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Melki R, Melloul M, Aissaoui S, El Harroudi T, Boukhatem N. Increased prevalence of the founder BRCA1 c.5309G>T and recurrent BRCA2 c.1310_1313delAAGA mutations in breast cancer families from Northerstern region of Morocco: evidence of geographical specificity and high relevance for genetic counseling. BMC Cancer 2023; 23:339. [PMID: 37055759 PMCID: PMC10099884 DOI: 10.1186/s12885-023-10822-5] [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: 02/02/2023] [Accepted: 04/06/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Inherited mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 (BRCA1/2) confer high risks of breast and ovarian cancer. Because the contribution of BRCA1/2 germline mutations to BC in the Northeastern population of Morocco remains largely unknown, we conducted this first study to evaluate the prevalence and the phenotypic spectrum of two BRCA1/2 pathogenic mutations (the founder BRCA1 c.5309G>T and BRCA2 c.1310_1313delAAGA). This choice was also argued by the presence of an apparent specific geographical connection of these mutations and the Northeastern region of Morocco. METHODS Screening for the germline mutations c.5309G>T and BRCA2 c.1310_1313delAAGA was performed by sequencing on a total of 184 breast cancer (BC) patients originated from the Northeastern region of Morocco. The likelihood of identifying a BRCA mutation is calculated using the Eisinger scoring model. The clinical and pathologic features were compared between the BRCA-positive and BRCA-negative groups of patients. Difference in survival outcomes was compared between mutation carriers and non-carriers. RESULTS BRCA1 c.5309G>T and BRCA2 c.1310_1313delAAGA are responsible for a significant proportion of all BC cases (12.5%) and at least 20% of familial BC. The screening of BRCA1/2 genes by NGS sequencing confirmed that there are no additional mutations detected among positive patients. The clinicopathological features in positive patients were in accordance with typical characteristics of BRCA pathogenic mutations. The mean features in the carriers were the early onset of the disease, familial history, triple negative status (for BRCA1 c.5309G>T) and worse prognosis in terms of overall surviving. Our study indicates that the Eisinger scoring model could be recommended to identify patients for referral to BRCA1/2 oncogenetic counseling. CONCLUSION Our findings suggest that BRCA1 c.5309G>T and BRCA2 c.1310_1313delAAGA mutations may have a strong founder and/or recurrent effect on breast cancer among the Northeastern Moroccan population. There contribution to breast cancer incidence is certainly substantial in this subgroup. Therefore, we believe that BRCA1 c.5309G>T and BRCA2 c.1310_1313delAAGA mutations have to be included in the array of tests aimed at revealing cancer syndrome carriers among subjects of Moroccan origin.
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Affiliation(s)
- Rahma Melki
- Genetics and Immune-Cell Therapy Unit, LBBES Laboratory, Faculty of Sciences, University Mohammed Premier, Oujda, Morocco.
| | - Marouane Melloul
- Microbiology and Molecular Biology Unit, PMBBE Center, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | | | - Tijani El Harroudi
- Surgical Oncology, Faculty of Medicine and Pharmacy, University Mohammed Premier , Oujda, Morocco
| | - Noureddine Boukhatem
- Genetics and Immune-Cell Therapy Unit, LBBES Laboratory, Faculty of Sciences, University Mohammed Premier, Oujda, Morocco
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2
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Rao ND, Shirts BH. Using species richness calculations to model the global profile of unsampled pathogenic variants: Examples from BRCA1 and BRCA2. PLoS One 2023; 18:e0278010. [PMID: 36753473 PMCID: PMC9907816 DOI: 10.1371/journal.pone.0278010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/26/2023] [Indexed: 02/09/2023] Open
Abstract
There have been many surveys of genetic variation in BRCA1 and BRCA2 to identify variant prevalence and catalogue population specific variants, yet none have evaluated the magnitude of unobserved variation. We applied species richness estimation methods from ecology to estimate "variant richness" and determine how many germline pathogenic BRCA1/2 variants have yet to be identified and the frequency of these missing variants in different populations. We also estimated the prevalence of germline pathogenic BRCA1/2 variants and identified those expected to be most common. Data was obtained from a literature search including studies conducted globally that tested the entirety of BRCA1/2 for pathogenic variation. Across countries, 45% to 88% of variants were estimated to be missing, i.e., present in the population but not observed in study data. Estimated variant frequencies in each country showed a higher proportion of rare variants compared to recurrent variants. The median prevalence estimate of BRCA1/2 pathogenic variant carriers was 0.64%. BRCA1 c.68_69del is likely the most recurrent BRCA1/2 variant globally due to its estimated prevalence in India. Modeling variant richness using ecology methods may assist in evaluating clinical targeted assays by providing a picture of what is observed with estimates of what is still unknown.
