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Grootes I, Keeman R, Blows FM, Milne RL, Giles GG, Swerdlow AJ, Fasching PA, Abubakar M, Andrulis IL, Anton-Culver H, Beckmann MW, Blomqvist C, Bojesen SE, Bolla MK, Bonanni B, Briceno I, Burwinkel B, Camp NJ, Castelao JE, Choi JY, Clarke CL, Couch FJ, Cox A, Cross SS, Czene K, Devilee P, Dörk T, Dunning AM, Dwek M, Easton DF, Eccles DM, Eriksson M, Ernst K, Evans DG, Figueroa JD, Fink V, Floris G, Fox S, Gabrielson M, Gago-Dominguez M, García-Sáenz JA, González-Neira A, Haeberle L, Haiman CA, Hall P, Hamann U, Harkness EF, Hartman M, Hein A, Hooning MJ, Hou MF, Howell SJ, Ito H, Jakubowska A, Janni W, John EM, Jung A, Kang D, Kristensen VN, Kwong A, Lambrechts D, Li J, Lubiński J, Manoochehri M, Margolin S, Matsuo K, Taib NAM, Mulligan AM, Nevanlinna H, Newman WG, Offit K, Osorio A, Park SK, Park-Simon TW, Patel AV, Presneau N, Pylkäs K, Rack B, Radice P, Rennert G, Romero A, Saloustros E, Sawyer EJ, Schneeweiss A, Schochter F, Schoemaker MJ, Shen CY, Shibli R, Sinn P, Tapper WJ, Tawfiq E, Teo SH, Teras LR, Torres D, Vachon CM, van Deurzen CHM, Wendt C, Williams JA, Winqvist R, Elwood M, Schmidt MK, García-Closas M, Pharoah PDP. Incorporating progesterone receptor expression into the PREDICT breast prognostic model. Eur J Cancer 2022; 173:178-193. [PMID: 35933885 PMCID: PMC10412460 DOI: 10.1016/j.ejca.2022.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Predict Breast (www.predict.nhs.uk) is an online prognostication and treatment benefit tool for early invasive breast cancer. The aim of this study was to incorporate the prognostic effect of progesterone receptor (PR) status into a new version of PREDICT and to compare its performance to the current version (2.2). METHOD The prognostic effect of PR status was based on the analysis of data from 45,088 European patients with breast cancer from 49 studies in the Breast Cancer Association Consortium. Cox proportional hazard models were used to estimate the hazard ratio for PR status. Data from a New Zealand study of 11,365 patients with early invasive breast cancer were used for external validation. Model calibration and discrimination were used to test the model performance. RESULTS Having a PR-positive tumour was associated with a 23% and 28% lower risk of dying from breast cancer for women with oestrogen receptor (ER)-negative and ER-positive breast cancer, respectively. The area under the ROC curve increased with the addition of PR status from 0.807 to 0.809 for patients with ER-negative tumours (p = 0.023) and from 0.898 to 0.902 for patients with ER-positive tumours (p = 2.3 × 10-6) in the New Zealand cohort. Model calibration was modest with 940 observed deaths compared to 1151 predicted. CONCLUSION The inclusion of the prognostic effect of PR status to PREDICT Breast has led to an improvement of model performance and more accurate absolute treatment benefit predictions for individual patients. Further studies should determine whether the baseline hazard function requires recalibration.
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Affiliation(s)
- Isabelle Grootes
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK.
| | - Renske Keeman
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam, 1066 CX, the Netherlands
| | - Fiona M Blows
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK
| | - Roger L Milne
- Cancer Council Victoria, Cancer Epidemiology Division, Melbourne, Victoria, 3004, Australia; The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Victoria, 3010, Australia; Monash University, Precision Medicine, School of Clinical Sciences at Monash Health, Clayton, Victoria, 3168, Australia
| | - Graham G Giles
- Cancer Council Victoria, Cancer Epidemiology Division, Melbourne, Victoria, 3004, Australia; The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Victoria, 3010, Australia; Monash University, Precision Medicine, School of Clinical Sciences at Monash Health, Clayton, Victoria, 3168, Australia
| | - Anthony J Swerdlow
- The Institute of Cancer Research, Division of Genetics and Epidemiology, London, SM2 5NG, UK; The Institute of Cancer Research, Division of Breast Cancer Research, London, SW7 3RP, UK
| | - Peter A Fasching
- University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, Los Angeles, CA, 90095, USA; Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, 91054, Germany
| | - Mustapha Abubakar
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, Bethesda, MD, 20850, USA
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Fred A. Litwin Center for Cancer Genetics, Toronto, ON, M5G 1X5, Canada; University of Toronto, Department of Molecular Genetics, Toronto, ON, M5S 1A8, Canada
| | - Hoda Anton-Culver
- University of California Irvine, Department of Medicine, Genetic Epidemiology Research Institute, Irvine, CA, 92617, USA
| | - Matthias W Beckmann
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, 91054, Germany
| | - Carl Blomqvist
- University of Helsinki, Department of Oncology, Helsinki University Hospital, Helsinki, 00290, Finland; Örebro University Hospital, Department of Oncology, Örebro, 70185, Sweden
| | - Stig E Bojesen
- Copenhagen University Hospital, Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev, 2730, Denmark; Copenhagen University Hospital, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Herlev, 2730, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, 2200, Denmark
| | - Manjeet K Bolla
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge, CB1 8RN, UK
| | - Bernardo Bonanni
- IEO, European Institute of Oncology IRCCS, Division of Cancer Prevention and Genetics, Milan, 20141, Italy
| | - Ignacio Briceno
- Universidad de La Sabana, Medical Faculty, Bogota, 140013, Colombia
| | - Barbara Burwinkel
- German Cancer Research Center (DKFZ), Molecular Epidemiology Group, C080, Heidelberg, 69120, Germany; University of Heidelberg, Molecular Biology of Breast Cancer, University Womens Clinic Heidelberg, Heidelberg, 69120, Germany
| | - Nicola J Camp
- University of Utah, Department of Internal Medicine and Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Jose E Castelao
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Xerencia de Xestion Integrada de Vigo-SERGAS, Oncology and Genetics Unit, Vigo, 36312, Spain
| | - Ji-Yeob Choi
- Seoul National University Graduate School, Department of Biomedical Sciences, Seoul, 03080, South Korea; Seoul National University, Cancer Research Institute, Seoul, 03080, South Korea; Seoul National University Medical Research Center, Institute of Health Policy and Management, Seoul, 03080, South Korea
| | - Christine L Clarke
- University of Sydney, Westmead Institute for Medical Research, Sydney, New South Wales, 2145, Australia
| | - Fergus J Couch
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, 55905, USA
| | - Angela Cox
- University of Sheffield, Sheffield Institute for Nucleic Acids (SInFoNiA), Department of Oncology and Metabolism, Sheffield, S10 2TN, UK
| | - Simon S Cross
- University of Sheffield, Academic Unit of Pathology, Department of Neuroscience, Sheffield, S10 2TN, UK
| | - Kamila Czene
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, 171 65, Sweden
| | - Peter Devilee
- Leiden University Medical Center, Department of Pathology, Leiden, 2333 ZA, the Netherlands; Leiden University Medical Center, Department of Human Genetics, Leiden, 2333 ZA, the Netherlands
| | - Thilo Dörk
- Hannover Medical School, Gynaecology Research Unit, Hannover, 30625, Germany
| | - Alison M Dunning
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK
| | - Miriam Dwek
- University of Westminster, School of Life Sciences, London, W1B 2HW, UK
| | - Douglas F Easton
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK; University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge, CB1 8RN, UK
| | - Diana M Eccles
- University of Southampton, Faculty of Medicine, Southampton, SO17 1BJ, UK
| | - Mikael Eriksson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, 171 65, Sweden
| | - Kristina Ernst
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - D Gareth Evans
- University of Manchester, Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester, M13 9WL, UK; St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester, M13 9WL, UK
| | - Jonine D Figueroa
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, Bethesda, MD, 20850, USA; The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, EH16 4UX, UK; The University of Edinburgh, Cancer Research UK Edinburgh Centre, Edinburgh, EH4 2XR, UK
| | - Visnja Fink
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - Giuseppe Floris
- Leuven Cancer Institute, University Hospitals Leuven, Leuven Multidisciplinary Breast Center, Department of Oncology, Leuven, 3000, Belgium
| | - Stephen Fox
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia, 3000
| | - Marike Gabrielson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, 171 65, Sweden
| | - Manuela Gago-Dominguez
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, SERGAS, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, 15706, Spain; University of California San Diego, Moores Cancer Center, La Jolla, CA, 92037, USA
| | - José A García-Sáenz
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Centro Investigación Biomédica en Red de Cáncer (CIBERONC), Medical Oncology Department, Hospital Clínico San Carlos, Madrid, 28040, Spain
| | - Anna González-Neira
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid, 28029, Spain
| | - Lothar Haeberle
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, 91054, Germany
| | - Christopher A Haiman
- University of Southern California, Department of Preventive Medicine, Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Per Hall
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, 171 65, Sweden; Södersjukhuset, Department of Oncology, Stockholm, 118 83, Sweden
| | - Ute Hamann
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg, 69120, Germany
| | - Elaine F Harkness
- University of Manchester, Manchester Academic Health Science Centre, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester, M13 9PT, UK; Wythenshawe Hospital, Manchester University NHS Foundation Trust, Nightingale & Genesis Prevention Centre, Manchester, M23 9LT, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Unit, Manchester, M13 9WL, UK
| | - Mikael Hartman
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore, 119077, Singapore; National University Health System, Department of Surgery, Singapore, 119228, Singapore
| | - Alexander Hein
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, 91054, Germany
| | - Maartje J Hooning
- Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, 3015 GD, the Netherlands
| | - Ming-Feng Hou
- Kaohsiung Municipal Hsiao-Kang Hospital, Department of Surgery, Kaohsiung, 812, Taiwan
| | - Sacha J Howell
- University of Manchester, Division of Cancer Sciences, Manchester, M13 9PL, UK
| | - Hidemi Ito
- Aichi Cancer Center Research Institute, Division of Cancer Information and Control, Nagoya, 464-8681, Japan; Nagoya University Graduate School of Medicine, Division of Cancer Epidemiology, Nagoya, 466-8550, Japan
| | - Anna Jakubowska
- Pomeranian Medical University, Department of Genetics and Pathology, Szczecin, 71-252, Poland; Pomeranian Medical University, Independent Laboratory of Molecular Biology and Genetic Diagnostics, Szczecin, 71-252, Poland
| | - Wolfgang Janni
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - Esther M John
- Stanford University School of Medicine, Department of Epidemiology & Population Health, Stanford, CA, 94305, USA; Stanford Cancer Institute, Stanford University School of Medicine, Department of Medicine, Division of Oncology, Stanford, CA, 94304, USA
| | - Audrey Jung
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, 69120, Germany
| | - Daehee Kang
- Seoul National University, Cancer Research Institute, Seoul, 03080, South Korea; Seoul National University College of Medicine, Department of Preventive Medicine, Seoul, 03080, South Korea
| | - Vessela N Kristensen
- Oslo University Hospital and University of Oslo, Department of Medical Genetics, Oslo, 0379, Norway; University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Oslo, 0450, Norway
| | - Ava Kwong
- Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong; The University of Hong Kong, Department of Surgery, Hong Kong; Hong Kong Sanatorium and Hospital, Department of Surgery and Cancer Genetics Center, Hong Kong
| | - Diether Lambrechts
- VIB Center for Cancer Biology, VIB, Leuven, 3001, Belgium; University of Leuven, Laboratory for Translational Genetics, Department of Human Genetics, Leuven, 3000, Belgium
| | - Jingmei Li
- Genome Institute of Singapore, Human Genetics Division, Singapore, 138672, Singapore
| | - Jan Lubiński
- Pomeranian Medical University, Department of Genetics and Pathology, Szczecin, 71-252, Poland
| | - Mehdi Manoochehri
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg, 69120, Germany
| | - Sara Margolin
- Södersjukhuset, Department of Oncology, Stockholm, 118 83, Sweden; Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, 118 83, Sweden
| | - Keitaro Matsuo
- Nagoya University Graduate School of Medicine, Division of Cancer Epidemiology, Nagoya, 466-8550, Japan; Aichi Cancer Center Research Institute, Division of Cancer Epidemiology and Prevention, Nagoya, 464-8681, Japan
| | - Nur Aishah Mohd Taib
- University of Malaya, Department of Surgery, Faculty of Medicine, Kuala Lumpur, 50603, Malaysia
| | - Anna Marie Mulligan
- University of Toronto, Department of Laboratory Medicine and Pathobiology, Toronto, ON, M5S 1A8, Canada; University Health Network, Laboratory Medicine Program, Toronto, ON, M5G 2C4, Canada
| | - Heli Nevanlinna
- University of Helsinki, Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, 00290, Finland
| | - William G Newman
- University of Manchester, Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester, M13 9WL, UK; St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester, M13 9WL, UK
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, Clinical Genetics Research Lab, Department of Cancer Biology and Genetics, New York, NY, 10065, USA; Memorial Sloan Kettering Cancer Center, Clinical Genetics Service, Department of Medicine, New York, NY, 10065, USA
| | - Ana Osorio
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid, 28029, Spain; Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, 28029, Spain
| | - Sue K Park
- Seoul National University, Cancer Research Institute, Seoul, 03080, South Korea; Seoul National University College of Medicine, Department of Preventive Medicine, Seoul, 03080, South Korea; Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul, 03080, South Korea
| | | | - Alpa V Patel
- American Cancer Society, Department of Population Science, Atlanta, GA, 30303, USA
| | - Nadege Presneau
- University of Westminster, School of Life Sciences, London, W1B 2HW, UK
| | - Katri Pylkäs
- University of Oulu, Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, Oulu, 90570, Finland; Northern Finland Laboratory Centre Oulu, Laboratory of Cancer Genetics and Tumor Biology, Oulu, 90570, Finland
| | - Brigitte Rack
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - Paolo Radice
- Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Milan, 20133, Italy
| | - Gad Rennert
- Carmel Medical Center and Technion Faculty of Medicine, Clalit National Cancer Control Center, Haifa, 35254, Israel
| | - Atocha Romero
