 mutation identified from January 1, 1995, to December 31, 2011, at 9 academic medical centers in the United States and the United Kingdom who underwent RRSO without a prior or concomitant hysterectomy. Of these, 627 participants were BRCA1+; 453, BRCA2+; and 3, both. Participants were prospectively followed up for a median 5.1 (interquartile range [IQR], 3.0-8.4) years after ascertainment, BRCA testing, or RRSO (whichever occurred last). Follow up data available through October 14, 2014, were included in the analyses. Censoring occurred at uterine cancer diagnosis, hysterectomy, last follow-up, or death. New cancers were categorized by histologic subtype, and available tumors were analyzed for loss of the wild-type BRCA gene and/or protein expression. MAIN OUTCOMES AND MEASURES Incidence of uterine corpus cancer in BRCA+ women who underwent RRSO without hysterectomy compared with rates expected from the Surveillance, Epidemiology, and End Results database. RESULTS Among the 1083 women women who underwent RRSO without hysterectomy at a median age 45.6 (IQR: 40.9 - 52.5), 8 incident uterine cancers were observed (4.3 expected; observed to expected [O:E] ratio, 1.9; 95% CI, 0.8-3.7; P = .09). No increased risk for endometrioid endometrial carcinoma or sarcoma was found after stratifying by subtype. Five serous and/or serous-like (serous/serous-like) endometrial carcinomas were observed (4 BRCA1+ and 1 BRCA2+) 7.2 to 12.9 years after RRSO (BRCA1: 0.18 expected [O:E ratio, 22.2; 95% CI, 6.1-56.9; P < .001]; BRCA2: 0.16 expected [O:E ratio, 6.4; 95% CI, 0.2-35.5; P = .15]). Tumor analyses confirmed loss of the wild-type BRCA1 gene and/or protein expression in all 3 available serous/serous-like BRCA1+ tumors. CONCLUSIONS AND RELEVANCE Although the overall risk for uterine cancer after RRSO was not increased, the risk for serous/serous-like endometrial carcinoma was increased in BRCA1+ women. This risk should be considered when discussing the advantages and risks of hysterectomy at the time of RRSO in BRCA1+ women.
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Affiliation(s)
- Catherine A. Shu
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | - Malcolm C. Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anjali R. Jotwani
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tara M. Friebel
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Robert A. Soslow
- Gynecologic Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Douglas A. Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine L. Nathanson
- Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason A. Konner
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Angela G. Arnold
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Faina Bogomolniy
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fanny Dao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Narciso Olvera
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Deborah J. Goldfrank
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zsofia K. Stadler
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark E. Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carol L. Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mario M. Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carol A. Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joanne L. Blum
- Baylor-Charles A. Sammons Cancer Center, Texas Oncology, Dallas, TX
| | - Susan L. Neuhausen
- Population Sciences Department, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA
| | - Judy E. Garber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Claudine Isaacs
- Department of Oncology and Medicine, Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC
| | - Rosalind A. Eeles
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Patricia A. Ganz
- UCLA Schools of Public Health and Medicine, and the Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA
| | - Richard R. Barakat
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Susan M. Domchek
- Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Timothy R. Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Noah D. Kauff
- Clinical Cancer Genetics Program, Duke Cancer Institute/Duke University Health System, Durham, NC
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Occult and subsequent cancer incidence following risk-reducing surgery in BRCA mutation carriers. Gynecol Oncol 2016; 143:231-235. [PMID: 27623252 DOI: 10.1016/j.ygyno.2016.08.336] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To report the frequency and features of occult carcinomas and the incidence of subsequent cancers following risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers. METHODS 257 consecutive women with germline BRCA mutations who underwent RRSO between January 1, 2000 and December 31, 2014 were identified in an Institutional Review Board approved study. All patients were asymptomatic with normal physical exams, CA 125 values, and imaging studies preoperatively, and had at least 12months of follow-up post-RRSO. All patients had comprehensive adnexal sectioning performed. Patient demographics and clinico-pathologic characteristics were extracted from medical and pathology records. RESULTS The cohort included 148 BRCA1, 98 BRCA2, 6 BRCA not otherwise specified (NOS), and 5 BRCA1 and 2 mutation carriers. Occult carcinoma was seen in 14/257 (5.4%) of patients: 9 serous tubal intraepithelial carcinomas (STIC), 3 tubal cancers, 1 ovarian cancer, and 1 endometrial cancer. Three patients (1.2%) with negative pathology at RRSO subsequently developed primary peritoneal serous carcinoma (PPSC), and 2 of 9 patients (22%) with STIC subsequently developed pelvic serous carcinoma. 110 women (43%) were diagnosed with breast cancer prior to RRSO, and 14 of the remaining 147 (9.5%) developed breast cancer following RRSO. Median follow-up of the cohort was 63months. CONCLUSION In this cohort, 5.4% of asymptomatic BRCA mutation carriers had occult carcinomas at RRSO, 86% of which were tubal in origin. The risk of subsequent PPSC for women with benign adnexa at RRSO is low; however, the risk of pelvic serous carcinoma among women with STIC is significantly higher.