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Affiliation(s)
- Nandana D. Rao
- Institute for Public Health Genetics, University of Washington, Seattle, Washington, United States of America
| | - Brian H. Shirts
- Institute for Public Health Genetics, University of Washington, Seattle, Washington, United States of America
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, United States of America
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3
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Hamdi Y, Mighri N, Boujemaa M, Mejri N, Ben Nasr S, Ben Rekaya M, Messaoud O, Bouaziz H, Berrazega Y, Rachdi H, Jaidane O, Daoud N, Zribi A, Ayari J, El Benna H, Labidi S, Ben Hassouna J, Haddaoui A, Rahal K, Benna F, Mrad R, Ben Ahmed S, Boussen H, Boubaker S, Abdelhak S. Identification of Eleven Novel BRCA Mutations in Tunisia: Impact on the Clinical Management of BRCA Related Cancers. Front Oncol 2021; 11:674965. [PMID: 34490083 PMCID: PMC8417726 DOI: 10.3389/fonc.2021.674965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022] Open
Abstract
Background Breast cancer is the world's most common cancer among women. It is becoming an increasingly urgent problem in low- and middle-income countries (LMICs) where a large fraction of women is diagnosed with advanced-stage disease and have no access to treatment or basic palliative care. About 5-10% of all breast cancers can be attributed to hereditary genetic components and up to 25% of familial cases are due to mutations in BRCA1/2 genes. Since their discovery in 1994 and 1995, as few as 18 mutations have been identified in BRCA genes in the Tunisian population. The aim of this study is to identify additional BRCA mutations, to estimate their contribution to the hereditary breast and ovarian cancers in Tunisia and to investigate the clinicopathological signatures associated with BRCA mutations. Methods A total of 354 patients diagnosed with breast and ovarian cancers, including 5 male breast cancer cases, have been investigated for BRCA1/2 mutations using traditional and/or next generation sequencing technologies. Clinicopathological signatures associated with BRCA mutations have also been investigated. Results In the current study, 16 distinct mutations were detected: 10 in BRCA1 and 6 in BRCA2, of which 11 are described for the first time in Tunisia including 3 variations that have not been reported previously in public databases namely BRCA1_c.915T>A; BRCA2_c.-227-?_7805+? and BRCA2_c.249delG. Early age at onset, family history of ovarian cancer and high tumor grade were significantly associated with BRCA status. BRCA1 carriers were more likely to be triple negative breast cancer compared to BRCA2 carriers. A relatively high frequency of contralateral breast cancer and ovarian cancer occurrence was observed among BRCA carriers and was more frequent in patients carrying BRCA1 mutations. Conclusion Our study provides new insights into breast and ovarian cancer genetic landscape in the under-represented North African populations. The prevalence assessment of novel and recurrent BRCA1/2 pathogenic mutations will enhance the use of personalized treatment and precise screening strategies by both affected and unaffected North African cancer cases.