- Hospital Universitario Puerta de Hierro, Medical Oncology Department, Madrid, 28222, Spain
| | | | - Elinor J Sawyer
- King's College London, School of Cancer & Pharmaceutical Sciences, Comprehensive Cancer Centre, Guy's Campus, London, UK
| | - Andreas Schneeweiss
- University of Heidelberg, Molecular Biology of Breast Cancer, University Womens Clinic Heidelberg, Heidelberg, 69120, Germany; University Hospital and German Cancer Research Center, National Center for Tumor Diseases, Heidelberg, 69120, Germany
| | - Fabienne Schochter
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm, 89075, Germany
| | - Minouk J Schoemaker
- The Institute of Cancer Research, Division of Genetics and Epidemiology, London, SM2 5NG, UK
| | - Chen-Yang Shen
- Academia Sinica, Institute of Biomedical Sciences, Taipei, 115, Taiwan; China Medical University, School of Public Health, Taichung, Taiwan
| | - Rana Shibli
- Carmel Medical Center and Technion Faculty of Medicine, Clalit National Cancer Control Center, Haifa, 35254, Israel
| | - Peter Sinn
- University Hospital Heidelberg, Department of Pathology, Institute of Pathology, Heidelberg, 69120, Germany
| | - William J Tapper
- University of Southampton, Faculty of Medicine, Southampton, SO17 1BJ, UK
| | - Essa Tawfiq
- University of Auckland, Auckland, New Zealand
| | - Soo Hwang Teo
- University of Malaya, Department of Surgery, Faculty of Medicine, Kuala Lumpur, 50603, Malaysia; Cancer Research Malaysia, Breast Cancer Research Programme, Subang Jaya, Selangor, 47500, Malaysia
| | - Lauren R Teras
- American Cancer Society, Department of Population Science, Atlanta, GA, 30303, USA
| | - Diana Torres
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg, 69120, Germany; Pontificia Universidad Javeriana, Institute of Human Genetics, Bogota, 110231, Colombia
| | - Celine M Vachon
- Mayo Clinic, Department of Quantitative Health Sciences, Division of Epidemiology, Rochester, MN, 55905, USA
| | | | - Camilla Wendt
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, 118 83, Sweden
| | - Justin A Williams
- University of Utah, Department of Internal Medicine and Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Robert Winqvist
- University of Oulu, Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, Oulu, 90570, Finland; Northern Finland Laboratory Centre Oulu, Laboratory of Cancer Genetics and Tumor Biology, Oulu, 90570, Finland
| | - Mark Elwood
- University of Auckland, Auckland, New Zealand
| | - Marjanka K Schmidt
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam, 1066 CX, the Netherlands; The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, Amsterdam, 1066 CX, the Netherlands
| | - Montserrat García-Closas
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, Bethesda, MD, 20850, USA
| | - Paul D P Pharoah
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge, CB1 8RN, UK; University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge, CB1 8RN, UK
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Fagerholm R, Khan S, Schmidt MK, GarcClosas M, Heikkilä P, Saarela J, Beesley J, Jamshidi M, Aittomäki K, Liu J, Raza Ali H, Andrulis IL, Beckmann MW, Behrens S, Blows FM, Brenner H, Chang-Claude J, Couch FJ, Czene K, Fasching PA, Figueroa J, Floris G, Glendon G, Guo Q, Hall P, Hallberg E, Hamann U, Holleczek B, Hooning MJ, Hopper JL, Jager A, Kabisch M, Investigators KC, Keeman R, Kosma VM, Lambrechts D, Lindblom A, Mannermaa A, Margolin S, Provenzano E, Shah M, Southey MC, Dennis J, Lush M, Michailidou K, Wang Q, Bolla MK, Dunning AM, Easton DF, Pharoah PD., Chenevix-Trench G, Blomqvist C, Nevanlinna H. TP53-based interaction analysis identifies cis-eQTL variants for TP53BP2, FBXO28, and FAM53A that associate with survival and treatment outcome in breast cancer. Oncotarget 2017; 8:18381-18398. [PMID: 28179588 PMCID: PMC5392336 DOI: 10.18632/oncotarget.15110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/01/2017] [Indexed: 01/13/2023] Open
Abstract
TP53 overexpression is indicative of somatic TP53 mutations and associates with aggressive tumors and poor prognosis in breast cancer. We utilized a two-stage SNP association study to detect variants associated with breast cancer survival in a TP53-dependent manner. Initially, a genome-wide study (n = 575 cases) was conducted to discover candidate SNPs for genotyping and validation in the Breast Cancer Association Consortium (BCAC). The SNPs were then tested for interaction with tumor TP53 status (n = 4,610) and anthracycline treatment (n = 17,828). For SNPs interacting with anthracycline treatment, siRNA knockdown experiments were carried out to validate candidate genes.In the test for interaction between SNP genotype and TP53 status, we identified one locus, represented by rs10916264 (p(interaction) = 3.44 × 10-5; FDR-adjusted p = 0.0011) in estrogen receptor (ER) positive cases. The rs10916264 AA genotype associated with worse survival among cases with ER-positive, TP53-positive tumors (hazard ratio [HR] 2.36, 95% confidence interval [C.I] 1.45 - 3.82). This is a cis-eQTL locus for FBXO28 and TP53BP2; expression levels of these genes were associated with patient survival specifically in ER-positive, TP53-mutated tumors. Additionally, the SNP rs798755 was associated with survival in interaction with anthracycline treatment (p(interaction) = 9.57 × 10-5, FDR-adjusted p = 0.0130). RNAi-based depletion of a predicted regulatory target gene, FAM53A, indicated that this gene can modulate doxorubicin sensitivity in breast cancer cell lines.If confirmed in independent data sets, these results may be of clinical relevance in the development of prognostic and predictive marker panels for breast cancer.
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Affiliation(s)
- Rainer Fagerholm
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sofia Khan
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marjanka K. Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Montserrat GarcClosas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jani Saarela
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
| | - Jonathan Beesley
- Department of Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Maral Jamshidi
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore, Singapore
| | - H. Raza Ali
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Irene L. Andrulis
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Matthias W. Beckmann
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fiona M. Blows
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter A. Fasching
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK
| | - Giuseppe Floris
- Leuven Multidisciplinary Breast Center, Department of Oncology, KULeuven, Leuven Cancer Institute, University Hospitals Leuven
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Canada
| | - Qi Guo
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emily Hallberg
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Maartje J. Hooning
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global health, The University of Melbourne, Melbourne, Australia
| | - Agnes Jager
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maria Kabisch
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Renske Keeman
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Veli-Matti Kosma
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Diether Lambrechts
- Vesalius Research Center, VIB, Leuven, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Arto Mannermaa
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Sara Margolin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Elena Provenzano
- Department of Oncology, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
- Department of Histopathology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Melissa C. Southey
- Department of Pathology, The University of Melbourne, Melbourne, Australia
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Michael Lush
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Manjeet K. Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison M. Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul D.P . Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Carl Blomqvist
- Department of Oncology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Oncology, University of Örebro, Örebro, Sweden
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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3
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Newcombe PJ, Raza Ali H, Blows FM, Provenzano E, Pharoah PD, Caldas C, Richardson S. Weibull regression with Bayesian variable selection to identify prognostic tumour markers of breast cancer survival. Stat Methods Med Res 2017; 26:414-436. [PMID: 25193065 PMCID: PMC6055985 DOI: 10.1177/0962280214548748] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
As data-rich medical datasets are becoming routinely collected, there is a growing demand for regression methodology that facilitates variable selection over a large number of predictors. Bayesian variable selection algorithms offer an attractive solution, whereby a sparsity inducing prior allows inclusion of sets of predictors simultaneously, leading to adjusted effect estimates and inference of which covariates are most important. We present a new implementation of Bayesian variable selection, based on a Reversible Jump MCMC algorithm, for survival analysis under the Weibull regression model. A realistic simulation study is presented comparing against an alternative LASSO-based variable selection strategy in datasets of up to 20,000 covariates. Across half the scenarios, our new method achieved identical sensitivity and specificity to the LASSO strategy, and a marginal improvement otherwise. Runtimes were comparable for both approaches, taking approximately a day for 20,000 covariates. Subsequently, we present a real data application in which 119 protein-based markers are explored for association with breast cancer survival in a case cohort of 2287 patients with oestrogen receptor-positive disease. Evidence was found for three independent prognostic tumour markers of survival, one of which is novel. Our new approach demonstrated the best specificity.
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Affiliation(s)
| | - H Raza Ali
- Cancer Research UK Cambridge Institute, Cambridge, UK
- Department of Pathology, University of Cambridge, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - FM Blows
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - E Provenzano
- NIH Cambridge Biomedical Research Centre, Cambridge, UK
| | - PD Pharoah
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Strangeways Research Laboratory, Cambridge, UK
| | - C Caldas
- Cancer Research UK Cambridge Institute, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
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4
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Blows FM, Ali HR, Dawson SJ, Le Quesne J, Provenzano E, Caldas C, Pharoah PD. Decline in Antigenicity of Tumor Markers by Storage Time Using Pathology Sections Cut From Tissue Microarrays. Appl Immunohistochem Mol Morphol 2016; 24:221-6. [PMID: 26067143 PMCID: PMC4892716 DOI: 10.1097/pai.0000000000000172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/19/2014] [Indexed: 11/27/2022]
Abstract
Sectioning a whole tissue microarrray (TMA block) and storing the sections maximizes the number of sections obtained, but may impair the antigenicity of the stored sections. We have investigated the impact of TMA section storage on antigenicity. First, we reexamined existing TMA data to determine whether antigenicity in stored sections changes over time. Component scores for each marker, based on cellular compartment of staining and score-type, were evaluated separately. Residual components scores adjusted for grade, tumor size, and node positivity, were regressed on the number of days storage to evaluate the effect of storage time. Storage time ranged from 2 to 1897 days, and the mean change in antigenicity per year ranged from -0.88 (95% confidence interval, -1.11 to -0.65) to 0.035 (95% confidence interval, 0.016-0.054). Further analysis showed no significant improvement in the fit of survival models if storage time adjusted scores were included in the models rather than unadjusted scores. We then compared 3 ways of processing TMA sections after cutting-immediate staining, staining after 1 year, and staining after 1 year coated in wax-on the immunohistochemistry results for: progesterone receptor, a routinely used, robust antibody, and MKI67, which is generally considered less robust. The progesterone receptor scores for stored sections were similar to those for unstored sections, whereas the MKI67 scores for stored sections were substantially different to those for unstored sections. Wax coating made little difference to the results. Biomarker antigenicity shows a small decline over time that is unlikely to have an important effect on studies of prognostic biomarkers.
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Affiliation(s)
| | - Hamid R. Ali
- Pathology
- Cancer Research UK Cambridge Institute, University of Cambridge
| | | | | | - Elena Provenzano
- Department of Pathology, Addenbrooke’s Hospital NHS Foundation Trust, Cambridge
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5
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Sung H, Garcia-Closas M, Chang-Claude J, Blows FM, Ali HR, Figueroa J, Nevanlinna H, Fagerholm R, Heikkilä P, Blomqvist C, Giles GG, Milne RL, Southey MC, McLean C, Mannermaa A, Kosma VM, Kataja V, Sironen R, Couch FJ, Olson JE, Hallberg E, Olswold C, Cox A, Cross SS, Kraft P, Tamimi RM, Eliassen AH, Schmidt MK, Bolla MK, Wang Q, Easton D, Howat WJ, Coulson P, Pharoah PDP, Sherman ME, Yang XR. Heterogeneity of luminal breast cancer characterised by immunohistochemical expression of basal markers. Br J Cancer 2016; 114:298-304. [PMID: 26679376 PMCID: PMC4742579 DOI: 10.1038/bjc.2015.437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/23/2015] [Accepted: 11/21/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Luminal A breast cancer defined as hormone receptor positive and human epidermal growth factor receptor 2 (HER2) negative is known to be heterogeneous. Previous study showed that luminal A tumours with the expression of basal markers ((cytokeratin (CK) 5 or CK5/6) or epidermal growth factor receptor (EGFR)) were associated with poorer prognosis compared with those that stained negative for basal markers. Prompted by this study, we assessed whether tumour characteristics and risk factors differed by basal marker status within luminal A tumours. METHODS We pooled 5040 luminal A cases defined by immunohistochemistry (4490 basal-negative ((CK5 (or CK5/6))- and EGFR-) and 550 basal-positive ((CK5 (or CK5/6+)) or EGFR+)) from eight studies participating in the Breast Cancer Association Consortium. Case-case comparison was performed using unconditional logistic regression. RESULTS Tumour characteristics and risk factors did not vary significantly by the expression of basal markers, although results suggested that basal-positive luminal tumours tended to be smaller and node negative, and were more common in women with a positive family history and lower body mass index. CONCLUSIONS Most established breast cancer risk factors were similar in basal-positive and basal-negative luminal A tumours. The non-significant but suggestive differences in tumour features and family history warrant further investigations.