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Frimer M, Levano KS, Rodriguez-Gabin A, Wang Y, Goldberg GL, Horwitz SB, Hou JY. Germline mutations of the DNA repair pathways in uterine serous carcinoma. Gynecol Oncol 2016; 141:101-7. [PMID: 27016235 DOI: 10.1016/j.ygyno.2015.12.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Treatment options are limited for patients with uterine serous carcinoma (USC). Knowledge of USC's somatic mutation landscape is rapidly increasing, but its role in hereditary cancers remains unclear. We aim to evaluate the frequency and characteristics of germline mutations in genes commonly implicated in carcinogenesis, including those within homologous recombination (HR) and mismatch repair (MMR) pathways in patients with pure USC. METHODS By using targeted capture exome sequencing, 43 genes were analyzed in a cohort of 7 consecutive patients with paired tumor and non-tumor USC samples in our institutional tumor repository. Mutations predicted to have damaging effects on protein function are validated by Sanger Sequencing. RESULTS We found 21 germline mutations in 11 genes in our USC cohort. Five patients harbored 7 germline mutations (33.3%) within genes involved in the HR pathway, RAD51D being the most common. Four patients had 9 (42.8%) germline mutations in hereditary colon cancer genes, most commonly MLH. All patients (42.7%) who are platinum-sensitive had HR germline mutations (RAD50, NBN, ATM). Patients with HER2 overexpression (2/7, 28.6%) had germline HR mutations and were platinum-sensitive. Three patients in our cohort reported a personal history of breast cancer, one with HR germline mutation, and 2 in patients with germline mutations in HCC genes. In addition, 5 out of 7 patients had germline mutations in genes associated with growth factor signaling pathway. CONCLUSIONS A significant proportion of our cohort harbor germline mutations in DNA repair genes. This may be associated with the high rate of breast cancer in our patients and their family, and suggests a targeted cohort for genetic counseling. If validated in a larger cohort, our findings may allow clinicians to expand therapeutic options to include targeted therapies and inclusion of USC patient in preventative and genetic counseling.
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Affiliation(s)
- Marina Frimer
- Division of Gynecologic Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, United States
| | - Kelly S Levano
- Laboratory of Molecular Biology Peruvian National Institute of Health, Lima 9, Peru
| | - Alicia Rodriguez-Gabin
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Yanhua Wang
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Gary L Goldberg
- Division of Gynecologic Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, United States
| | - Susan Band Horwitz
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - June Y Hou
- Division of Gynecologic Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, United States.
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Weitzel JN. The Genetics of Breast Cancer: What the Surgical Oncologist Needs to Know. Surg Oncol Clin N Am 2016; 24:705-32. [PMID: 26363538 DOI: 10.1016/j.soc.2015.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article summarizes the impact of germline predisposition to breast cancer on the surgical management of breast cancer and breast cancer risk. Surgical implications of germline predisposition to breast cancer are now more nuanced due to the application of increasingly more complicated next-generation sequencing-based tests. The rapid pace of change will continue to challenge paradigms for genetic cancer risk assessment, which can influence the medical and surgical management of breast cancer risk as well as strategies for screening and for risk reduction.
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Affiliation(s)
- Jeffrey N Weitzel
- Division of Clinical Cancer Genetics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Beirne JP, Irwin GW, McIntosh SA, Harley IJG, Harkin DP. The molecular and genetic basis of inherited cancer risk in gynaecology. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/tog.12213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- James P Beirne
- Northern Ireland Gynaecological Cancer Centre; Belfast City Hospital; Belfast Health and Social Care Trust; Belfast, Northern Ireland and Gynaecological Cancer Research Focus Group; Centre for Cancer Research and Cell Biology; Queens University; Belfast Northern Ireland
| | - Gareth W Irwin
- Northern Ireland Regional Breast Unit, Belfast City Hospital; Belfast Health and Social Care Trust; Belfast; Northern Ireland and Breast Cancer Research Focus Group; Centre for Cancer Research and Cell Biology; Queens University; Belfast Northern Ireland
| | - Stuart A McIntosh
- Northern Ireland Regional Breast Unit, Belfast City Hospital; Belfast Health and Social Care Trust; Belfast; Northern Ireland and Breast Cancer Research Focus Group; Centre for Cancer Research and Cell Biology; Queens University; Belfast Northern Ireland
| | - Ian JG Harley
- Northern Ireland Gynaecological Cancer Centre; Belfast City Hospital; Belfast Health and Social Care Trust; Belfast, Northern Ireland and Gynaecological Cancer Research Focus Group; Centre for Cancer Research and Cell Biology; Queens University; Belfast Northern Ireland
