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Borja NA, Silva-Smith R, Calfa C, Sussman DA, Tekin M. Triple Primary Cancers: An Analysis of Genetic and Environmental Factors. Cancer Prev Res (Phila) 2024; 17:209-215. [PMID: 38361103 DOI: 10.1158/1940-6207.capr-23-0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/07/2023] [Accepted: 02/14/2024] [Indexed: 02/17/2024]
Abstract
The occurrence of multiple primary cancers (MPC) is thought to reflect increased cancer susceptibility in patients due to a combination of genetic and environmental factors. Here we conducted a retrospective review of 2,894 consecutive patients evaluated at a single institution and identified 31 (1.14%) individuals with a history of three or more primary cancers, then analyzed the genetic and environmental influences associated with their propensity for developing malignancies. We found that 35.5% of patients had a hereditary cancer syndrome (HCS), with high penetrance HCS in 72.7% of cases, suggesting that monogenic causes underly a significant proportion of triple primary cancer risk. Analysis of cancer frequencies found that the diagnosis of breast cancer was associated with a significantly lower likelihood of HCS, while the diagnosis of colorectal, prostate, and pancreas cancer was associated with a significantly higher likelihood of HCS. Comparison of HCS-positive and HCS-negative patients revealed similar demographic characteristics, mean age at first diagnosis, and family history of cancer. Moreover, no significant differences in lifestyle behaviors, occupational exposures, chronic health conditions, or treatment with chemotherapy and radiation were observed between HCS-positive and -negative groups, though outliers in tobacco smoking, as well as systemic treatment after both first and second primary cancers were observed. These findings indicate a robust contribution of HCS to cancer susceptibility among patients with triple primary cancers while environmental influences were less evident. This emphasizes the need for larger MPC cohorts incorporating additional genetic and environmental factors to more comprehensively characterize drivers of cancer risk. PREVENTION RELEVANCE In patients with three or more primary cancers, genetic predisposition explained a significant proportion of cases; however, treatment history, lifestyle habits, and other exposures appeared to play a less significant role. This highlights the value of early genetic screening and the need to develop more sensitive markers of cancer susceptibility. See related Spotlight, p. 193.
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Affiliation(s)
- Nicholas A Borja
- Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rachel Silva-Smith
- Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Carmen Calfa
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Daniel A Sussman
- Division of Digestive Health and Liver Diseases, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mustafa Tekin
- Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
- John P. Hussmann Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida
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McVeigh TP, Lalloo F, Frayling IM, Latchford A, Snape K, Durkie M, Monahan KJ, Hanson H. Challenges in developing and implementing international best practice guidance for intermediate-risk variants in cancer susceptibility genes: APC c.3920T>A p.(Ile1307Lys) as an exemplar. J Med Genet 2024:jmg-2024-109900. [PMID: 38697781 DOI: 10.1136/jmg-2024-109900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Terri Patricia McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Fiona Lalloo
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ian M Frayling
- St Vincent's University Hospital, Dublin, Ireland
- St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Andrew Latchford
- St Mark's the National Bowel Hospital and Academic Institute, London, UK
| | - Katie Snape
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Miranda Durkie
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Kevin J Monahan
- St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Imperial College London, London, UK
| | - Helen Hanson
- Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
- Peninsula Regional Genetics Service, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Jacobs MF, Stoffel EM. Genetic and other risk factors for pancreatic ductal adenocarcinoma (PDAC). Fam Cancer 2024:10.1007/s10689-024-00372-5. [PMID: 38573398 DOI: 10.1007/s10689-024-00372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at an advanced stage, resulting in poor prognosis and low 5-year survival rates. While early evidence suggests increased long-term survival in those with screen-detected resectable cancers, surveillance imaging is currently only recommended for individuals with a lifetime risk of PDAC ≥ 5%. Identification of risk factors for PDAC provides opportunities for early detection, risk reducing interventions, and targeted therapies, thus potentially improving patient outcomes. Here, we summarize modifiable and non-modifiable risk factors for PDAC. We review hereditary cancer syndromes associated with risk for PDAC and their implications for patients and their relatives. In addition, other biologically relevant pathways and environmental and lifestyle risk factors are discussed. Future work may focus on elucidating additional genetic, environmental, and lifestyle risk factors that may modify PDAC risk to continue to identify individuals at increased risk for PDAC who may benefit from surveillance and risk reducing interventions.