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MESH Headings
- Adult
- Age Factors
- Aged
- Biomarkers, Tumor/metabolism
- Body Mass Index
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- ErbB Receptors/metabolism
- Female
- Humans
- Immunohistochemistry
- Keratin-5/metabolism
- Keratin-6/metabolism
- Menarche
- Menopause
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Parity
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Risk Factors
- Tumor Burden
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Affiliation(s)
- Hyuna Sung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, 20850 MD, USA
| | - Montserrat Garcia-Closas
- Division of Breast Cancer Research, Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, 15 Cotswold Rd, Sutton, Surrey, SM2 5NG London, UK
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Fiona M Blows
- Department of Oncology, University of Cambridge, Worts Causeway, CB1 8RN Cambridge, UK
| | - H Raza Ali
- Cancer Research UK Cambridge Institute, University of Cambridge, Robinson Way, CB2 0RE Cambridge, UK
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, 20850 MD, USA
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, PO Box 700, 00029 HUS Helsinki, Finland
| | - Rainer Fagerholm
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, PO Box 700, 00029 HUS Helsinki, Finland
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Hospital and University of Helsinki, PO Box 400, 00029 Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Hospital and University of Helsinki, PO Box 400, 00029 Helsinki, Finland
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, 3010 Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, 3010 Victoria, Australia
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Melbourne, 3010 Victoria, Australia
| | - Catriona McLean
- Anatomical Pathology, The Alfred Hospital, Commercial Rd, Prahran, 3181, 3053 Victoria, Australia
| | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Cancer Center of Eastern Finland, University of Eastern Finland, Yliopistonranta 1, PO Box 1627, 70211 Kuopio, Finland
- Department of Clinical Pathology, Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS Kuopio, Finland
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Cancer Center of Eastern Finland, University of Eastern Finland, Yliopistonranta 1, PO Box 1627, 70211 Kuopio, Finland
- Department of Clinical Pathology, Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS Kuopio, Finland
| | - Vesa Kataja
- Jyväskylä Central Hospital, Central Finland Health Care District, Adm Bldg 6/2, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Reijo Sironen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Cancer Center of Eastern Finland, University of Eastern Finland, Yliopistonranta 1, PO Box 1627, 70211 Kuopio, Finland
- Department of Clinical Pathology, Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS Kuopio, Finland
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Stabile 2-42, 200 First Street SW, Rochester, 55905 MN, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, 55905 MN, USA
| | - Emily Hallberg
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, 55905 MN, USA
| | - Curtis Olswold
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, 55905 MN, USA
| | - Angela Cox
- Sheffield Cancer Research, Department of Oncology, University of Sheffield, Beech Hill Road, S10 2RX Sheffield, UK
| | - Simon S Cross
- Department of Neuroscience, University of Sheffield, Beech Hill Road, S10 2RX Sheffield, UK
| | - Peter Kraft
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, 02115 MA, USA
| | - Rulla M Tamimi
- Department of Medicine, Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, 181 Longwood Avenue, Boston, 02115 MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, 02115 MA, USA
| | - A Heather Eliassen
- Department of Medicine, Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, 181 Longwood Avenue, Boston, 02115 MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, 02115 MA, USA
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Manjeet K Bolla
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, CB1 8RN Cambridge, UK
| | - Qin Wang
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, CB1 8RN Cambridge, UK
| | - Douglas Easton
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, CB1 8RN Cambridge, UK
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, CB1 8RN Cambridge, UK
| | - William J Howat
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, CB2 0RE Cambridge, UK
| | - Penny Coulson
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Rd, Sutton, Surrey, SM2 5NG London, UK
| | - Paul DP Pharoah
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, CB1 8RN Cambridge, UK
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, CB1 8RN Cambridge, UK
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, 20850 MD, USA
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, 20850 MD, USA
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6
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Sobral-Leite M, Wesseling J, Smit VTHBM, Nevanlinna H, van Miltenburg MH, Sanders J, Hofland I, Blows FM, Coulson P, Patrycja G, Schellens JHM, Fagerholm R, Heikkilä P, Aittomäki K, Blomqvist C, Provenzano E, Ali HR, Figueroa J, Sherman M, Lissowska J, Mannermaa A, Kataja V, Kosma VM, Hartikainen JM, Phillips KA, Couch FJ, Olson JE, Vachon C, Visscher D, Brenner H, Butterbach K, Arndt V, Holleczek B, Hooning MJ, Hollestelle A, Martens JWM, van Deurzen CHM, van de Water B, Broeks A, Chang-Claude J, Chenevix-Trench G, Easton DF, Pharoah PDP, García-Closas M, de Graauw M, Schmidt MK. Annexin A1 expression in a pooled breast cancer series: association with tumor subtypes and prognosis. BMC Med 2015; 13:156. [PMID: 26137966 PMCID: PMC4489114 DOI: 10.1186/s12916-015-0392-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/04/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Annexin A1 (ANXA1) is a protein related with the carcinogenesis process and metastasis formation in many tumors. However, little is known about the prognostic value of ANXA1 in breast cancer. The purpose of this study is to evaluate the association between ANXA1 expression, BRCA1/2 germline carriership, specific tumor subtypes and survival in breast cancer patients. METHODS Clinical-pathological information and follow-up data were collected from nine breast cancer studies from the Breast Cancer Association Consortium (BCAC) (n = 5,752) and from one study of familial breast cancer patients with BRCA1/2 mutations (n = 107). ANXA1 expression was scored based on the percentage of immunohistochemical staining in tumor cells. Survival analyses were performed using a multivariable Cox model. RESULTS The frequency of ANXA1 positive tumors was higher in familial breast cancer patients with BRCA1/2 mutations than in BCAC patients, with 48.6 % versus 12.4 %, respectively; P <0.0001. ANXA1 was also highly expressed in BCAC tumors that were poorly differentiated, triple negative, EGFR-CK5/6 positive or had developed in patients at a young age. In the first 5 years of follow-up, patients with ANXA1 positive tumors had a worse breast cancer-specific survival (BCSS) than ANXA1 negative (HRadj = 1.35; 95 % CI = 1.05-1.73), but the association weakened after 10 years (HRadj = 1.13; 95 % CI = 0.91-1.40). ANXA1 was a significant independent predictor of survival in HER2+ patients (10-years BCSS: HRadj = 1.70; 95 % CI = 1.17-2.45). CONCLUSIONS ANXA1 is overexpressed in familial breast cancer patients with BRCA1/2 mutations and correlated with poor prognosis features: triple negative and poorly differentiated tumors. ANXA1 might be a biomarker candidate for breast cancer survival prediction in high risk groups such as HER2+ cases.
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Affiliation(s)
- Marcelo Sobral-Leite
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Programa de Farmacologia, Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brazil.
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Division of Diagnostic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Heli Nevanlinna
- University of Helsinki, Helsinki, Finland.
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
| | | | - Joyce Sanders
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Ingrid Hofland
- Core Facility Molecular Pathology and Biobanking, Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Fiona M Blows
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK.
| | - Penny Coulson
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK.
| | | | - Jan H M Schellens
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands.
| | - Rainer Fagerholm
- University of Helsinki, Helsinki, Finland.
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
| | - Päivi Heikkilä
- University of Helsinki, Helsinki, Finland.
- Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland.
| | - Kristiina Aittomäki
- University of Helsinki, Helsinki, Finland.
- Department of Clinical Genetics, Helsinki University Central Hospital, Helsinki, Finland.
| | - Carl Blomqvist
- University of Helsinki, Helsinki, Finland.
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
| | - Elena Provenzano
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge, UK.
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
| | - Hamid Raza Ali
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge, UK.
- Department of Pathology, University of Cambridge, Cambridge, UK.
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Mark Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
| | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland.
| | - Vesa Kataja
- Cancer Center, Kuopio University Hospital, Kuopio, Finland.
- Jyväskylä Central Hospital, Jyväskylä, Finland.
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland.
| | - Jaana M Hartikainen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland.
| | - Kelly-Anne Phillips
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Melbourne, Australia.
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Daniel Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Katja Butterbach
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | | | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Antoinette Hollestelle
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - John W M Martens
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | | | - Bob van de Water
- Division of Toxicology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
| | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, Unit of Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | | | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK.
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK.
| | - Montserrat García-Closas
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK.
- Breakthrough Breast Cancer Centre, London, UK.
| | - Marjo de Graauw
- Division of Toxicology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
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7
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Ali HR, Glont SE, Blows FM, Provenzano E, Dawson SJ, Liu B, Hiller L, Dunn J, Poole CJ, Bowden S, Earl HM, Pharoah PDP, Caldas C. PD-L1 protein expression in breast cancer is rare, enriched in basal-like tumours and associated with infiltrating lymphocytes. Ann Oncol 2015; 26:1488-93. [PMID: 25897014 DOI: 10.1093/annonc/mdv192] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/13/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Expression of programmed death ligand 1 (PD-L1) in solid tumours has been shown to predict whether patients are likely to respond to anti-PD-L1 therapies. To estimate the therapeutic potential of PD-L1 inhibition in breast cancer, we evaluated the prevalence and significance of PD-L1 protein expression in a large collection of breast tumours. PATIENTS AND METHODS Correlations between CD274 (PD-L1) copy number, transcript and protein levels were evaluated in tumours from 418 patients recruited to the METABRIC genomic study. Immunohistochemistry was used to detect PD-L1 protein in breast tumours in tissue microarrays from 5763 patients recruited to the SEARCH population-based study (N = 4079) and the NEAT randomised, controlled trial (N = 1684). RESULTS PD-L1 protein data was available for 3916 of the possible 5763 tumours from the SEARCH and NEAT studies. PD-L1 expression by immune cells was observed in 6% (235/3916) of tumours and expression by tumour cells was observed in just 1.7% (66/3916). PD-L1 was most frequently expressed in basal-like tumours. This was observed both where tumours were subtyped by combined copy number and expression profiling [39% (17/44) of IntClust 10 i.e. basal-like tumours were PD-L1 immune cell positive; P < 0.001] and where a surrogate IHC-based classifier was used [19% (56/302) of basal-like tumours were PD-L1 immune cell positive; P < 0.001]. Moreover, CD274 (PD-L1) amplification was observed in five tumours of which four were IntClust 10. Expression of PD-L1 by either tumour cells or infiltrating immune cells was positively correlated with infiltration by both cytotoxic and regulatory T cells (P < 0.001). There was a nominally significant association between PD-L1 and improved disease-specific survival (hazard ratio 0.53, 95% confidence interval 0.26-1.07; P = 0.08) in ER-negative disease. CONCLUSIONS Expression of PD-L1 is rare in breast cancer, markedly enriched in basal-like tumours and is correlated with infiltrating lymphocytes. PD-L1 inhibition may benefit the 19% of patients with basal-like tumours in which the protein is expressed. NEAT CLINICALTRIALSGOV NCT00003577.
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Affiliation(s)
- H R Ali
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge Department of Pathology, University of Cambridge, Cambridge
| | - S-E Glont
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge
| | - F M Blows
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge
| | - E Provenzano
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - S-J Dawson
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - B Liu
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge
| | - L Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - J Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - C J Poole
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - S Bowden
- Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, The University of Birmingham, Edgbaston, Birmingham
| | - H M Earl
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - P D P Pharoah
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
| | - C Caldas
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
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8
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Candido dos Reis FJ, Lynn S, Ali HR, Eccles D, Hanby A, Provenzano E, Caldas C, Howat WJ, McDuffus LA, Liu B, Daley F, Coulson P, Vyas RJ, Harris LM, Owens JM, Carton AF, McQuillan JP, Paterson AM, Hirji Z, Christie SK, Holmes AR, Schmidt MK, Garcia-Closas M, Easton DF, Bolla MK, Wang Q, Benitez J, Milne RL, Mannermaa A, Couch F, Devilee P, Tollenaar RA, Seynaeve C, Cox A, Cross SS, Blows FM, Sanders J, de Groot R, Figueroa J, Sherman M, Hooning M, Brenner H, Holleczek B, Stegmaier C, Lintott C, Pharoah PD. Crowdsourcing the General Public for Large Scale Molecular Pathology Studies in Cancer. EBioMedicine 2015; 2:681-9. [PMID: 26288840 PMCID: PMC4534635 DOI: 10.1016/j.ebiom.2015.05.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Citizen science, scientific research conducted by non-specialists, has the potential to facilitate biomedical research using available large-scale data, however validating the results is challenging. The Cell Slider is a citizen science project that intends to share images from tumors with the general public, enabling them to score tumor markers independently through an internet-based interface. METHODS From October 2012 to June 2014, 98,293 Citizen Scientists accessed the Cell Slider web page and scored 180,172 sub-images derived from images of 12,326 tissue microarray cores labeled for estrogen receptor (ER). We evaluated the accuracy of Citizen Scientist's ER classification, and the association between ER status and prognosis by comparing their test performance against trained pathologists. FINDINGS The area under ROC curve was 0.95 (95% CI 0.94 to 0.96) for cancer cell identification and 0.97 (95% CI 0.96 to 0.97) for ER status. ER positive tumors scored by Citizen Scientists were associated with survival in a similar way to that scored by trained pathologists. Survival probability at 15 years were 0.78 (95% CI 0.76 to 0.80) for ER-positive and 0.72 (95% CI 0.68 to 0.77) for ER-negative tumors based on Citizen Scientists classification. Based on pathologist classification, survival probability was 0.79 (95% CI 0.77 to 0.81) for ER-positive and 0.71 (95% CI 0.67 to 0.74) for ER-negative tumors. The hazard ratio for death was 0.26 (95% CI 0.18 to 0.37) at diagnosis and became greater than one after 6.5 years of follow-up for ER scored by Citizen Scientists, and 0.24 (95% CI 0.18 to 0.33) at diagnosis increasing thereafter to one after 6.7 (95% CI 4.1 to 10.9) years of follow-up for ER scored by pathologists. INTERPRETATION Crowdsourcing of the general public to classify cancer pathology data for research is viable, engages the public and provides accurate ER data. Crowdsourced classification of research data may offer a valid solution to problems of throughput requiring human input.