| | - D Paul Harkin
- Breast Cancer Research Focus Group; Centre for Cancer Research and Cell Biology; Queens University; Belfast Northern Ireland
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Segev Y, Rosen B, Lubinski J, Gronwald J, Lynch HT, Moller P, Kim-Sing C, Ghadirian P, Karlan B, Eng C, Gilchrist D, Neuhausen SL, Eisen A, Friedman E, Euhus D, Ping S, Narod SA. Risk factors for endometrial cancer among women with a BRCA1 or BRCA2 mutation: a case control study. Fam Cancer 2015; 14:383-91. [PMID: 25838159 PMCID: PMC4962606 DOI: 10.1007/s10689-015-9798-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BRCA mutation carriers may use tamoxifen for breast cancer prevention or treatment. Hormone replacement therapy is often prescribed after surgical menopause and oral contraceptives are recommended for ovarian cancer prevention. The objective of this study was to assess the impact of these medications and other risk factors on endometrial cancer risk in BRCA carriers. Women with a BRCA1 or BRCA2 mutation were identified from a registry of mutation carriers. Cases were 83 women who had a diagnosis of endometrial cancer. Controls were 1027 matched women who did not develop endometrial cancer and who had an intact uterus. All women completed a baseline questionnaire, which included questions about ages at menarche and menopause, oral contraceptive use, hormone replacement therapy use, hysterectomy, oophorectomy, breast cancer history and tamoxifen use. We estimated the odds ratio associated with each risk factor in a multivariate analysis. No differences were found between cases and controls in terms of age at menarche, BMI, smoking, or oral contraceptive use. In a multivariate analysis, for women taking estrogen-only hormone replacement therapy, the odds ratio was 0.23 (95% CI 0.03-1.78, p = 0.16), and for women taking progesterone-only hormone replacement therapy the odds ratio was 6.91 (95% CI 0.99-98.1, p = 0.05). The adjusted odds ratio for endometrial cancer associated with a history of tamoxifen use was 3.50 (95% CI 1.51-8.10, p = 0.003). The observed increased risk of endometrial cancer associated with progesterone-only therapy merits further study.
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Affiliation(s)
- Yakir Segev
- Women’s College Research Institute, 790 Bay Street, Toronto, ON, M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, ON, M5G 2M9, Canada
| | - Barry Rosen
- Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, ON, M5G 2M9, Canada
| | - Jan Lubinski
- International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Jacek Gronwald
- International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Henry T. Lynch
- Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, NE, 68178 USA
| | - Pal Moller
- Inherited Cancer Research Group, The Norwegian Radium Hospital, Department for Medical Genetics, University Hospital, Oslo, Norway
| | | | - Parviz Ghadirian
- Epidemiology Research Unit, Research Centre of the University of Montreal Hospital Centre (CRCHUM), Montreal, QC, Canada
| | - Beth Karlan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Beverly Hills, CA, USA
| | - Charis Eng
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dawna Gilchrist
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Susan L. Neuhausen
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
| | - Andrea Eisen
- Sunnybrook Regional Health Sciences Center, Toronto, ON, Canada
| | - Eitan Friedman
- Susanne Levy Gertner Oncogenetics Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - David Euhus
- Department of Surgery, John Hopkins University, Baltimore, MD, 21218, USA
| | - Sun Ping
- Women’s College Research Institute, 790 Bay Street, Toronto, ON, M5G 1N8, Canada
| | - Steven A. Narod
- Women’s College Research Institute, 790 Bay Street, Toronto, ON, M5G 1N8, Canada
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Wong A, Ngeow J. Hereditary Syndromes Manifesting as Endometrial Carcinoma: How Can Pathological Features Aid Risk Assessment? BIOMED RESEARCH INTERNATIONAL 2015; 2015:219012. [PMID: 26161390 PMCID: PMC4486295 DOI: 10.1155/2015/219012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 11/23/2014] [Indexed: 01/08/2023]
Abstract
Endometrial carcinoma is the most common gynecological tumor worldwide. It can be the presenting malignancy, acting as the harbinger, of an undiagnosed hereditary syndrome. Up to 50% of females with Lynch syndrome present in this manner. Differentiation between Lynch, Muir-Torre, and Cowden syndromes can at times be challenging due to the overlapping features. Our review emphasizes on the strengths, pitfalls, and limitations of microscopic features as well as immunohistochemical and polymerase chain reaction- (PCR-) based tests used by laboratories to screen for DNA mismatch repair (MMR) and PTEN gene mutations in patients to enable a more targeted and cost effective approach in the use of confirmatory gene mutational analysis tests. This is crucial towards initiating timely and appropriate surveillance measures for the patient and affected family members. We also review the evidence postulating on the possible inclusion of uterine serous carcinoma as part of the spectrum of malignancies seen in hereditary breast and ovarian carcinoma syndrome, driven by mutations in BRCA1/2.