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Affiliation(s)
- Michelle F Jacobs
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Elena M Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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Abu Shtaya A, Kedar I, Mattar S, Mahamid A, Basel-Salmon L, Farage Barhom S, Naftaly Nathan S, Magal N, Azulay N, Levy Zalcberg M, Chen-Shtoyerman R, Segol O, Seri M, Reznick Levi G, Shkedi-Rafid S, Vinkler C, Netzer I, Hagari Bechar O, Chamma L, Liberman S, Goldberg Y. The Diagnostic Yield and Implications of Targeted Founder Pathogenic Variant Testing in an Israeli Cohort. Cancers (Basel) 2023; 16:94. [PMID: 38201524 PMCID: PMC10777957 DOI: 10.3390/cancers16010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Founder pathogenic variants (PVs) are prevalent in Israel. This study investigated the current practice of offering cancer patients two-step genetic testing, starting with targeted testing for recurring founder PVs, followed, if negative, by next-generation sequencing. A total of 2128 subjects with cancer or a positive family history underwent oncogenetic testing with a panel of 51 recurring PVs at a tertiary medical center in March 2020-January 2023. Those with a known familial PV (n = 370) were excluded from the analysis. Among the remainder, 128/1758 (7%) were heterozygous for at least one variant, and 44 (34%) carried a PV of medium-high penetrance (MHPV). Cancer was diagnosed in 1519/1758 patients (86%). The diagnostic yield of founder MHPV testing was 2% in cancer patients and 4% in healthy individuals with a positive family history. It was higher in Ashkenazi Jews than non-Ashkenazi Jews and Arabs, but not over 10% for any type of cancer, and it was significantly higher in younger (<40 years) than older (>50 years) individuals (7% vs. 1%). Eighty-four of the heterozygotes (66%), mostly Ashkenazi Jews, harbored a low-penetrance variant (LPV) not associated with the diagnosed cancer, usually APC c.3902T>A. These findings question the advantage of two-step testing. LPVs should not be included in targeted testing because this can lead to an overestimation of the yield, and their detection does not preclude further comprehensive testing.
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Affiliation(s)
- Aasem Abu Shtaya
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
- Unit of Gastroenterology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel;
| | - Inbal Kedar
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
| | - Samar Mattar
- Department of Surgery B, Carmel Medical Center, Haifa 3436212, Israel; (S.M.); (A.M.)
| | - Ahmad Mahamid
- Department of Surgery B, Carmel Medical Center, Haifa 3436212, Israel; (S.M.); (A.M.)
| | - Lina Basel-Salmon
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Felsenstein Medical Research Center, Petach Tikva 4920235, Israel
- Pediatric Genetics Unit, Schneider Children’s Medical Center of Israel, Petch Tikva 49202, Israel
| | - Sarit Farage Barhom
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
| | - Sofia Naftaly Nathan
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
| | - Nurit Magal
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
| | - Noy Azulay
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
| | | | - Rakefet Chen-Shtoyerman
- Adelson School of Medicine, Department of Molecular Biology, Ariel University, Ariel 40700, Israel;
- Kaplan Medical Center, Genetics Institute, Oncogenetic Clinic, Rehovot 7610001, Israel
| | - Ori Segol
- Unit of Gastroenterology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel;
| | - Mor Seri
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
| | | | - Shiri Shkedi-Rafid
- Department of Genetics and Metabolic Diseases, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Chana Vinkler
- Institute for Medical Genetics, Wolfson Medical Center, Holon 5822012, Israel;
| | - Iris Netzer
- Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel;
| | - Ofir Hagari Bechar
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
| | - Liat Chamma
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
| | - Sari Liberman
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem 9112102, Israel
| | - Yael Goldberg
- Recanati Genetics Institute, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (I.K.); (L.B.-S.); (N.M.); (M.S.); (O.H.B.); (Y.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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