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Affiliation(s)
- Francisco J. Candido dos Reis
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Gynecology and Obstetrics, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Stuart Lynn
- Department of Physics (Astrophysics), University of Oxford, Oxford, UK
| | - H. Raza Ali
- Cancer Research UK, Cambridge Institute, Cambridge, UK
| | | | | | | | - Carlos Caldas
- Cancer Research UK, Cambridge Institute, Cambridge, UK
| | | | | | - Bin Liu
- Cancer Research UK, Cambridge Institute, Cambridge, UK
| | | | | | | | | | | | | | | | | | | | | | | | - Marjanka K. Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Douglas F. Easton
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Manjeet K. Bolla
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Qin Wang
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Javier Benitez
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Roger L. Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Arto Mannermaa
- Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Finland
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Peter Devilee
- Department of Human Genetics & Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Caroline Seynaeve
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Angela Cox
- Sheffield Cancer Research, Department of Oncology, University of Sheffield, Sheffield, UK
| | - Simon S. Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Fiona M. Blows
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Joyce Sanders
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Renate de Groot
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | | | - Maartje Hooning
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Chris Lintott
- Department of Physics (Astrophysics), University of Oxford, Oxford, UK
| | - Paul D.P. Pharoah
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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9
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Lin WY, Camp NJ, Ghoussaini M, Beesley J, Michailidou K, Hopper JL, Apicella C, Southey MC, Stone J, Schmidt MK, Broeks A, Van't Veer LJ, Th Rutgers EJ, Muir K, Lophatananon A, Stewart-Brown S, Siriwanarangsan P, Fasching PA, Haeberle L, Ekici AB, Beckmann MW, Peto J, Dos-Santos-Silva I, Fletcher O, Johnson N, Bolla MK, Wang Q, Dennis J, Sawyer EJ, Cheng T, Tomlinson I, Kerin MJ, Miller N, Marmé F, Surowy HM, Burwinkel B, Guénel P, Truong T, Menegaux F, Mulot C, Bojesen SE, Nordestgaard BG, Nielsen SF, Flyger H, Benitez J, Zamora MP, Arias Perez JI, Menéndez P, González-Neira A, Pita G, Alonso MR, Alvarez N, Herrero D, Anton-Culver H, Brenner H, Dieffenbach AK, Arndt V, Stegmaier C, Meindl A, Lichtner P, Schmutzler RK, Müller-Myhsok B, Brauch H, Brüning T, Ko YD, Tessier DC, Vincent D, Bacot F, Nevanlinna H, Aittomäki K, Blomqvist C, Khan S, Matsuo K, Ito H, Iwata H, Horio A, Bogdanova NV, Antonenkova NN, Dörk T, Lindblom A, Margolin S, Mannermaa A, Kataja V, Kosma VM, Hartikainen JM, Wu AH, Tseng CC, Van Den Berg D, Stram DO, Neven P, Wauters E, Wildiers H, Lambrechts D, Chang-Claude J, Rudolph A, Seibold P, Flesch-Janys D, Radice P, Peterlongo P, Manoukian S, Bonanni B, Couch FJ, Wang X, Vachon C, Purrington K, Giles GG, Milne RL, Mclean C, Haiman CA, Henderson BE, Schumacher F, Le Marchand L, Simard J, Goldberg MS, Labrèche F, Dumont M, Teo SH, Yip CH, Hassan N, Vithana EN, Kristensen V, Zheng W, Deming-Halverson S, Shrubsole MJ, Long J, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Kauppila S, Andrulis IL, Knight JA, Glendon G, Tchatchou S, Devilee P, Tollenaar RAEM, Seynaeve C, Van Asperen CJ, García-Closas M, Figueroa J, Lissowska J, Brinton L, Czene K, Darabi H, Eriksson M, Brand JS, Hooning MJ, Hollestelle A, Van Den Ouweland AMW, Jager A, Li J, Liu J, Humphreys K, Shu XO, Lu W, Gao YT, Cai H, Cross SS, Reed MWR, Blot W, Signorello LB, Cai Q, Pharoah PDP, Perkins B, Shah M, Blows FM, Kang D, Yoo KY, Noh DY, Hartman M, Miao H, Chia KS, Putti TC, Hamann U, Luccarini C, Baynes C, Ahmed S, Maranian M, Healey CS, Jakubowska A, Lubinski J, Jaworska-Bieniek K, Durda K, Sangrajrang S, Gaborieau V, Brennan P, Mckay J, Slager S, Toland AE, Yannoukakos D, Shen CY, Hsiung CN, Wu PE, Ding SL, Ashworth A, Jones M, Orr N, Swerdlow AJ, Tsimiklis H, Makalic E, Schmidt DF, Bui QM, Chanock SJ, Hunter DJ, Hein R, Dahmen N, Beckmann L, Aaltonen K, Muranen TA, Heikkinen T, Irwanto A, Rahman N, Turnbull CA, Waisfisz Q, Meijers-Heijboer HEJ, Adank MA, Van Der Luijt RB, Hall P, Chenevix-Trench G, Dunning A, Easton DF, Cox A. Identification and characterization of novel associations in the CASP8/ALS2CR12 region on chromosome 2 with breast cancer risk. Hum Mol Genet 2015; 24:285-98. [PMID: 25168388 PMCID: PMC4334820 DOI: 10.1093/hmg/ddu431] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/30/2014] [Accepted: 08/20/2014] [Indexed: 11/14/2022] Open
Abstract
Previous studies have suggested that polymorphisms in CASP8 on chromosome 2 are associated with breast cancer risk. To clarify the role of CASP8 in breast cancer susceptibility, we carried out dense genotyping of this region in the Breast Cancer Association Consortium (BCAC). Single-nucleotide polymorphisms (SNPs) spanning a 1 Mb region around CASP8 were genotyped in 46 450 breast cancer cases and 42 600 controls of European origin from 41 studies participating in the BCAC as part of a custom genotyping array experiment (iCOGS). Missing genotypes and SNPs were imputed and, after quality exclusions, 501 typed and 1232 imputed SNPs were included in logistic regression models adjusting for study and ancestry principal components. The SNPs retained in the final model were investigated further in data from nine genome-wide association studies (GWAS) comprising in total 10 052 case and 12 575 control subjects. The most significant association signal observed in European subjects was for the imputed intronic SNP rs1830298 in ALS2CR12 (telomeric to CASP8), with per allele odds ratio and 95% confidence interval [OR (95% confidence interval, CI)] for the minor allele of 1.05 (1.03-1.07), P = 1 × 10(-5). Three additional independent signals from intronic SNPs were identified, in CASP8 (rs36043647), ALS2CR11 (rs59278883) and CFLAR (rs7558475). The association with rs1830298 was replicated in the imputed results from the combined GWAS (P = 3 × 10(-6)), yielding a combined OR (95% CI) of 1.06 (1.04-1.08), P = 1 × 10(-9). Analyses of gene expression associations in peripheral blood and normal breast tissue indicate that CASP8 might be the target gene, suggesting a mechanism involving apoptosis.
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Affiliation(s)
- Wei-Yu Lin
- Department of Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan County 333, Taiwan
| | - Nicola J Camp
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108-1266, USA
| | - Maya Ghoussaini
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | | | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health
| | | | - Jennifer Stone
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, the Netherlands
| | - Annegien Broeks
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, the Netherlands
| | - Laura J Van't Veer
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, the Netherlands
| | - Emiel J Th Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, the Netherlands
| | - Kenneth Muir
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry CV4 7AL, UK Institute of Population Health, University of Manchester, Manchester M13 9QQ, UK
| | - Artitaya Lophatananon
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry CV4 7AL, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry CV4 7AL, UK
| | | | - Peter A Fasching
- University Breast Center Franconia, Department of Gynecology and Obstetrics David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California, Los Angeles, CA 90095, USA
| | - Lothar Haeberle
- University Breast Center Franconia, Department of Gynecology and Obstetrics
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen D-91054, Germany
| | | | - Julian Peto
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Isabel Dos-Santos-Silva
- Non-communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | | | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care
| | - Elinor J Sawyer
- Division of Cancer Studies, Kings College London, Guy's Hospital, London SE1 9RT, UK
| | - Timothy Cheng
- Wellcome Trust Centre for Human Genetics and Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7BN, UK
| | - Ian Tomlinson
- Wellcome Trust Centre for Human Genetics and Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 7BN, UK
| | - Michael J Kerin
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Nicola Miller
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Frederik Marmé
- Department of Obstetrics and Gynecology National Center for Tumor Diseases, University of Heidelberg, Heidelberg 69117, Germany
| | - Harald M Surowy
- Department of Obstetrics and Gynecology Molecular Epidemiology Group
| | - Barbara Burwinkel
- Department of Obstetrics and Gynecology Molecular Epidemiology Group
| | - Pascal Guénel
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif 94807, France University Paris-Sud, UMRS 1018, Villejuif 94807, France
| | - Thérèse Truong
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif 94807, France University Paris-Sud, UMRS 1018, Villejuif 94807, France
| | - Florence Menegaux
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif 94807, France University Paris-Sud, UMRS 1018, Villejuif 94807, France
| | - Claire Mulot
- Université Paris Sorbonne Cité, UMR-S775 Inserm, Paris 75015, France
| | - Stig E Bojesen
- Copenhagen General Population Study, Herlev Hospital, 2730 Herlev, Copenhagen, Denmark Department of Clinical Biochemistry Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Børge G Nordestgaard
- Copenhagen General Population Study, Herlev Hospital, 2730 Herlev, Copenhagen, Denmark Department of Clinical Biochemistry Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Sune F Nielsen
- Copenhagen General Population Study, Herlev Hospital, 2730 Herlev, Copenhagen, Denmark Department of Clinical Biochemistry
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Copenhagen 2100, Denmark
| | - Javier Benitez
- Human Genetics Group, Human Cancer Genetics Program Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia 28029, Spain
| | - M Pilar Zamora
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid 28046, Spain
| | | | - Primitiva Menéndez
- Servicio de Anatomía Patológica, Hospital Monte Naranco, Oviedo 33012, Spain
| | - Anna González-Neira
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - Guillermo Pita
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - M Rosario Alonso
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - Nuria Alvarez
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - Daniel Herrero
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid E-28029, Spain
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California Irvine, Irvine, CA 92697, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Aida Karina Dieffenbach
- Division of Clinical Epidemiology and Aging Research German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research
| | | | | | - Peter Lichtner
- Insitute of Human Genetics, Technische Universität München, Munich D-80333, Germany
| | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, 50932 Cologne, Germany
| | | | - Hiltrud Brauch
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart 70376, Germany University of Tübingen, Tübingen 72074, Germany German Cancer Consortium (DKTK)
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum D-44789, Germany
| | - Yon-Dschun Ko
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn 53113, Germany
| | - Daniel C Tessier
- Centre D'innovation Génome Québec et Université McGill, Montréal, QC, Canada H3A 0G1
| | - Daniel Vincent
- Centre D'innovation Génome Québec et Université McGill, Montréal, QC, Canada H3A 0G1
| | - Francois Bacot
- Centre D'innovation Génome Québec et Université McGill, Montréal, QC, Canada H3A 0G1
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Carl Blomqvist
- Department of Oncology, University of Helsinki Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Sofia Khan
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Keitaro Matsuo
- Department of Preventive Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka 812-8582, Japan
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Akiyo Horio
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Natalia V Bogdanova
- Department of Obstetrics and Gynaecology Department of Radiation Oncology, Hannover Medical School, Hannover 30625, Germany
| | - Natalia N Antonenkova
- N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk 223040, Belarus
| | - Thilo Dörk
- Department of Obstetrics and Gynaecology
| | | | | | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland Imaging Center, Department of Clinical Pathology
| | - Vesa Kataja
- School of Medicine, Institute of Clinical Medicine, Oncology, University of Eastern Finland, Kuopio 70210, Finland Cancer Center, Kuopio University Hospital, Kuopio 70029, Finland
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland Imaging Center, Department of Clinical Pathology
| | - Jaana M Hartikainen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland Imaging Center, Department of Clinical Pathology
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Chiu-Chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Patrick Neven
- University Hospital Gashuisberg, Leuven 3000, Belgium
| | - Els Wauters
- Vesalius Research Center (VRC), VIB, Leuven 3000, Belgium Department of Oncology
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Diether Lambrechts
- Vesalius Research Center (VRC), VIB, Leuven 3000, Belgium Laboratory for Translational Genetics, Department of Oncology
| | | | | | | | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine
| | - Paolo Peterlongo
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan 20139, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan 20133, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Milan 20141, Italy
| | | | | | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC 3004, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC 3004, Australia
| | - Catriona Mclean
- Anatomical Pathology, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI 96813, USA
| | - Jacques Simard
- Centre Hospitalier Universitaire de Québec Research Centre and Laval University, Quebec City, QC, Canada G1V 4G2
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, QC, Canada H3A 0G4 Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada H3A 1A1
| | - France Labrèche
- Départements de Santé Environnementale et Santé au Travail et de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal, QC, Canada H3T 1J4
| | - Martine Dumont
- Centre Hospitalier Universitaire de Québec Research Centre and Laval University, Quebec City, QC, Canada G1V 4G2
| | - Soo Hwang Teo
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Subang Jaya, Selangor, Malaysia Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia
| | - Cheng Har Yip
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia
| | - Norhashimah Hassan
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Subang Jaya, Selangor, Malaysia Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia
| | | | - Vessela Kristensen
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo 0372, Norway Faculty of Medicine (Faculty Division Ahus), University of Oslo (UiO), Oslo 0316, Norway
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Sandra Deming-Halverson
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Martha J Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Jirong Long
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, Northern Finland Laboratory Centre NordLab
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, Northern Finland Laboratory Centre NordLab
| | | | - Saila Kauppila
- Department of Pathology, Oulu University Hospital, University of Oulu, Oulu 90570, Finland
| | - Irene L Andrulis
- Ontario Cancer Genetics Network Department of Molecular Genetics
| | - Julia A Knight
- Prosserman Centre for Health Research Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada M5S 2J7
| | | | - Sandrine Tchatchou
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5
| | - Peter Devilee
- Department of Human Genetics & Department of Pathology
| | | | - Caroline Seynaeve
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam 3075 EA, The Netherlands
| | - Christi J Van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - Montserrat García-Closas
- Breakthrough Breast Cancer Research Centre, Division of Breast Cancer Research Division of Genetics and Epidemiology
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw 02-781, Poland
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Hatef Darabi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Maartje J Hooning
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam 3075 EA, The Netherlands
| | - Antoinette Hollestelle
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam 3075 EA, The Netherlands
| | - Ans M W Van Den Ouweland
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam 3075 EA, The Netherlands
| | - Agnes Jager
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam 3075 EA, The Netherlands
| | - Jingmei Li
- Shanghai Center for Disease Control and Prevention, Shanghai 200336, China
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore 138672, Singapore
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Wei Lu
- Shanghai Center for Disease Control and Prevention, Shanghai 200336, China
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai 220025, China
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Simon S Cross
- Department of Neuroscience, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Malcolm W R Reed
- Department of Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK
| | - William Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA International Epidemiology Institute, Rockville, MD 20850, USA