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Affiliation(s)
- Yosr Hamdi
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Najah Mighri
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Maroua Boujemaa
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nesrine Mejri
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sonia Ben Nasr
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of Medical Oncology, Military Hospital of Tunis, Tunis, Tunisia
| | - Mariem Ben Rekaya
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,UR17ES15, Oncotheranostic Biomarkers, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Olfa Messaoud
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hanen Bouaziz
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,Surgical Oncology Department, Salah Azaiez Institute of Cancer, Tunis, Tunisia
| | - Yosra Berrazega
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Haifa Rachdi
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Olfa Jaidane
- Surgical Oncology Department, Salah Azaiez Institute of Cancer, Tunis, Tunisia
| | - Nouha Daoud
- Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Aref Zribi
- Department of Medical Oncology, Military Hospital of Tunis, Tunis, Tunisia
| | - Jihene Ayari
- Department of Medical Oncology, Military Hospital of Tunis, Tunis, Tunisia
| | - Houda El Benna
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Soumaya Labidi
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Jamel Ben Hassouna
- Surgical Oncology Department, Salah Azaiez Institute of Cancer, Tunis, Tunisia
| | | | - Khaled Rahal
- Surgical Oncology Department, Salah Azaiez Institute of Cancer, Tunis, Tunisia
| | - Farouk Benna
- Department of Radiation Oncology, University of Tunis, Tunis, Tunisia
| | - Ridha Mrad
- Department of Human Genetics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Slim Ben Ahmed
- Faculty of Medicine of Sousse Department of Medical Oncology Farhat Hached University Hospital University of Sousse, Sousse, Tunisia
| | - Hamouda Boussen
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,Medical Oncology Department, Abderrahman Mami Hospital, Faculty of Medicine Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Samir Boubaker
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.,Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Sonia Abdelhak
- Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
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Spectrum of genetic variants of BRCA1 and BRCA2 in a German single center study. Arch Gynecol Obstet 2017; 295:1227-1238. [PMID: 28324225 DOI: 10.1007/s00404-017-4330-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/10/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Determination of mutation status of BRCA1 and BRCA2 has become part of the clinical routine. However, the spectrum of genetic variants differs between populations. The aim of this study was to deliver a comprehensive description of all detected variants. METHODS In families fulfilling one of the German Consortium for Hereditary Breast and Ovarian Cancer (GC-HBOC) criteria for genetic testing, one affected was chosen for analysis. DNA of blood lymphocytes was amplified by PCR and prescreened by DHPLC. Aberrant fragments were sequenced. All coding exons and splice sites of BRCA1 and BRCA2 were analyzed. Screening for large rearrangements in both genes was performed by MLPA. RESULTS Of 523 index patients, 121 (23.1%) were found to carry a pathogenic or likely pathogenic (class 4/5) mutation. A variant of unknown significance (VUS) was detected in 73/523 patients (13.9%). Two mutations p.Gln1756Profs*74 and p.Cys61Gly comprised 42.3% (n = 33/78) of all detected pathogenic mutations in BRCA1. Most of the other mutations were unique mutations. The most frequently detected mutation in BRCA2 was p.Val1283Lys (13.9%; n = 6/43). Altogether, 101 different neutral genetic variants were counted in BRCA1 (n = 35) and in BRCA2 (n = 66). CONCLUSION The two most frequently detected mutations are founder mutations in Poland and Czech Republic. More similarities seem to be shared with our direct neighbor countries compared to other European countries. For comparison of the extended genotype, a shared database is needed.