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Affiliation(s)
- Adele Wong
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Joanne Ngeow
- Cancer Genetics Service, National Cancer Centre Singapore, Singapore 169610
- Oncology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore 169857
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
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Abstract
Women who report a history of endometrial cancer in a first-degree relative are at increased risk of endometrial cancer, with a hazard ratio of 1.5 to 2.0. Only a minority of patients with familial endometrial cancer have a recognized cancer syndrome. Lynch syndrome is the most common genetic syndrome associated with endometrial cancer and a marked increased risk of colon cancer. Cowden syndrome is a rare condition resulting from a mutation in the tumor suppressor gene phosphatase and tensin homolog. The risk for endometrial cancer is about five times higher in women with Cowden syndrome than in the general population. Recently, a novel germline mutation in the POLD1 gene that encodes the catalytic subunit of DNA polymerase δ was described in several families with multiple cases of endometrial cancer. This mutation is also associated with colorectal cancer. The association between BRCA1 mutations and endometrial cancer has been investigated in several studies; it appears that the risk of endometrial cancer is restricted to women with a history of tamoxifen exposure. In recent years, research has focused on genetic polymorphisms that are associated with endometrial cancer risk. Although many polymorphisms have been identified, their clinical significance is unclear and they have not been adapted for clinical practice.
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Should hysterectomy complement prophylactic salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers? Gynecol Oncol 2014; 134:219-21. [DOI: 10.1016/j.ygyno.2014.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 12/24/2022]
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Buza N, Roque DM, Santin AD. HER2/neu in Endometrial Cancer: A Promising Therapeutic Target With Diagnostic Challenges. Arch Pathol Lab Med 2014; 138:343-50. [PMID: 24576030 DOI: 10.5858/arpa.2012-0416-ra] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT In the era of targeted cancer therapy, there is growing interest in developing novel therapeutic strategies against endometrial carcinoma, especially its most biologically aggressive variant, serous adenocarcinoma. Several publications have demonstrated that a significant proportion of uterine serous carcinomas show HER2 overexpression and/or amplification, suggesting that HER2 may be a promising therapeutic target. Case reports have already shown clinical response to trastuzumab, a humanized monoclonal immunoglobulin (Ig) G1 antibody against HER2, and patients are currently being enrolled in a multi-institutional prospective randomized trial to evaluate the therapeutic efficacy of trastuzumab. OBJECTIVE To review current data on HER2 testing and targeted therapy against HER2/neu in endometrial carcinoma. DATA SOURCES Review of the literature and personal experience of the authors. CONCLUSIONS Parallel to the clinical studies, there is a need to develop standardized criteria for HER2 testing in endometrial carcinoma that reflect the unique biological and pathogenetic features of these tumors and correlate with clinical response to therapy. This article presents a comprehensive review of the current state of HER2-based therapy and HER2 testing in endometrial carcinoma.
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Affiliation(s)
- Natalia Buza
- From the Departments of Pathology (Dr Buza) and Obstetrics, Gynecology, and Reproductive Sciences (Drs Roque and Santin), Yale University School of Medicine, New Haven, Connecticut; and the Gynecologic Oncology Program, Yale Cancer Center, New Haven, Connecticut (Dr Santin)
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Fadare O. Is there an association between type II endometrial carcinomas and breast cancers? A critical appraisal. ACTA ACUST UNITED AC 2013; 9:315-7. [PMID: 23826773 DOI: 10.2217/whe.13.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Segev Y, Iqbal J, Lubinski J, Gronwald J, Lynch HT, Moller P, Ghadirian P, Rosen B, Tung N, Kim-Sing C, Foulkes WD, Neuhausen SL, Senter L, Singer CF, Karlan B, Ping S, Narod SA. The incidence of endometrial cancer in women with BRCA1 and BRCA2 mutations: An international prospective cohort study. Gynecol Oncol 2013; 130:127-31. [DOI: 10.1016/j.ygyno.2013.03.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/20/2013] [Accepted: 03/26/2013] [Indexed: 12/24/2022]
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Pathiraja P, Dhar S, Haldar K. Serous endometrial intraepithelial carcinoma: a case series and literature review. Cancer Manag Res 2013; 5:117-22. [PMID: 23861597 PMCID: PMC3704304 DOI: 10.2147/cmar.s45141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Minimal uterine serous cancer (MUSC) or serous endometrial intraepithelial carcinoma (EIC) has been described by many different names since 1998. There have been very few cases reported in literature since EIC/MUSC was recognized as a separate entity. The World health Organization (WHO) Classification favors the term serous EIC. Although serous EIC is confined to the uterine endometrium at initial histology diagnosis, a significant number of patients could have distal metastasis at diagnosis, without symptoms. Serous EIC is considered as being the precursor of uterine serous cancer (USC), but pure serous EIC also has an aggressive behavior similar to USC. It is therefore prudent to have an accurate diagnosis and appropriate surgical staging. There are very few published articles in literature that discuss the pure form of serous EIC. The aim of this series is to share our experience and review evidence for optimum management of serous EIC. PATIENTS AND METHODS We report a series of five women treated in our institute in the last 3 years. We reviewed the relevant literature on serous EIC and various management strategies, to recommend best clinical practice. CONCLUSION Pure serous EIC is a difficult histopathological diagnosis, which requires ancillary immunohistochemical staining. It can have an aggressive clinical behavior with early recurrence and poor survival. Optimum surgical staging, with appropriate adjuvant treatment, should be discussed when treating these patients.