| | - Lisa B Signorello
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA International Epidemiology Institute, Rockville, MD 20850, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Barbara Perkins
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Fiona M Blows
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Daehee Kang
- Department of Preventive Medicine Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 151-742, Korea
| | - Keun-Young Yoo
- Seoul National University College of Medicine, Seoul 110-799, Korea
| | | | - Mikael Hartman
- Saw Swee Hock School of Public Health Department of Surgery, Yong Loo Lin School of Medicine National University Health System, Singapore 119228, Singapore
| | - Hui Miao
- Saw Swee Hock School of Public Health National University Health System, Singapore 119228, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health National University Health System, Singapore 119228, Singapore
| | - Thomas Choudary Putti
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | | | - Craig Luccarini
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Caroline Baynes
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Shahana Ahmed
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Mel Maranian
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Catherine S Healey
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | | | - Katarzyna Durda
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | | | | | - Paul Brennan
- International Agency for Research on Cancer, Lyon 69372, France
| | - James Mckay
- International Agency for Research on Cancer, Lyon 69372, France
| | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Amanda E Toland
- Department of Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, IRRP, National Centre for Scientific Research 'Demokritos', Aghia Paraskevi Attikis, Athens 153 10, Greece
| | - Chen-Yang Shen
- Institute of Biomedical Sciences College of Public Health, China Medical University, Taichung 40402, Taiwan
| | | | - Pei-Ei Wu
- Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Shian-Ling Ding
- Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei 11529, Taiwan
| | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, Division of Breast Cancer Research
| | | | - Nick Orr
- Breakthrough Breast Cancer Research Centre and Division of Breast Cancer Research, The Institute of Cancer Research, London SW3 6JB, UK
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology Division of Breast Cancer Research
| | | | - Enes Makalic
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Daniel F Schmidt
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Quang M Bui
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - David J Hunter
- Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - Rebecca Hein
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany PMV Research Group at the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Cologne 50923, Germany
| | - Norbert Dahmen
- Department of Psychiatry, University of Mainz, Mainz 55122, Germany
| | - Lars Beckmann
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne 50670, Germany
| | - Kirsimari Aaltonen
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Taru A Muranen
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Tuomas Heikkinen
- Department of Obstetrics and Gynecology Helsinki University Central Hospital, Helsinki 00029, Finland
| | - Astrid Irwanto
- Human Genetics Division, Genome Institute of Singapore, Singapore 138672, Singapore
| | | | | | - Quinten Waisfisz
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam 1081 HZ, The Netherlands and
| | - Hanne E J Meijers-Heijboer
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam 1081 HZ, The Netherlands and
| | - Muriel A Adank
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam 1081 HZ, The Netherlands and
| | - Rob B Van Der Luijt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden
| | | | - Alison Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Angela Cox
- Department of Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK
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10
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Howat WJ, Blows FM, Provenzano E, Brook MN, Morris L, Gazinska P, Johnson N, McDuffus LA, Miller J, Sawyer EJ, Pinder S, van Deurzen CHM, Jones L, Sironen R, Visscher D, Caldas C, Daley F, Coulson P, Broeks A, Sanders J, Wesseling J, Nevanlinna H, Fagerholm R, Blomqvist C, Heikkilä P, Ali HR, Dawson SJ, Figueroa J, Lissowska J, Brinton L, Mannermaa A, Kataja V, Kosma VM, Cox A, Brock IW, Cross SS, Reed MW, Couch FJ, Olson JE, Devillee P, Mesker WE, Seyaneve CM, Hollestelle A, Benitez J, Perez JIA, Menéndez P, Bolla MK, Easton DF, Schmidt MK, Pharoah PD, Sherman ME, García-Closas M. Performance of automated scoring of ER, PR, HER2, CK5/6 and EGFR in breast cancer tissue microarrays in the Breast Cancer Association Consortium. J Pathol Clin Res 2015; 1:18-32. [PMID: 27499890 PMCID: PMC4858117 DOI: 10.1002/cjp2.3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/28/2014] [Indexed: 01/02/2023]
Abstract
Breast cancer risk factors and clinical outcomes vary by tumour marker expression. However, individual studies often lack the power required to assess these relationships, and large-scale analyses are limited by the need for high throughput, standardized scoring methods. To address these limitations, we assessed whether automated image analysis of immunohistochemically stained tissue microarrays can permit rapid, standardized scoring of tumour markers from multiple studies. Tissue microarray sections prepared in nine studies containing 20 263 cores from 8267 breast cancers stained for two nuclear (oestrogen receptor, progesterone receptor), two membranous (human epidermal growth factor receptor 2 and epidermal growth factor receptor) and one cytoplasmic (cytokeratin 5/6) marker were scanned as digital images. Automated algorithms were used to score markers in tumour cells using the Ariol system. We compared automated scores against visual reads, and their associations with breast cancer survival. Approximately 65-70% of tissue microarray cores were satisfactory for scoring. Among satisfactory cores, agreement between dichotomous automated and visual scores was highest for oestrogen receptor (Kappa = 0.76), followed by human epidermal growth factor receptor 2 (Kappa = 0.69) and progesterone receptor (Kappa = 0.67). Automated quantitative scores for these markers were associated with hazard ratios for breast cancer mortality in a dose-response manner. Considering visual scores of epidermal growth factor receptor or cytokeratin 5/6 as the reference, automated scoring achieved excellent negative predictive value (96-98%), but yielded many false positives (positive predictive value = 30-32%). For all markers, we observed substantial heterogeneity in automated scoring performance across tissue microarrays. Automated analysis is a potentially useful tool for large-scale, quantitative scoring of immunohistochemically stained tissue microarrays available in consortia. However, continued optimization, rigorous marker-specific quality control measures and standardization of tissue microarray designs, staining and scoring protocols is needed to enhance results.
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Affiliation(s)
- William J Howat
- Cancer Research UK Cambridge Institute, University of Cambridge Cambridge UK
| | - Fiona M Blows
- Centre for Cancer Genetic Epidemiology, Department of Oncology University of Cambridge Cambridge UK
| | | | - Mark N Brook
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
| | - Lorna Morris
- Cancer Research UK Cambridge Institute, University of CambridgeCambridgeUK; Department of OncologyUniversity of CambridgeCambridgeUK
| | - Patrycja Gazinska
- Breakthrough Breast Cancer Research Unit, Division of Cancer Studies King's College London, Guy's Hospital London UK
| | - Nicola Johnson
- Cancer Research UK Cambridge Institute, University of Cambridge Cambridge UK
| | - Leigh-Anne McDuffus
- Cancer Research UK Cambridge Institute, University of Cambridge Cambridge UK
| | - Jodi Miller
- Cancer Research UK Cambridge Institute, University of Cambridge Cambridge UK
| | - Elinor J Sawyer
- Division of Cancer Studies, NIHR Comprehensive Biomedical Research Centre Guy's & St. Thomas' NHS Foundation Trust in partnership with King's College London London UK
| | - Sarah Pinder
- Research Oncology, Division of Cancer Studies King's College London, Guy's Hospital London UK
| | | | - Louise Jones
- Centre for Tumour BiologyBarts Institute of CancerBartsUK; The London School of Medicine and DentistryLondonUK
| | - Reijo Sironen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic MedicineCancer Center of Eastern Finland, University of Eastern FinlandKuopioFinland; Imaging Center, Department of Clinical PathologyKuopio University HospitalKuopioFinland
| | - Daniel Visscher
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, University of Cambridge Cambridge UK
| | - Frances Daley
- Breakthrough Breast Cancer Research Centre, Division of Breast Cancer Research The Institute of Cancer Research London UK
| | - Penny Coulson
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
| | - Annegien Broeks
- Core Facility for Molecular Pathology and Biobanking Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands
| | - Joyce Sanders
- Department of Pathology, Division of Diagnostic Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands
| | - Jelle Wesseling
- Department of Pathology, Division of Diagnostic Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | - Rainer Fagerholm
- Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | - Carl Blomqvist
- Department of Oncology Helsinki University Central Hospital Helsinki Finland
| | - Päivi Heikkilä
- Department of Pathology Helsinki University Central Hospital Helsinki Finland
| | - H Raza Ali
- Cancer Research UK Cambridge Institute, University of Cambridge Cambridge UK
| | - Sarah-Jane Dawson
- Cancer Research UK Cambridge Institute, University of Cambridge Cambridge UK
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology Warsaw Poland
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland USA
| | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic MedicineCancer Center of Eastern Finland, University of Eastern FinlandKuopioFinland; Imaging Center, Department of Clinical PathologyKuopio University HospitalKuopioFinland
| | - Vesa Kataja
- Kuopio University Hospital, Cancer CenterKuopioFinland; School of Medicine, Institute of Clinical MedicineUniversity of Eastern Finland, Oncology and Central Hospital of Central Finland, Central Finland Hospital DistrictKuopioFinland
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic MedicineCancer Center of Eastern Finland, University of Eastern FinlandKuopioFinland; Imaging Center, Department of Clinical PathologyKuopio University HospitalKuopioFinland
| | - Angela Cox
- CRUK/YCR Sheffield Cancer Research Centre, Department of Oncology University of Sheffield Sheffield UK
| | - Ian W Brock
- CRUK/YCR Sheffield Cancer Research Centre, Department of Oncology University of Sheffield Sheffield UK
| | - Simon S Cross
- Academic Unit of Pathology, Department of Neuroscience University of Sheffield Sheffield UK
| | - Malcolm W Reed
- CRUK/YCR Sheffield Cancer Research Centre, Department of Oncology University of Sheffield Sheffield UK
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA
| | - Janet E Olson
- Department of Health Sciences Research Mayo Clinic Rochester MN USA
| | - Peter Devillee
- Department of Human Genetics & Department of Pathology Leiden University Medical Center Leiden The Netherlands
| | - Wilma E Mesker
- Department of Surgical Oncology Leiden University Medical Center RC Leiden The Netherlands
| | - Caroline M Seyaneve
- Family Cancer Clinic, Department of Medical Oncology Erasmus MC Cancer Institute Rotterdam The Netherlands
| | - Antoinette Hollestelle
- Family Cancer Clinic, Department of Medical Oncology Erasmus MC Cancer Institute Rotterdam The Netherlands
| | - Javier Benitez
- Human Genetics Group, Human Cancer Genetics ProgramSpanish National Cancer Research Centre (CNIO)MadridSpain; Centro de Investigación en Red de Enfermedades Raras (CIBERER)ValenciaSpain
| | | | | | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of OncologyUniversity of CambridgeCambridgeUK; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Marjanka K Schmidt
- Division of Molecular Pathology Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands
| | - Paul D Pharoah
- Centre for Cancer Genetic Epidemiology, Department of OncologyUniversity of CambridgeCambridgeUK; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland USA
| | - Montserrat García-Closas
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK; Breakthrough Breast Cancer Research Centre, Division of Breast Cancer ResearchThe Institute of Cancer ResearchLondonUK
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11
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Spurdle AB, Couch FJ, Parsons MT, McGuffog L, Barrowdale D, Bolla MK, Wang Q, Healey S, Schmutzler RK, Wappenschmidt B, Rhiem K, Hahnen E, Engel C, Meindl A, Ditsch N, Arnold N, Plendl H, Niederacher D, Sutter C, Wang-Gohrke S, Steinemann D, Preisler-Adams S, Kast K, Varon-Mateeva R, Ellis S, Frost D, Platte R, Perkins J, Evans DG, Izatt L, Eeles R, Adlard J, Davidson R, Cole T, Scuvera G, Manoukian S, Bonanni B, Mariette F, Fortuzzi S, Viel A, Pasini B, Papi L, Varesco L, Balleine R, Nathanson KL, Domchek SM, Offitt K, Jakubowska A, Lindor N, Thomassen M, Jensen UB, Rantala J, Borg Å, Andrulis IL, Miron A, Hansen TVO, Caldes T, Neuhausen SL, Toland AE, Nevanlinna H, Montagna M, Garber J, Godwin AK, Osorio A, Factor RE, Terry MB, Rebbeck TR, Karlan BY, Southey M, Rashid MU, Tung N, Pharoah PDP, Blows FM, Dunning AM, Provenzano E, Hall P, Czene K, Schmidt MK, Broeks A, Cornelissen S, Verhoef S, Fasching PA, Beckmann MW, Ekici AB, Slamon DJ, Bojesen SE, Nordestgaard BG, Nielsen SF, Flyger H, Chang-Claude J, Flesch-Janys D, Rudolph A, Seibold P, Aittomäki K, Muranen TA, Heikkilä P, Blomqvist C, Figueroa J, Chanock SJ, Brinton L, Lissowska J, Olson JE, Pankratz VS, John EM, Whittemore AS, West DW, Hamann U, Torres D, Ulmer HU, Rüdiger T, Devilee P, Tollenaar RAEM, Seynaeve C, Van Asperen CJ, Eccles DM, Tapper WJ, Durcan L, Jones L, Peto J, dos-Santos-Silva I, Fletcher O, Johnson N, Dwek M, Swann R, Bane AL, Glendon G, Mulligan AM, Giles GG, Milne RL, Baglietto L, McLean C, Carpenter J, Clarke C, Scott R, Brauch H, Brüning T, Ko YD, Cox A, Cross SS, Reed MWR, Lubinski J, Jaworska-Bieniek K, Durda K, Gronwald J, Dörk T, Bogdanova N, Park-Simon TW, Hillemanns P, Haiman CA, Henderson BE, Schumacher F, Le Marchand L, Burwinkel B, Marme F, Surovy H, Yang R, Anton-Culver H, Ziogas A, Hooning MJ, Collée JM, Martens JWM, Tilanus-Linthorst MMA, Brenner H, Dieffenbach AK, Arndt V, Stegmaier C, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Grip M, Lindblom A, Margolin S, Joseph V, Robson M, Rau-Murthy R, González-Neira A, Arias JI, Zamora P, Benítez J, Mannermaa A, Kataja V, Kosma VM, Hartikainen JM, Peterlongo P, Zaffaroni D, Barile M, Capra F, Radice P, Teo SH, Easton DF, Antoniou AC, Chenevix-Trench G, Goldgar DE. Refined histopathological predictors of BRCA1 and BRCA2 mutation status: a large-scale analysis of breast cancer characteristics from the BCAC, CIMBA, and ENIGMA consortia. Breast Cancer Res 2014; 16:3419. [PMID: 25857409 PMCID: PMC4352262 DOI: 10.1186/s13058-014-0474-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 11/05/2014] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The distribution of histopathological features of invasive breast tumors in BRCA1 or BRCA2 germline mutation carriers differs from that of individuals with no known mutation. Histopathological features thus have utility for mutation prediction, including statistical modeling to assess pathogenicity of BRCA1 or BRCA2 variants of uncertain clinical significance. We analyzed large pathology datasets accrued by the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA) and the Breast Cancer Association Consortium (BCAC) to reassess histopathological predictors of BRCA1 and BRCA2 mutation status, and provide robust likelihood ratio (LR) estimates for statistical modeling. METHODS Selection criteria for study/center inclusion were estrogen receptor (ER) status or grade data available for invasive breast cancer diagnosed younger than 70 years. The dataset included 4,477 BRCA1 mutation carriers, 2,565 BRCA2 mutation carriers, and 47,565 BCAC breast cancer cases. Country-stratified estimates of the likelihood of mutation status by histopathological markers were derived using a Mantel-Haenszel approach. RESULTS ER-positive phenotype negatively predicted BRCA1 mutation status, irrespective of grade (LRs from 0.08 to 0.90). ER-negative grade 3 histopathology was more predictive of positive BRCA1 mutation status in women 50 years or older (LR = 4.13 (3.70 to 4.62)) versus younger than 50 years (LR = 3.16 (2.96 to 3.37)). For BRCA2, ER-positive grade 3 phenotype modestly predicted positive mutation status irrespective of age (LR = 1.7-fold), whereas ER-negative grade 3 features modestly predicted positive mutation status at 50 years or older (LR = 1.54 (1.27 to 1.88)). Triple-negative tumor status was highly predictive of BRCA1 mutation status for women younger than 50 years (LR = 3.73 (3.43 to 4.05)) and 50 years or older (LR = 4.41 (3.86 to 5.04)), and modestly predictive of positive BRCA2 mutation status in women 50 years or older (LR = 1.79 (1.42 to 2.24)). CONCLUSIONS These results refine likelihood-ratio estimates for predicting BRCA1 and BRCA2 mutation status by using commonly measured histopathological features. Age at diagnosis is an important variable for most analyses, and grade is more informative than ER status for BRCA2 mutation carrier prediction. The estimates will improve BRCA1 and BRCA2 variant classification and inform patient mutation testing and clinical management.