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van Driel CMG, Oosterwijk JC, Meijers-Heijboer EJ, van Asperen CJ, Zeijlmans van Emmichoven IA, de Vries J, Mourits MJE, Henneman L, Timmermans DRM, de Bock GH. Psychological factors associated with the intention to choose for risk-reducing mastectomy in family cancer clinic attendees. Breast 2016; 30:66-72. [PMID: 27639031 DOI: 10.1016/j.breast.2016.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Women seeking counseling because of familial breast cancer occurrence face difficult decisions, such as whether and when to opt for risk-reducing mastectomy (RRM) in case of BRCA1/2 mutation. Only limited research has been done to identify the psychological factors associated with the decision for RRM. This study investigated which psychological factors are related to the intention to choose for RRM. MATERIALS & METHODS A cohort of 486 cancer-unaffected women with a family history of breast cancer completed the following questionnaires prior to genetic counseling: the Cancer Worry Scale, Positive And Negative Affect Scale, Perceived Personal Control Scale, Hospital Anxiety and Depression Scale and State Anxiety Scale and questions regarding socio-demographic characteristics, family history, risk perception and RRM intention. Multivariate logistic regression was used to analyze the relation between psychological factors and women's intention to choose for RRM. RESULTS Factors associated with RRM intention were high positive affect (OR = 1.86, 95%CI = 1.12-3.08), high negative affect (OR = 2.52, 95%CI = 1.44-4.43), high cancer worry (OR = 1.65, 95%CI = 1.00-2.72), high perceived personal control (OR = 3.58, 95%CI = 2.18-5.89), high risk-perception (OR = 1.85, 95%CI = 1.15-2.95) and having children (OR = 2.06, 95%CI = 1.21-3.50). CONCLUSION Negative and positive affects play an important role in the intention for RRM. Furthermore, perceived personal control over the situation is associated with an intention for RRM. In addition to focusing on accurate risk communication, counseling should pay attention to the influence of perceived control and emotions to facilitate decision-making.
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Affiliation(s)
- C M G van Driel
- Department of Obstetrics & Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| | - J C Oosterwijk
- Department of Genetics, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - E J Meijers-Heijboer
- Department of Clinical Genetics, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - C J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - I A Zeijlmans van Emmichoven
- Department of Medical Psychology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - J de Vries
- Department of Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - M J E Mourits
- Department of Obstetrics & Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - L Henneman
- Department of Clinical Genetics, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - D R M Timmermans
- EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Public and Occupational Health, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Vos JR, Mourits MJ, Teixeira N, Jansen L, Oosterwijk JC, de Bock GH. Inverse birth cohort effects in ovarian cancer: Increasing risk in BRCA1/2 mutation carriers and decreasing risk in the general population. Gynecol Oncol 2015; 140:289-94. [PMID: 26631606 DOI: 10.1016/j.ygyno.2015.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE BRCA1/2 carriers are at increased risk of ovarian cancer, and some reports suggest an increasing risk in more recent birth cohorts. In contrast, decreasing incidences have been observed in the general population. The aim was to assess the birth cohort effect on ovarian cancer risk in BRCA1/2 carriers relative to their background general population. METHODS Data on ovarian cancer incidence was collected for a cohort of 1050 BRCA1/2 mutation carriers ascertained by our regional clinic and retrieved from the general Dutch population cancer registry. Birth cohorts were categorized as pre-1935, 1935-1953, post-1953. Birth cohort effects on the ovarian cancer risk were estimated using hazard ratios (HRs) in BRCA1/2 carriers and Poisson rate ratios in the general population. Standardized incidence ratios (SIRs) were calculated to compare populations. HRs were adjusted for mutation position and family history. RESULTS Compared to the pre-1935 cohort, BRCA1 carriers in the 1935-1953 and post-1953 cohorts had an increased ovarian cancer risk of HRadjusted 1.54 (95% CI 1.11-2.14) and 2.40 (95% CI 1.56-3.69), respectively. BRCA2 carriers in the 1935-1953 cohort had an HRadjusted of 3.01 (95% CI 1.47-6.13). The SIRs for the 1935-1953 and post-1953 cohorts were 1.7 and 2.7, respectively, for the BRCA1 carriers and 1.6 times and 2.4 times, respectively, for BRCA2 carriers. CONCLUSIONS Mutation carriers, particularly BRCA1 carriers, born in the most recent cohorts, have the highest additional ovarian cancer risk as compared to the general population.