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Reitsma W, Mourits MJE, de Bock GH, Hollema H. Endometrium is not the primary site of origin of pelvic high-grade serous carcinoma in BRCA1 or BRCA2 mutation carriers. Mod Pathol 2013; 26:572-8. [PMID: 23080033 DOI: 10.1038/modpathol.2012.169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Serous endometrial intraepithelial carcinoma has been proposed to be a potential precursor lesion of pelvic high-grade serous carcinoma. If true, an increased incidence of uterine papillary serous carcinomas would be expected in BRCA1 and BRCA2 mutation carriers, who are at high-risk of developing pelvic high-grade serous carcinoma. This study explored particularly the occurrence of uterine papillary serous carcinoma, as well as other endometrial cancers, following risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 germline mutation attending a tertiary multidisciplinary clinic. A consecutive series of women with a BRCA1 or BRCA2 mutation who had undergone risk-reducing salpingo-oophorectomy without hysterectomy at the University Medical Center Groningen from January 1996 until March 2012 were followed prospectively. They were crossed with the histopathology list of endometrial cancer diagnoses reported by the Dutch nationwide pathology database PALGA. To assess the risk of endometrial cancer, a standardized incidence ratio was calculated comparing the observed with the expected number of endometrial cancer cases. Overall, 201 BRCA1 and 144 BRCA2 mutation carriers at a median age of 50 years (range, 32-78) were analyzed. After a median follow-up period of 6 years, after risk-reducing salpingo-oophorectomy, two cases of endometrial cancer were diagnosed, whereas the expected number was 0.94 cases (standardized incidence ratio 2.13; 95% confidence interval 0.24-7.69; P=0.27). Both endometrial cancer cases were of the endometrioid histological subtype. We showed that the incidence of endometrial cancer following risk-reducing salpingo-oophorectomy, especially uterine papillary serous carcinoma, in women at high-risk of developing pelvic high-grade serous carcinoma is not increased. On the basis of our data, the hypothesis of serous endometrial intraepithelial carcinoma being an important precursor lesion of pelvic high-grade serous carcinoma seems unlikely. There is no need to add a prophylactic hysterectomy to risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers.
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Affiliation(s)
- Welmoed Reitsma
- Department of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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del Carmen MG, Birrer M, Schorge JO. Uterine papillary serous cancer: a review of the literature. Gynecol Oncol 2012; 127:651-61. [PMID: 23000148 DOI: 10.1016/j.ygyno.2012.09.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/09/2012] [Accepted: 09/13/2012] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Uterine papillary serous carcinoma (UPSC) represents a distinct subtype of endometrial cancer. UPSC is less common than endometrioid carcinoma (ECC) but accounts for a disproportionate number of uterine cancer related deaths. This article critically reviews the literature pertinent to the pathology, pathogenesis, diagnosis, management, and outcome of patients with UPSC. METHODS MEDLINE was searched for all research articles published in English between January 1, 1967-January 1, 2012 which reported on patients diagnosed with UPSC. Given the rarity of this tumor, studies were not limited by design or number of reported patients. RESULTS UPSC represents a histologically aggressive subtype of endometrial cancer. It commonly presents with extra uterine disease involvement which can be identified by comprehensive surgical staging. Optimal cytoreduction and systemic platinum/taxane-based adjuvant therapy appear to confer a survival advantage. CONCLUSIONS UPSC is a biologically distinct entity, different from ECC. Future studies should explore the role of targeted therapies in the management of UPSC.