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Affiliation(s)
- Amanda B Spurdle
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, 4006 QLD Australia
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
| | - Michael T Parsons
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, 4006 QLD Australia
| | - Lesley McGuffog
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Daniel Barrowdale
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Sue Healey
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, 4006 QLD Australia
| | - Rita Katharina Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Barbara Wappenschmidt
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Eric Hahnen
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstrasse 16-18, Leipzig, 04107 Germany
| | - Alfons Meindl
- Division of Gynaecology and Obstetrics, Technische Universität München, Ismaninger Straße 22, Munich, 81675 Germany
| | - Nina Ditsch
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians-Universität, Maistrasse 11, Munich, 80337 Germany
| | - Norbert Arnold
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
| | - Hansjoerg Plendl
- Institute of Human Genetics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Dieter Niederacher
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Sutter
- Institute of Human Genetics, University Hospital Heidelberg, Im Neuenheimer Feld 366, Heidelberg, 69120 Germany
| | - Shan Wang-Gohrke
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081 Germany
| | - Doris Steinemann
- Institute of Cell and Molecular Pathology, Hannover Medical School, Hannover, Germany
| | | | - Karin Kast
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Steve Ellis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Debra Frost
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Radka Platte
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jo Perkins
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - D Gareth Evans
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Louise Izatt
- Clinical Genetics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Ros Eeles
- Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Julian Adlard
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
| | - Rosemarie Davidson
- Department of Clinical Genetics, Southern General Hospital, 1345 Glovan Rd, Glasgow, G51 4TF UK
| | - Trevor Cole
- West Midlands Regional Genetics Service, Birmingham Women’s Hospital Healthcare NHS Trust, Edgbaston, Birmingham UK
| | - Giulietta Scuvera
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian, 1, Milan, 20133 Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian, 1, Milan, 20133 Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Via Giuseppe Ripamonti, 435, Milan, 20141 Italy
| | - Frederique Mariette
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello, 16, Milan, 20139 Italy
- Cogentech Cancer Genetic Test Laboratory, Via Adamello, 16, Milan, 20139 Italy
| | - Stefano Fortuzzi
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello, 16, Milan, 20139 Italy
- Cogentech Cancer Genetic Test Laboratory, Via Adamello, 16, Milan, 20139 Italy
| | - Alessandra Viel
- Division of Experimental Oncology 1, CRO Aviano National Cancer Institute, Via Franco Gallini 2, Aviano, 33081 PN Italy
| | - Barbara Pasini
- Department of Medical Sciences, University of Turin, Via Santena 19, Turin, 10126 Italy
- AOU Città della Salute e della Scienza, corso Bramante 88, 10126 Turin Italy
| | - Laura Papi
- Unit of Medical Genetics, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Viale Pieraccini 6, Florence, 50139 Italy
| | - Liliana Varesco
- Unit of Hereditary Cancer, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, largo Rosanna Benzi 10, Genoa, 16132 Italy
| | - Rosemary Balleine
- Western Sydney and Nepean Blue Mountains Local Health Districts, Westmead Millennium Institute for Medical Research, University of Sydney, 176 Hawkesbury Rd, Westmead, NSW 2145 Australia
| | - Katherine L Nathanson
- Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104 PA USA
| | - Susan M Domchek
- Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104 PA USA
| | - Kenneth Offitt
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 417 East 68th Street, New York, 10021 NY USA
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
| | - Noralane Lindor
- Department of Health Sciences Research, Mayo Clinic, 13400 E. Scottsdale Blvd., Scottsdale, AZ USA
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Sonder Boulevard 29, Odense, C, Denmark
| | - Uffe Birk Jensen
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgaardsvej 21C, Aarhus, N, Denmark
| | - Johanna Rantala
- Department of Clinical Genetics, Karolinska University Hospital L5:03, Stockholm, S-171 76 Sweden
| | - Åke Borg
- Department of Oncology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Irene L Andrulis
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
| | - Alexander Miron
- Department of Genetics and Genome Services, Case Western Reserve University Medical School, 2109 Adelbert Rd, Cleveland, 44106-4955 OH USA
| | - Thomas VO Hansen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100 Denmark
| | - Trinidad Caldes
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, IdISSC, Martin Lagos s/n, Madrid, Spain
| | - Susan L Neuhausen
- Beckman Research Institute of City of Hope, 1500 East Duarte Rd, Duarte, 91010 CA USA
| | - Amanda E Toland
- Divison of Human Cancer Genetics, Departments of Internal Medicine and Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State Universit, 998 Biomedical Research Tower, Columbus, OH USA
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
| | - Marco Montagna
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, Padua, Italy
| | - Judy Garber
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA USA
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard,4019 Wahl Hall East, Kansas, MS 3040 KS USA
| | - Ana Osorio
- Human Genetics Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, Madrid, 28029 Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Rachel E Factor
- Department of Pathology, University of Utah Health Sciences Center, 50 N Medical Dr, Salt Lake City, 84132 UT USA
| | - Mary B Terry
- Department of Epidemiology, Columbia University, New York, NY USA
| | - Timothy R Rebbeck
- Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104 PA USA
| | - Beth Y Karlan
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 290 W, Los Angeles, CA USA
| | - Melissa Southey
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Parkville, Victoria Australia
| | - Muhammad Usman Rashid
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 580, Heidelberg, 69120 Germany
- Department of Basic Sciences, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) 7A, Block R3, Johar, Pakistan
| | | | - Paul DP Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona M Blows
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX Netherlands
| | - Annegien Broeks
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX Netherlands
| | - Sten Cornelissen
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX Netherlands
| | - Senno Verhoef
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX Netherlands
| | - Peter A Fasching
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, 90095 CA USA
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, Erlangen, 91054 Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, Erlangen, 91054 Germany
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Schlossplatz 4, Erlangen, 91054 Germany
| | - Dennis J Slamon
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, 90095 CA USA
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, 10833 Le Conte Ave, Los Angeles, 90024 CA USA
| | - Stig E Bojesen
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, 2200 Denmark
| | - Børge G Nordestgaard
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, 2200 Denmark
| | - Sune F Nielsen
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246 Germany
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Kristiina Aittomäki
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
| | - Taru A Muranen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
| | - Carl Blomqvist
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS, Finland
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, 20850 MD USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, 20850 MD USA
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, 20850 MD USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
| | - Vernon S Pankratz
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
| | - Esther M John
- Cancer Prevention Institute of California, 2201 Walnut Avenue #300, Fremont, 94538 CA USA
- Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, 94305 CA USA
| | - Alice S Whittemore
- Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, 94305 CA USA
| | - Dee W West
- Cancer Prevention Institute of California, 2201 Walnut Avenue #300, Fremont, 94538 CA USA
- Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, 94305 CA USA
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 580, Heidelberg, 69120 Germany
| | - Diana Torres
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 580, Heidelberg, 69120 Germany
- Institute of Human Genetics, Pontificia University Javeriana, Carrera 7, Bogotá, 11001000 DC Colombia
| | - Hans Ulrich Ulmer
- Frauenklinik der Stadtklinik Baden-Baden, Balger Straße 50, Baden-Baden, 76532 Germany
| | - Thomas Rüdiger
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Moltkestraße 90, Karlsruhe, 76133 Germany
| | - Peter Devilee
- Department of Human Genetics & Department of Pathology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
| | - Robert AEM Tollenaar
- Department of Surgical Oncology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
| | - Caroline Seynaeve
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Centrer, Groene Hilledijk 301, EA Rotterdam, 3075 Netherlands
| | - Christi J Van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Einthovenweg 20, ZC Leiden, 2333 Netherlands
| | - Diana M Eccles
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ England
| | - William J Tapper
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ England
| | - Lorraine Durcan
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ England
| | - Louise Jones
- Queen Mary University London, Mile End Road, London, E1 4NS England
| | - Julian Peto
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Olivia Fletcher
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB UK
| | - Nichola Johnson
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB UK
| | - Miriam Dwek
- Department of Molecular and Applied Biosciences, Faculty of Science and Technology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW UK
| | - Ruth Swann
- Department of Molecular and Applied Biosciences, Faculty of Science and Technology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW UK
| | - Anita L Bane
- Department of Pathology & Molecular Medicine, Juravinski Hospital, Concession St, Hamilton, L8V 1C3 Ontario Canada
- Cancer Centre, McMaster University, Hamilton, L8V 1C4 ON Canada
| | - Gord Glendon
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
| | - Anna M Mulligan
- Department of Pathology, University Health Network, Toronto, M5G 2C4 ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, The University of Melbourne, Level 1, 723 Swanston Street, Melbourne, 3010 Victoria Australia
| | - Roger L Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, The University of Melbourne, Level 1, 723 Swanston Street, Melbourne, 3010 Victoria Australia
| | - Laura Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, The University of Melbourne, Level 1, 723 Swanston Street, Melbourne, 3010 Victoria Australia
| | - Catriona McLean
- Anatomical Pathology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004 Victoria Australia
| | - Jane Carpenter
- Australian Breast Cancer Tissue Bank, Westmead Millennium Institute, University of Sydney, Darcy Rd, Sydney, NSW 2145 Australia
| | - Christine Clarke
- Westmead Institute for Cancer Research, University of Sydney, Darcy Road, Sydney, NSW 2145 Australia
| | - Rodney Scott
- Discipline of Medical Genetics, School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, University Drive, Callaghan, NSW 2305 Australia
- Division of Genetics, Hunter Area Pathology Service, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305 Australia
| | - Hiltrud Brauch
- University of Tübingen, Geschwister-Scholl-Platz, Tübingen, 72074 Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstraße 112, Stuttgart, 70376 Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Bürkle-de-la-Camp-Platz 1, Bochum, 44789 Germany
| | - Yon-Dschun Ko
- Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Johanniterstraße 3, Bonn, 53113 Germany
| | - Angela Cox
- Department of Oncology, CRUK/YCR Sheffield Cancer Research Centre, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Simon S Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ UK
| | - Malcolm WR Reed
- Department of Oncology, CRUK/YCR Sheffield Cancer Research Centre, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
| | - Katarzyna Jaworska-Bieniek
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
| | - Katarzyna Durda
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
| | - Jacek Gronwald
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
| | - Thilo Dörk
- Clinics of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
| | - Natalia Bogdanova
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
| | - Tjoung-Won Park-Simon
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Health Science Campus, 1975 San Pablo St., Los Angeles, 90033 CA USA
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Health Science Campus, 1975 San Pablo St., Los Angeles, 90033 CA USA
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Health Science Campus, 1975 San Pablo St., Los Angeles, 90033 CA USA
| | - Loic Le Marchand
- Epidemiology Program, Cancer Research Center, University of Hawaii, 701 Ilalo Street, Honolulu, 96813 HI USA
| | - Barbara Burwinkel
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120 Germany
- Molecular Epidemiology Group,, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Frederik Marme
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120 Germany
- National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Harald Surovy
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120 Germany
- Molecular Epidemiology Group,, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Rongxi Yang
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120 Germany
- Molecular Epidemiology Group,, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, 92697 CA USA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, 92697 CA USA
| | - Maartje J Hooning
- Department of Medical Oncology, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3008 AE Netherlands
| | - J Margriet Collée
- Department of Clinical Genetics, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3000 CA Netherlands
| | - John WM Martens
- Department of Medical Oncology, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3008 AE Netherlands
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Aida Karina Dieffenbach
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Volke Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Christa Stegmaier
- Saarland Cancer Registry, Präsident-Baltz-Straße 5, Saarbrücken, 66119 Germany
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Aapistie 5A, Oulu, FI-90220 Finland
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Aapistie 5A, Oulu, FI-90220 Finland
| | - Arja Jukkola-Vuorinen
- Department of Oncology, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
| | - Mervi Grip
- Department of Surgery, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
| | - Sara Margolin
- Department of Oncology and Pathology, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
| | - Vijai Joseph
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 417 East 68th Street, New York, 10021 NY USA
| | - Mark Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 417 East 68th Street, New York, 10021 NY USA
| | - Rohini Rau-Murthy
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 417 East 68th Street, New York, 10021 NY USA
| | - Anna González-Neira
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, 28029 Madrid, Spain
| | - José Ignacio Arias
- Servicio de Cirugía General y Especialidades, Hospital Monte Naranco, Av Doctores Fernández Vega, 107, Oviedo, 33012 Asturias, Spain
| | - Pilar Zamora
- Servicio de Oncología Médica, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046 Spain
| | - Javier Benítez
- Human Genetics Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, Madrid, 28029 Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Yliopistonranta 1C, Kuopio, FI-70211 Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
| | - Vesa Kataja
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Yliopistonranta 1C, Kuopio, FI-70211 Finland
- Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Yliopistonranta 1C, Kuopio, FI-70211 Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
| | - Jaana M Hartikainen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Yliopistonranta 1C, Kuopio, FI-70211 Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
| | - Paolo Peterlongo
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello, 16, Milan, 20139 Italy
| | - Daniela Zaffaroni