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Affiliation(s)
- Janet R Vos
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Marian J Mourits
- Department of Gynaecologic Oncology, University of Groningen, University Medical Centre Groningen, Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Natalia Teixeira
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Liesbeth Jansen
- Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Teixeira N, Mourits MJE, Vos JR, Kolk DMVD, Jansen L, Oosterwijk JC, Bock GHD. Ovarian cancer in BRCA1/2 mutation carriers: The impact of mutation position and family history on the cancer risk. Maturitas 2015; 82:197-202. [PMID: 26239500 DOI: 10.1016/j.maturitas.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/01/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Assessing the combined impact of mutation position, regarding the ovarian cancer cluster region (OCCR), and type of cancer family history (FH) on age-related penetrance of ovarian cancer (OC) in women from BRCA1/2 families from the northern Netherlands. STUDY DESIGN A consecutive series of 1763 mutation carriers and their first-degree relatives from 355 proven BRCA1/2 families with a history of breast and/or ovarian cancer with in total 248 OC cases was included. Mutations were stratified for gene (BRCA1 or BRCA2) and location (within or outside the OCCR). FH was stratified for type of cancer occurring in first and second-degree relatives (OC only, breast cancer (BC) only or both OC and BC). MAIN OUTCOME MEASURES Cox-proportional hazard models were applied to estimate the OCCR effect, including and excluding a FH of cancer. RESULTS Among BRCA1 families, OC risks were higher in women with OCCR mutations versus those with non-OCCR mutations (HR=1.59, 95%CI=1.19-2.12). This effect remained significant after adjustment for the type of FH (HR=1.50, 95%CI=1.11-2.01). In BRCA2 families, mutation position did not significantly affect the OC risk (HR=1.50, 95%CI=0.74-3.04). However, in the BRCA2 group, a FH including only OC presented by itself a strong impact on OC risk (HR=4.63, 95%CI=2.38-9.02), which remained stable after adjustment for mutation position (HR=4.48, 95%CI=2.28-8.81). CONCLUSION OCCR mutations significantly increased the OC risk in BRCA1 families regardless of the type of FH, but in BRCA2 families, type of FH seems to have a higher impact than mutation position on OC risk.
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Affiliation(s)
- Natalia Teixeira
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands; Department of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Marian J E Mourits
- Department of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Janet R Vos
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Dorina M van der Kolk
- Department of Clinical Genetics, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Liesbeth Jansen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan C Oosterwijk
- Department of Clinical Genetics, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands.
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Vos JR, Hsu L, Brohet RM, Mourits MJE, de Vries J, Malone KE, Oosterwijk JC, de Bock GH. Bias Correction Methods Explain Much of the Variation Seen in Breast Cancer Risks of BRCA1/2 Mutation Carriers. J Clin Oncol 2015; 33:2553-62. [PMID: 26150446 DOI: 10.1200/jco.2014.59.0463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Recommendations for treating patients who carry a BRCA1/2 gene are mainly based on cumulative lifetime risks (CLTRs) of breast cancer determined from retrospective cohorts. These risks vary widely (27% to 88%), and it is important to understand why. We analyzed the effects of methods of risk estimation and bias correction and of population factors on CLTRs in this retrospective clinical cohort of BRCA1/2 carriers. PATIENTS AND METHODS The following methods to estimate the breast cancer risk of BRCA1/2 carriers were identified from the literature: Kaplan-Meier, frailty, and modified segregation analyses with bias correction consisting of including or excluding index patients combined with including or excluding first-degree relatives (FDRs) or different conditional likelihoods. These were applied to clinical data of BRCA1/2 families derived from our family cancer clinic for whom a simulation was also performed to evaluate the methods. CLTRs and 95% CIs were estimated and compared with the reference CLTRs. RESULTS CLTRs ranged from 35% to 83% for BRCA1 and 41% to 86% for BRCA2 carriers at age 70 years width of 95% CIs: 10% to 35% and 13% to 46%, respectively). Relative bias varied from -38% to +16%. Bias correction with inclusion of index patients and untested FDRs gave the smallest bias: +2% (SD, 2%) in BRCA1 and +0.9% (SD, 3.6%) in BRCA2. CONCLUSION Much of the variation in breast cancer CLTRs in retrospective clinical BRCA1/2 cohorts is due to the bias-correction method, whereas a smaller part is due to population differences. Kaplan-Meier analyses with bias correction that includes index patients and a proportion of untested FDRs provide suitable CLTRs for carriers counseled in the clinic.