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Affiliation(s)
- Marcela G del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Pennington KP, Walsh T, Lee M, Pennil C, Novetsky AP, Agnew KJ, Thornton A, Garcia R, Mutch D, King MC, Goodfellow P, Swisher EM. BRCA1, TP53, and CHEK2 germline mutations in uterine serous carcinoma. Cancer 2012; 119:332-8. [PMID: 22811390 DOI: 10.1002/cncr.27720] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/24/2012] [Accepted: 05/31/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Uterine serous carcinoma (USC) is not recognized as part of any defined hereditary cancer syndrome, and its association with hereditary breast and ovarian carcinoma and Lynch syndrome are uncertain. METHODS Using targeted capture and massively parallel genomic sequencing, 151 subjects with USC were assessed for germline mutations in 30 tumor suppressor genes, including BRCA1 (breast cancer 1, early onset), BRCA2, the DNA mismatch repair genes (MLH1 [mutL homolog 1], MSH2 [mutS homolog 2], MSH6, PMS2 [postmeiotic segregation increased 2]), TP53 (tumor protein p53), and 10 other genes in the Fanconi anemia-BRCA pathway. Ten cases with < 10% serous histology were also assessed. RESULTS Seven subjects (4.6%) carried germline loss-of-function mutations: 3 subjects (2.0%) with mutations in BRCA1, 2 subjects (1.3%) with mutations in TP53, and 2 subjects (1.3%) with mutations in CHEK2 (checkpoint kinase 2). One subject with < 10% serous histology had an MSH6 mutation. Subjects with MSH6 and TP53 mutations had neither personal nor family histories suggestive of Lynch or Li-Fraumeni syndromes. Of the 22 women with USC and a personal history of breast carcinoma, the frequency of BRCA1 mutations was 9%, compared to 0.9% in 119 women with no such history. CONCLUSIONS Approximately 5% of women with USC have germline mutations in 3 different tumor suppressor genes: BRCA1, CHEK2, and TP53. Mutations in DNA mismatch repair genes that cause Lynch syndrome are rare in USC. The germline BRCA1 mutation rate in USC subjects of 2% is higher than expected in a nonfounder population, suggesting that USC is associated with hereditary breast and ovarian carcinoma in a small proportion of cases. Women with USC and breast cancer should be offered genetic testing for BRCA1 and BRCA2 mutations.
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Affiliation(s)
- Kathryn P Pennington
- Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, Washington 98195-6460, USA
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Rashid MU, Gull S, Faisal S, Khaliq S, Asghar K, Siddiqui N, Amin A, Hamann U. Identification of the deleterious 2080insA BRCA1 mutation in a male renal cell carcinoma patient from a family with multiple cancer diagnoses from Pakistan. Fam Cancer 2012; 10:709-12. [PMID: 21751003 DOI: 10.1007/s10689-011-9467-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pathogenic germ line mutations in the BRCA1 and BRCA2 genes confer elevated risk of breast and ovarian cancer in females and have a link with variety of cancers other than breast cancer in males. Here we report the first case of a 45-year-old Pakistani male with renal cell carcinoma who was identified to harbor a disease-associated BRCA1 germ line mutation, 2080insA. Detailed description of the family history, clinical presentation and histopathological features of the renal cell carcinoma are presented.
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Dreyer G. Screening for gynaecologic cancers in genetically predisposed women. Best Pract Res Clin Obstet Gynaecol 2012; 26:267-82. [PMID: 22361688 DOI: 10.1016/j.bpobgyn.2011.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 11/09/2011] [Indexed: 12/24/2022]
Abstract
Hereditary breast and ovarian cancer syndrome and hereditary non-polyposis colon cancer syndrome are the two most important syndromes responsible for inherited cancers in gynaecology. Genetic testing is available for both these syndromes. Breast cancer gene testing is affordable and easy in women with ancestry where the mutation patterns are known, whereas other population groups need full gene screening. Hereditary non-polyposis colon cancer syndrome can now be diagnosed more frequently with the use of immunohistochemistry. Ovarian cancer risk is high in hereditary breast and ovarian cancer syndromes, and advanced screening techniques should be used when preventive surgery is not an option. Early detection techniques offer less protection than prophylactic removal, but enable women to retain their reproductive organs. Oophorectomy has the advantage of reducing breast cancer risk. In colorectal cancer syndromes, the risk for endometrial and ovarian cancer is much elevated. These risks should be recognised and addressed as these diseases are easy to prevent.
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Affiliation(s)
- Greta Dreyer
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, 183 Charles Street, Brooklyn 0181, South Africa.