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian, 1, Milan, 20133 Italy
| | - Monica Barile
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Via Giuseppe Ripamonti, 435, Milan, 20141 Italy
| | - Fabio Capra
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello, 16, Milan, 20139 Italy
- Cogentech Cancer Genetic Test Laboratory, Via Adamello, 16, Milan, 20139 Italy
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian 1, Milan, 20133 Italy
| | - Soo H Teo
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, 1 Jalan SS 12/1a, Ss 12, Subang Jaya, Selangor Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, 50603 Malaysia
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Georgia Chenevix-Trench
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, 4006 QLD Australia
| | - David E Goldgar
- Department of Dermatology and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, 84112 UT USA
| | - EMBRACE Group
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, 4006 QLD Australia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstrasse 16-18, Leipzig, 04107 Germany
- Division of Gynaecology and Obstetrics, Technische Universität München, Ismaninger Straße 22, Munich, 81675 Germany
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians-Universität, Maistrasse 11, Munich, 80337 Germany
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- Institute of Human Genetics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Human Genetics, University Hospital Heidelberg, Im Neuenheimer Feld 366, Heidelberg, 69120 Germany
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081 Germany
- Institute of Cell and Molecular Pathology, Hannover Medical School, Hannover, Germany
- Institute of Human Genetics, University of Münster, Münster, Germany
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Human Genetics, Campus Virchov Klinikum, Charite Berlin, Germany
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Clinical Genetics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
- Department of Clinical Genetics, Southern General Hospital, 1345 Glovan Rd, Glasgow, G51 4TF UK
- West Midlands Regional Genetics Service, Birmingham Women’s Hospital Healthcare NHS Trust, Edgbaston, Birmingham UK
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian, 1, Milan, 20133 Italy
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Via Giuseppe Ripamonti, 435, Milan, 20141 Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello, 16, Milan, 20139 Italy
- Cogentech Cancer Genetic Test Laboratory, Via Adamello, 16, Milan, 20139 Italy
- Division of Experimental Oncology 1, CRO Aviano National Cancer Institute, Via Franco Gallini 2, Aviano, 33081 PN Italy
- Department of Medical Sciences, University of Turin, Via Santena 19, Turin, 10126 Italy
- AOU Città della Salute e della Scienza, corso Bramante 88, 10126 Turin Italy
- Unit of Medical Genetics, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Viale Pieraccini 6, Florence, 50139 Italy
- Unit of Hereditary Cancer, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, largo Rosanna Benzi 10, Genoa, 16132 Italy
- Western Sydney and Nepean Blue Mountains Local Health Districts, Westmead Millennium Institute for Medical Research, University of Sydney, 176 Hawkesbury Rd, Westmead, NSW 2145 Australia
- Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104 PA USA
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 417 East 68th Street, New York, 10021 NY USA
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
- Department of Health Sciences Research, Mayo Clinic, 13400 E. Scottsdale Blvd., Scottsdale, AZ USA
- Department of Clinical Genetics, Odense University Hospital, Sonder Boulevard 29, Odense, C, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgaardsvej 21C, Aarhus, N, Denmark
- Department of Clinical Genetics, Karolinska University Hospital L5:03, Stockholm, S-171 76 Sweden
- Department of Oncology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
- Department of Genetics and Genome Services, Case Western Reserve University Medical School, 2109 Adelbert Rd, Cleveland, 44106-4955 OH USA
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100 Denmark
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, IdISSC, Martin Lagos s/n, Madrid, Spain
- Beckman Research Institute of City of Hope, 1500 East Duarte Rd, Duarte, 91010 CA USA
- Divison of Human Cancer Genetics, Departments of Internal Medicine and Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State Universit, 998 Biomedical Research Tower, Columbus, OH USA
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, Padua, Italy
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA USA
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard,4019 Wahl Hall East, Kansas, MS 3040 KS USA
- Human Genetics Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, Madrid, 28029 Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
- Department of Pathology, University of Utah Health Sciences Center, 50 N Medical Dr, Salt Lake City, 84132 UT USA
- Department of Epidemiology, Columbia University, New York, NY USA
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 290 W, Los Angeles, CA USA
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Parkville, Victoria Australia
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 580, Heidelberg, 69120 Germany
- Department of Basic Sciences, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) 7A, Block R3, Johar, Pakistan
- 331 Brookline Avenue, Boston, 02215 MA USA
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX Netherlands
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, 90095 CA USA
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, Erlangen, 91054 Germany
- Institute of Human Genetics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Schlossplatz 4, Erlangen, 91054 Germany
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, 10833 Le Conte Ave, Los Angeles, 90024 CA USA
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, 2200 Denmark
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246 Germany
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Department of Pathology, Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS, Finland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, 20850 MD USA
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
- Cancer Prevention Institute of California, 2201 Walnut Avenue #300, Fremont, 94538 CA USA
- Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, 94305 CA USA
- Institute of Human Genetics, Pontificia University Javeriana, Carrera 7, Bogotá, 11001000 DC Colombia
- Frauenklinik der Stadtklinik Baden-Baden, Balger Straße 50, Baden-Baden, 76532 Germany
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Moltkestraße 90, Karlsruhe, 76133 Germany
- Department of Human Genetics & Department of Pathology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
- Department of Surgical Oncology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Centrer, Groene Hilledijk 301, EA Rotterdam, 3075 Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Einthovenweg 20, ZC Leiden, 2333 Netherlands
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ England
- Queen Mary University London, Mile End Road, London, E1 4NS England
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB UK
- Department of Molecular and Applied Biosciences, Faculty of Science and Technology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW UK
- Department of Pathology & Molecular Medicine, Juravinski Hospital, Concession St, Hamilton, L8V 1C3 Ontario Canada
- Cancer Centre, McMaster University, Hamilton, L8V 1C4 ON Canada
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
- Department of Pathology, University Health Network, Toronto, M5G 2C4 ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, The University of Melbourne, Level 1, 723 Swanston Street, Melbourne, 3010 Victoria Australia
- Anatomical Pathology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004 Victoria Australia
- Australian Breast Cancer Tissue Bank, Westmead Millennium Institute, University of Sydney, Darcy Rd, Sydney, NSW 2145 Australia
- Westmead Institute for Cancer Research, University of Sydney, Darcy Road, Sydney, NSW 2145 Australia
- Discipline of Medical Genetics, School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, University Drive, Callaghan, NSW 2305 Australia
- Division of Genetics, Hunter Area Pathology Service, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305 Australia
- University of Tübingen, Geschwister-Scholl-Platz, Tübingen, 72074 Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstraße 112, Stuttgart, 70376 Germany
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Bürkle-de-la-Camp-Platz 1, Bochum, 44789 Germany
- Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Johanniterstraße 3, Bonn, 53113 Germany
- Department of Oncology, CRUK/YCR Sheffield Cancer Research Centre, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ UK
- Clinics of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Health Science Campus, 1975 San Pablo St., Los Angeles, 90033 CA USA
- Epidemiology Program, Cancer Research Center, University of Hawaii, 701 Ilalo Street, Honolulu, 96813 HI USA
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120 Germany
- Molecular Epidemiology Group,, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, 92697 CA USA
- Department of Medical Oncology, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3008 AE Netherlands
- Department of Clinical Genetics, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3000 CA Netherlands
- Department of Surgical Oncology, Erasmus University Medical Center, Doctor Molewaterplein 50-60, Rotterdam, Netherlands
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Saarland Cancer Registry, Präsident-Baltz-Straße 5, Saarbrücken, 66119 Germany
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Aapistie 5A, Oulu, FI-90220 Finland
- Department of Oncology, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
- Department of Surgery, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, 28029 Madrid, Spain
- Servicio de Cirugía General y Especialidades, Hospital Monte Naranco, Av Doctores Fernández Vega, 107, Oviedo, 33012 Asturias, Spain
- Servicio de Oncología Médica, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046 Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Yliopistonranta 1C, Kuopio, FI-70211 Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
- Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian 1, Milan, 20133 Italy
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, 1 Jalan SS 12/1a, Ss 12, Subang Jaya, Selangor Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, 50603 Malaysia
- Department of Dermatology and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, 84112 UT USA
| | - GENICA Network
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, 4006 QLD Australia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstrasse 16-18, Leipzig, 04107 Germany
- Division of Gynaecology and Obstetrics, Technische Universität München, Ismaninger Straße 22, Munich, 81675 Germany
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians-Universität, Maistrasse 11, Munich, 80337 Germany
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- Institute of Human Genetics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Human Genetics, University Hospital Heidelberg, Im Neuenheimer Feld 366, Heidelberg, 69120 Germany
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081 Germany
- Institute of Cell and Molecular Pathology, Hannover Medical School, Hannover, Germany
- Institute of Human Genetics, University of Münster, Münster, Germany
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Human Genetics, Campus Virchov Klinikum, Charite Berlin, Germany
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Clinical Genetics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
- Department of Clinical Genetics, Southern General Hospital, 1345 Glovan Rd, Glasgow, G51 4TF UK
- West Midlands Regional Genetics Service, Birmingham Women’s Hospital Healthcare NHS Trust, Edgbaston, Birmingham UK
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian, 1, Milan, 20133 Italy
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Via Giuseppe Ripamonti, 435, Milan, 20141 Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello, 16, Milan, 20139 Italy
- Cogentech Cancer Genetic Test Laboratory, Via Adamello, 16, Milan, 20139 Italy
- Division of Experimental Oncology 1, CRO Aviano National Cancer Institute, Via Franco Gallini 2, Aviano, 33081 PN Italy
- Department of Medical Sciences, University of Turin, Via Santena 19, Turin, 10126 Italy
- AOU Città della Salute e della Scienza, corso Bramante 88, 10126 Turin Italy
- Unit of Medical Genetics, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Viale Pieraccini 6, Florence, 50139 Italy
- Unit of Hereditary Cancer, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, largo Rosanna Benzi 10, Genoa, 16132 Italy
- Western Sydney and Nepean Blue Mountains Local Health Districts, Westmead Millennium Institute for Medical Research, University of Sydney, 176 Hawkesbury Rd, Westmead, NSW 2145 Australia
- Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104 PA USA
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 417 East 68th Street, New York, 10021 NY USA
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
- Department of Health Sciences Research, Mayo Clinic, 13400 E. Scottsdale Blvd., Scottsdale, AZ USA
- Department of Clinical Genetics, Odense University Hospital, Sonder Boulevard 29, Odense, C, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgaardsvej 21C, Aarhus, N, Denmark
- Department of Clinical Genetics, Karolinska University Hospital L5:03, Stockholm, S-171 76 Sweden
- Department of Oncology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
- Department of Genetics and Genome Services, Case Western Reserve University Medical School, 2109 Adelbert Rd, Cleveland, 44106-4955 OH USA
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100 Denmark
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, IdISSC, Martin Lagos s/n, Madrid, Spain
- Beckman Research Institute of City of Hope, 1500 East Duarte Rd, Duarte, 91010 CA USA
- Divison of Human Cancer Genetics, Departments of Internal Medicine and Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State Universit, 998 Biomedical Research Tower, Columbus, OH USA
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, Padua, Italy
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA USA
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard,4019 Wahl Hall East, Kansas, MS 3040 KS USA
- Human Genetics Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, Madrid, 28029 Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
- Department of Pathology, University of Utah Health Sciences Center, 50 N Medical Dr, Salt Lake City, 84132 UT USA
- Department of Epidemiology, Columbia University, New York, NY USA
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 290 W, Los Angeles, CA USA
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Parkville, Victoria Australia
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 580, Heidelberg, 69120 Germany
- Department of Basic Sciences, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) 7A, Block R3, Johar, Pakistan
- 331 Brookline Avenue, Boston, 02215 MA USA
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX Netherlands
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, 90095 CA USA
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, Erlangen, 91054 Germany
- Institute of Human Genetics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Schlossplatz 4, Erlangen, 91054 Germany
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, 10833 Le Conte Ave, Los Angeles, 90024 CA USA
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, 2200 Denmark
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246 Germany
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Department of Pathology, Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS, Finland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, 20850 MD USA
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
- Cancer Prevention Institute of California, 2201 Walnut Avenue #300, Fremont, 94538 CA USA
- Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, 94305 CA USA
- Institute of Human Genetics, Pontificia University Javeriana, Carrera 7, Bogotá, 11001000 DC Colombia
- Frauenklinik der Stadtklinik Baden-Baden, Balger Straße 50, Baden-Baden, 76532 Germany
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Moltkestraße 90, Karlsruhe, 76133 Germany
- Department of Human Genetics & Department of Pathology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
- Department of Surgical Oncology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Centrer, Groene Hilledijk 301, EA Rotterdam, 3075 Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Einthovenweg 20, ZC Leiden, 2333 Netherlands
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ England
- Queen Mary University London, Mile End Road, London, E1 4NS England
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB UK
- Department of Molecular and Applied Biosciences, Faculty of Science and Technology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW UK
- Department of Pathology & Molecular Medicine, Juravinski Hospital, Concession St, Hamilton, L8V 1C3 Ontario Canada
- Cancer Centre, McMaster University, Hamilton, L8V 1C4 ON Canada
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