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Affiliation(s)
- Janet R Vos
- Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Li Hsu
- Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Richard M Brohet
- Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marian J E Mourits
- Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jakob de Vries
- Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kathleen E Malone
- Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jan C Oosterwijk
- Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Geertruida H de Bock
- Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA
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Lesueur F. Breast Cancer Risk Gene Discovery: Opportunities and Challenges. CURRENT GENETIC MEDICINE REPORTS 2015. [DOI: 10.1007/s40142-015-0066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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El Saghir NS, Zgheib NK, Assi HA, Khoury KE, Bidet Y, Jaber SM, Charara RN, Farhat RA, Kreidieh FY, Decousus S, Romero P, Nemer GM, Salem Z, Shamseddine A, Tfayli A, Abbas J, Jamali F, Seoud M, Armstrong DK, Bignon YJ, Uhrhammer N. BRCA1 and BRCA2 mutations in ethnic Lebanese Arab women with high hereditary risk breast cancer. Oncologist 2015; 20:357-64. [PMID: 25777348 DOI: 10.1634/theoncologist.2014-0364] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/06/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Breast cancer is the most common malignancy among women in Lebanon and in Arab countries, with 50% of cases presenting before the age of 50 years. METHODS Between 2009 and 2012, 250 Lebanese women with breast cancer who were considered to be at high risk of carrying BRCA1 or BRCA2 mutations because of presentation at young age and/or positive family history (FH) of breast or ovarian cancer were recruited. Clinical data were analyzed statistically. Coding exons and intron-exon boundaries of BRCA1 and BRCA2 were sequenced from peripheral blood DNA. All patients were tested for BRCA1 rearrangements using multiplex ligation-dependent probe amplification (MLPA). BRCA2 MLPA was done in selected cases. RESULTS Overall, 14 of 250 patients (5.6%) carried a deleterious BRCA mutation (7 BRCA1, 7 BRCA2) and 31 (12.4%) carried a variant of uncertain significance. Eight of 74 patients (10.8%) aged ≤40 years with positive FH and only 1 of 74 patients (1.4%) aged ≤40 years without FH had a mutated BRCA. Four of 75 patients (5.3%) aged 41-50 years with FH had a deleterious mutation. Only 1 of 27 patients aged >50 years at diagnosis had a BRCA mutation. All seven patients with BRCA1 mutations had grade 3 infiltrating ductal carcinoma and triple-negative breast cancer. Nine BRCA1 and 17 BRCA2 common haplotypes were observed. CONCLUSION Prevalence of deleterious BRCA mutations is lower than expected and does not support the hypothesis that BRCA mutations alone cause the observed high percentage of breast cancer in young women of Lebanese and Arab descent. Studies to search for other genetic mutations are recommended.
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Affiliation(s)
- Nagi S El Saghir
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nathalie K Zgheib
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hussein A Assi
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katia E Khoury
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yannick Bidet
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sara M Jaber
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Raghid N Charara
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rania A Farhat
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Firas Y Kreidieh
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephanie Decousus
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Pierre Romero
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Georges M Nemer
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ziad Salem
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ali Shamseddine
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arafat Tfayli
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jaber Abbas
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Faek Jamali
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Muhieddine Seoud
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deborah K Armstrong
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yves-Jean Bignon
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nancy Uhrhammer
- Division of Hematology-Oncology, Department of Internal Medicine, and Departments of Pharmacology and Toxicology, Surgery, and Obstetrics and Gynecology, American University of Beirut, Lebanon; University of Auvergne and Laboratoire Diagnostique Génétique et Moléculaire, Centre Jean Perrin, Clermont-Ferrand, France; Sidney Kimmel Comprehensive Cancer Center and Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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