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Dewdney SB, Kizer NT, Andaya AA, Babb SA, Luo J, Mutch DG, Schmidt AP, Brinton LA, Broaddus RR, Ramirez NC, Huettner PC, McMeekin DS, Darcy K, Ali S, Judson PL, Mannel RS, Lele SB, O'Malley DM, Goodfellow PJ. Uterine serous carcinoma: increased familial risk for lynch-associated malignancies. Cancer Prev Res (Phila) 2012; 5:435-43. [PMID: 22246618 DOI: 10.1158/1940-6207.capr-11-0499] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Serous uterine cancer is not a feature of any known hereditary cancer syndrome. This study evaluated familial risk of cancers for patients with serous uterine carcinoma, focusing on Lynch syndrome malignancies. Fifty serous or mixed serous endometrial carcinoma cases were prospectively enrolled. Pedigrees were developed for 29 probands and tumors were assessed for DNA mismatch repair (MMR) abnormalities. Standardized incidence ratios for cancers in relatives were estimated. A second-stage analysis was undertaken using data from Gynecologic Oncology Group (GOG)-210. Incidence data for cancers reported in relatives of 348 patients with serous and mixed epithelial and 624 patients with endometrioid carcinoma were compared. Nineteen of 29 (65.5%) patients in the single-institution series reported a Lynch-related cancer in relatives. Endometrial and ovarian cancers were significantly overrepresented and a high number of probands (6 of 29, 20.7%) reported pancreatic cancers. None of the probands' tumors had DNA MMR abnormalities. There was no difference in endometrial or ovarian cancer incidence in relatives of serous and endometrioid cancer probands in the case-control study. Pancreatic cancers were, however, significantly more common in relatives of patients with serous cancer [OR, 2.39; 95% confidence interval (CI), 1.06-5.38]. We identified an excess of endometrial, ovarian, and pancreatic cancers in relatives of patients with serous cancer in a single-institution study. Follow-up studies suggest that only pancreatic cancers are overrepresented in relatives. DNA MMR defects in familial clustering of pancreatic and other Lynch-associated malignancies are unlikely. The excess of pancreatic cancers in relatives may reflect an as yet unidentified hereditary syndrome that includes uterine serous cancers.
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Affiliation(s)
- Summer B Dewdney
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 660 South Euclid, St. Louis, MO 63110, USA
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Duffy DL, Antill YC, Stewart CJ, Young JP, Spurdle AB. Report of Endometrial Cancer in Australian BRCA1 and BRCA2 mutation-positive Families. Twin Res Hum Genet 2011; 14:111-8. [PMID: 21425892 DOI: 10.1375/twin.14.2.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is evidence that tamoxifen treatment of BRCA1 and BRCA2 carriers for prior breast cancer increases risk of endometrioid subtype endometrial cancer (EC), and suggestive evidence that BRCA1 and BRCA2 mutation carriers may be predisposed to EC in the absence of tamoxifen exposure. We assessed the association of EC with BRCA1 or BRCA2 mutation status in Australasian breast-ovarian families. Report of at least one case of EC was significantly greater in BRCA1-positive families (35/218 (16%); p = .03) and non-significantly greater in BRCA2-positive families (23/189 (12%); p = .6), compared to high-risk breast cancer families without a BRCA1/2 mutation (86/796 (11%)). EC was the first/concurrent cancer for 41% of EC cases with multiple cancer diagnoses from BRCA1/2 families, and early onset for most of these diagnoses. Mutation status was imputed for ungeno-typed individuals from 57 BRCA1/2 pedigrees reporting EC using BRCAPRO. Effects of genotype on EC diagnosis age, and interaction with tamoxifen therapy, were assessed using Cox proportional hazards regression analysis. EC risk was non-significantly marginally greater for BRCA1 carriers (hazard ratio = 1.25, 95%CI = 0.65-2.41), and BRCA2 carriers (HR = 1.12, 95%CI = 0.51-2.45), compared to non-carrier family members. Tamoxifen therapy was highly significantly associated with EC (HR = 6.68, 95%CI = 3.12-15.15; p = 1.7 x 10(-6)) in BRCA1/2 families, with no evidence for interaction between tamoxifen therapy and BRCA1/2 genotype. Our family-based study supports a 7-fold increase in EC risk with tamoxifen exposure for female family members from BRCA1/2 families. Early onset EC in carriers without tamoxifen use suggests that further study is required to assess association of modest EC risk with BRCA1/2 mutation status alone.
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Affiliation(s)
- David L Duffy
- Genetics and Population Health Division, Queensland Institute of Medical Research, Herston, Queensland, Australia
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Barak F, Milgrom R, Laitman Y, Gemer O, Rabinovich A, Piura B, Anteby E, Baruch GB, Korach J, Friedman E. The rate of the predominant Jewish mutations in the BRCA1, BRCA2, MSH2 and MSH6 genes in unselected Jewish endometrial cancer patients. Gynecol Oncol 2010; 119:511-5. [DOI: 10.1016/j.ygyno.2010.08.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/04/2010] [Accepted: 08/21/2010] [Indexed: 11/25/2022]
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Bruchim I, Amichay K, Kidron D, Attias Z, Biron-Shental T, Drucker L, Friedman E, Werner H, Fishman A. BRCA1/2 Germline Mutations in Jewish Patients With Uterine Serous Carcinoma. Int J Gynecol Cancer 2010; 20:1148-53. [DOI: 10.1111/igc.0b013e3181ef622d] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Cass I, Walts A, Karlan BY. Does risk-reducing bilateral salpingo-oophorectomy leave behind residual tube? Gynecol Oncol 2010; 117:27-31. [DOI: 10.1016/j.ygyno.2009.12.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 11/25/2022]
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Benito V, Lubrano A, Arencibia O, Alvarez EE, León L, Medina N, Falcón JM, Falcón O. Pure papillary serous tumors of the endometrium: a clinicopathological analysis of 61 cases from a single institution. Int J Gynecol Cancer 2010; 19:1364-9. [PMID: 20009891 DOI: 10.1111/igc.0b013e3181b7a1d5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinicopathological data and prognosis factors corresponding to patients with papillary serous carcinoma of the endometrium treated at a single institution. METHODS Medical and anatomopathological records were reviewed in the Department of Gynecological Oncology of the Canarian University Hospital between 1989 and 2006. Only pure cases of papillary serous carcinoma of the endometrium were included. Survival rates were analyzed using the Kaplan-Meier technique. RESULTS The study included 61 patients. Stages I, II, III, and IV were identified in 32.8%, 19.7%, 31.1%, and 8.2% of patients, respectively. Event-free survival rates after 5 and 10 years were 59% and 40%, respectively, with a median time of 83 months (95% confidence interval, 63-110). Relapse occurred in 40.5% of the patients. Overall survival rates after 5 and 10 years were 37.7% and 29%, respectively, with a median time of 55 months (95% confidence interval, 40-70). A univariate analysis showed that prognosis factors were tumor markers, stage, myometrial infiltration, lymphovascular invasion, and ganglia involvement. A multivariate analysis showed that tumor markers, stage, and myometrial infiltration had an independent influence on overall survival. CONCLUSIONS Papillary serous carcinoma of the endometrium is a very aggressive type of endometrial carcinoma that behaves more similar to ovarian carcinoma than to endometrial carcinoma. Tumor markers at diagnosis, stage, and myometrial infiltration mainly determine prognosis at our institution.
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Affiliation(s)
- Virginia Benito
- Department of Gynecology Oncology, University Hospital of Canary Islands, Las Palmas de Gran Canaria, Spain.
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Management of women with uterine papillary serous cancer: A Society of Gynecologic Oncology (SGO) review. Gynecol Oncol 2009; 115:142-153. [DOI: 10.1016/j.ygyno.2009.06.011] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 06/05/2009] [Accepted: 06/08/2009] [Indexed: 11/22/2022]
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Candidate serous cancer precursors in fallopian tube epithelium of BRCA1/2 mutation carriers. Mod Pathol 2009; 22:1133-8. [PMID: 19543244 DOI: 10.1038/modpathol.2009.89] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Occult invasive and intraepithelial carcinomas have been identified in the tubal fimbria of BRCA mutation carriers undergoing prophylactic surgery, and recently described lesions overexpressing p53 in the distal tubes of mutation carriers, and non-carriers, have been proposed as histological precursors of high-grade serous carcinoma. The aim of this study was to confirm these findings in a larger, independent case set, to further characterize the cancer precursor lesions, and to determine their frequency in BRCA mutation-positive (n=176) and control groups (n=64). For the purposes of this study, we excluded cases without documentation of a germline mutation of BRCA1/2, and without histological examination of the entire tube, and cases with a diagnosis of invasive carcinoma. Controls included salpingectomies from women undergoing surgery for reasons other than ovarian malignancy. Diagnostic categories were assigned based on combined histological review and immunostaining results. Histological abnormalities were identified in 23% of the BRCA group and in 25% of the control group, and included localized p53 overexpression in 20% of the BRCA group and 25% of the control group. Tubal intramucosal carcinoma was identified in 8% of the BRCA cases and in 3% of the control group. Four cases of intraepithelial carcinoma (21%) did not overexpress p53. There was no significant difference in the median age, frequency of histological abnormalities, p53 signatures, or tubal intraepithelial carcinoma between the BRCA mutation-positive and control groups. This large, blinded review of tubes from BRCA mutation carriers confirms previous reports of putative cancer precursors in distal tubal mucosa, and that p53 signatures occur with similar frequency in women at low and high genetic risk of tubal/ovarian carcinoma. Tubal intraepithelial carcinoma, which, like invasive serous cancer, usually but not always overexpresses p53 protein, is more frequent in BRCA mutation carriers.
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Ko ML, Jeng CJ, Huang SH, Shen J, Tzeng CR, Chen SC. Primary peritoneal carcinosarcoma (malignant mixed mullerian tumor): Report of a case with five-year disease free survival after surgery and chemoradiation and a review of literature. Acta Oncol 2009; 44:756-60. [PMID: 16227168 DOI: 10.1080/02841860500252016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Malignant mixed mullerian tumors (MMMTs), also known as carcinosarcoma because they contain both carcinomatous and sarcomatous elements are aggressive tumors, which usually arise in the uterus and ovary. Extragenital carcinosarcomas are extremely rare and most cases develop from the peritoneum. To our knowledge, only 29 cases have been described in English literature. Here we report a case of a primary carcinosarcoma of the pelvic peritoneum with five-year disease-free survival after managing the patient with surgery, chemotherapy and radiotherapy.
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Affiliation(s)
- Ma-Lee Ko
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
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