- Department of Pathology, University Health Network, Toronto, M5G 2C4 ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, The University of Melbourne, Level 1, 723 Swanston Street, Melbourne, 3010 Victoria Australia
- Anatomical Pathology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004 Victoria Australia
- Australian Breast Cancer Tissue Bank, Westmead Millennium Institute, University of Sydney, Darcy Rd, Sydney, NSW 2145 Australia
- Westmead Institute for Cancer Research, University of Sydney, Darcy Road, Sydney, NSW 2145 Australia
- Discipline of Medical Genetics, School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, University Drive, Callaghan, NSW 2305 Australia
- Division of Genetics, Hunter Area Pathology Service, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305 Australia
- University of Tübingen, Geschwister-Scholl-Platz, Tübingen, 72074 Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstraße 112, Stuttgart, 70376 Germany
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Bürkle-de-la-Camp-Platz 1, Bochum, 44789 Germany
- Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Johanniterstraße 3, Bonn, 53113 Germany
- Department of Oncology, CRUK/YCR Sheffield Cancer Research Centre, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ UK
- Clinics of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Health Science Campus, 1975 San Pablo St., Los Angeles, 90033 CA USA
- Epidemiology Program, Cancer Research Center, University of Hawaii, 701 Ilalo Street, Honolulu, 96813 HI USA
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120 Germany
- Molecular Epidemiology Group,, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, 92697 CA USA
- Department of Medical Oncology, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3008 AE Netherlands
- Department of Clinical Genetics, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3000 CA Netherlands
- Department of Surgical Oncology, Erasmus University Medical Center, Doctor Molewaterplein 50-60, Rotterdam, Netherlands
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Saarland Cancer Registry, Präsident-Baltz-Straße 5, Saarbrücken, 66119 Germany
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Aapistie 5A, Oulu, FI-90220 Finland
- Department of Oncology, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
- Department of Surgery, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, 28029 Madrid, Spain
- Servicio de Cirugía General y Especialidades, Hospital Monte Naranco, Av Doctores Fernández Vega, 107, Oviedo, 33012 Asturias, Spain
- Servicio de Oncología Médica, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046 Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Yliopistonranta 1C, Kuopio, FI-70211 Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
- Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian 1, Milan, 20133 Italy
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, 1 Jalan SS 12/1a, Ss 12, Subang Jaya, Selangor Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, 50603 Malaysia
- Department of Dermatology and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, 84112 UT USA
| | - HEBON Group
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, 4006 QLD Australia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstrasse 16-18, Leipzig, 04107 Germany
- Division of Gynaecology and Obstetrics, Technische Universität München, Ismaninger Straße 22, Munich, 81675 Germany
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians-Universität, Maistrasse 11, Munich, 80337 Germany
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- Institute of Human Genetics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Human Genetics, University Hospital Heidelberg, Im Neuenheimer Feld 366, Heidelberg, 69120 Germany
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081 Germany
- Institute of Cell and Molecular Pathology, Hannover Medical School, Hannover, Germany
- Institute of Human Genetics, University of Münster, Münster, Germany
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Human Genetics, Campus Virchov Klinikum, Charite Berlin, Germany
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Clinical Genetics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
- Department of Clinical Genetics, Southern General Hospital, 1345 Glovan Rd, Glasgow, G51 4TF UK
- West Midlands Regional Genetics Service, Birmingham Women’s Hospital Healthcare NHS Trust, Edgbaston, Birmingham UK
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian, 1, Milan, 20133 Italy
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Via Giuseppe Ripamonti, 435, Milan, 20141 Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello, 16, Milan, 20139 Italy
- Cogentech Cancer Genetic Test Laboratory, Via Adamello, 16, Milan, 20139 Italy
- Division of Experimental Oncology 1, CRO Aviano National Cancer Institute, Via Franco Gallini 2, Aviano, 33081 PN Italy
- Department of Medical Sciences, University of Turin, Via Santena 19, Turin, 10126 Italy
- AOU Città della Salute e della Scienza, corso Bramante 88, 10126 Turin Italy
- Unit of Medical Genetics, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Viale Pieraccini 6, Florence, 50139 Italy
- Unit of Hereditary Cancer, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, largo Rosanna Benzi 10, Genoa, 16132 Italy
- Western Sydney and Nepean Blue Mountains Local Health Districts, Westmead Millennium Institute for Medical Research, University of Sydney, 176 Hawkesbury Rd, Westmead, NSW 2145 Australia
- Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104 PA USA
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 417 East 68th Street, New York, 10021 NY USA
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
- Department of Health Sciences Research, Mayo Clinic, 13400 E. Scottsdale Blvd., Scottsdale, AZ USA
- Department of Clinical Genetics, Odense University Hospital, Sonder Boulevard 29, Odense, C, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgaardsvej 21C, Aarhus, N, Denmark
- Department of Clinical Genetics, Karolinska University Hospital L5:03, Stockholm, S-171 76 Sweden
- Department of Oncology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
- Department of Genetics and Genome Services, Case Western Reserve University Medical School, 2109 Adelbert Rd, Cleveland, 44106-4955 OH USA
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100 Denmark
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, IdISSC, Martin Lagos s/n, Madrid, Spain
- Beckman Research Institute of City of Hope, 1500 East Duarte Rd, Duarte, 91010 CA USA
- Divison of Human Cancer Genetics, Departments of Internal Medicine and Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State Universit, 998 Biomedical Research Tower, Columbus, OH USA
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, Padua, Italy
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA USA
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard,4019 Wahl Hall East, Kansas, MS 3040 KS USA
- Human Genetics Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, Madrid, 28029 Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
- Department of Pathology, University of Utah Health Sciences Center, 50 N Medical Dr, Salt Lake City, 84132 UT USA
- Department of Epidemiology, Columbia University, New York, NY USA
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 290 W, Los Angeles, CA USA
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Parkville, Victoria Australia
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 580, Heidelberg, 69120 Germany
- Department of Basic Sciences, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) 7A, Block R3, Johar, Pakistan
- 331 Brookline Avenue, Boston, 02215 MA USA
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX Netherlands
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, 90095 CA USA
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, Erlangen, 91054 Germany
- Institute of Human Genetics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Schlossplatz 4, Erlangen, 91054 Germany
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, 10833 Le Conte Ave, Los Angeles, 90024 CA USA
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, 2200 Denmark
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246 Germany
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Department of Pathology, Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS, Finland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, 20850 MD USA
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
- Cancer Prevention Institute of California, 2201 Walnut Avenue #300, Fremont, 94538 CA USA
- Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, 94305 CA USA
- Institute of Human Genetics, Pontificia University Javeriana, Carrera 7, Bogotá, 11001000 DC Colombia
- Frauenklinik der Stadtklinik Baden-Baden, Balger Straße 50, Baden-Baden, 76532 Germany
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Moltkestraße 90, Karlsruhe, 76133 Germany
- Department of Human Genetics & Department of Pathology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
- Department of Surgical Oncology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Centrer, Groene Hilledijk 301, EA Rotterdam, 3075 Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Einthovenweg 20, ZC Leiden, 2333 Netherlands
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ England
- Queen Mary University London, Mile End Road, London, E1 4NS England
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB UK
- Department of Molecular and Applied Biosciences, Faculty of Science and Technology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW UK
- Department of Pathology & Molecular Medicine, Juravinski Hospital, Concession St, Hamilton, L8V 1C3 Ontario Canada
- Cancer Centre, McMaster University, Hamilton, L8V 1C4 ON Canada
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
- Department of Pathology, University Health Network, Toronto, M5G 2C4 ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, The University of Melbourne, Level 1, 723 Swanston Street, Melbourne, 3010 Victoria Australia
- Anatomical Pathology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004 Victoria Australia
- Australian Breast Cancer Tissue Bank, Westmead Millennium Institute, University of Sydney, Darcy Rd, Sydney, NSW 2145 Australia
- Westmead Institute for Cancer Research, University of Sydney, Darcy Road, Sydney, NSW 2145 Australia
- Discipline of Medical Genetics, School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, University Drive, Callaghan, NSW 2305 Australia
- Division of Genetics, Hunter Area Pathology Service, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305 Australia
- University of Tübingen, Geschwister-Scholl-Platz, Tübingen, 72074 Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstraße 112, Stuttgart, 70376 Germany
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Bürkle-de-la-Camp-Platz 1, Bochum, 44789 Germany
- Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Johanniterstraße 3, Bonn, 53113 Germany
- Department of Oncology, CRUK/YCR Sheffield Cancer Research Centre, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ UK
- Clinics of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Health Science Campus, 1975 San Pablo St., Los Angeles, 90033 CA USA
- Epidemiology Program, Cancer Research Center, University of Hawaii, 701 Ilalo Street, Honolulu, 96813 HI USA
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120 Germany
- Molecular Epidemiology Group,, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, 92697 CA USA
- Department of Medical Oncology, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3008 AE Netherlands
- Department of Clinical Genetics, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3000 CA Netherlands
- Department of Surgical Oncology, Erasmus University Medical Center, Doctor Molewaterplein 50-60, Rotterdam, Netherlands
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Saarland Cancer Registry, Präsident-Baltz-Straße 5, Saarbrücken, 66119 Germany
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Aapistie 5A, Oulu, FI-90220 Finland
- Department of Oncology, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
- Department of Surgery, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, 28029 Madrid, Spain
- Servicio de Cirugía General y Especialidades, Hospital Monte Naranco, Av Doctores Fernández Vega, 107, Oviedo, 33012 Asturias, Spain
- Servicio de Oncología Médica, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046 Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Yliopistonranta 1C, Kuopio, FI-70211 Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
- Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian 1, Milan, 20133 Italy
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, 1 Jalan SS 12/1a, Ss 12, Subang Jaya, Selangor Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, 50603 Malaysia
- Department of Dermatology and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, 84112 UT USA
| | - kConFab Investigators
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, 4006 QLD Australia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstrasse 16-18, Leipzig, 04107 Germany
- Division of Gynaecology and Obstetrics, Technische Universität München, Ismaninger Straße 22, Munich, 81675 Germany
- Department of Gynaecology and Obstetrics, Ludwig-Maximilians-Universität, Maistrasse 11, Munich, 80337 Germany
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- Institute of Human Genetics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
- University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Human Genetics, University Hospital Heidelberg, Im Neuenheimer Feld 366, Heidelberg, 69120 Germany
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081 Germany
- Institute of Cell and Molecular Pathology, Hannover Medical School, Hannover, Germany
- Institute of Human Genetics, University of Münster, Münster, Germany
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Human Genetics, Campus Virchov Klinikum, Charite Berlin, Germany
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Clinical Genetics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
- Department of Clinical Genetics, Southern General Hospital, 1345 Glovan Rd, Glasgow, G51 4TF UK
- West Midlands Regional Genetics Service, Birmingham Women’s Hospital Healthcare NHS Trust, Edgbaston, Birmingham UK
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian, 1, Milan, 20133 Italy
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia (IEO), Via Giuseppe Ripamonti, 435, Milan, 20141 Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello, 16, Milan, 20139 Italy
- Cogentech Cancer Genetic Test Laboratory, Via Adamello, 16, Milan, 20139 Italy
- Division of Experimental Oncology 1, CRO Aviano National Cancer Institute, Via Franco Gallini 2, Aviano, 33081 PN Italy
- Department of Medical Sciences, University of Turin, Via Santena 19, Turin, 10126 Italy
- AOU Città della Salute e della Scienza, corso Bramante 88, 10126 Turin Italy
- Unit of Medical Genetics, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Viale Pieraccini 6, Florence, 50139 Italy
- Unit of Hereditary Cancer, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, largo Rosanna Benzi 10, Genoa, 16132 Italy
- Western Sydney and Nepean Blue Mountains Local Health Districts, Westmead Millennium Institute for Medical Research, University of Sydney, 176 Hawkesbury Rd, Westmead, NSW 2145 Australia
- Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, 19104 PA USA
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 417 East 68th Street, New York, 10021 NY USA
- Department of Genetics and Pathology, Pomeranian Medical University, Połabska 4, Szczecin, 70-115 Poland
- Department of Health Sciences Research, Mayo Clinic, 13400 E. Scottsdale Blvd., Scottsdale, AZ USA
- Department of Clinical Genetics, Odense University Hospital, Sonder Boulevard 29, Odense, C, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgaardsvej 21C, Aarhus, N, Denmark
- Department of Clinical Genetics, Karolinska University Hospital L5:03, Stockholm, S-171 76 Sweden
- Department of Oncology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
- Department of Genetics and Genome Services, Case Western Reserve University Medical School, 2109 Adelbert Rd, Cleveland, 44106-4955 OH USA
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100 Denmark
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, IdISSC, Martin Lagos s/n, Madrid, Spain
- Beckman Research Institute of City of Hope, 1500 East Duarte Rd, Duarte, 91010 CA USA
- Divison of Human Cancer Genetics, Departments of Internal Medicine and Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State Universit, 998 Biomedical Research Tower, Columbus, OH USA
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, Padua, Italy
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA USA
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard,4019 Wahl Hall East, Kansas, MS 3040 KS USA
- Human Genetics Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, Madrid, 28029 Spain
- Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
- Department of Pathology, University of Utah Health Sciences Center, 50 N Medical Dr, Salt Lake City, 84132 UT USA
- Department of Epidemiology, Columbia University, New York, NY USA
- Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 290 W, Los Angeles, CA USA
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Parkville, Victoria Australia
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 580, Heidelberg, 69120 Germany
- Department of Basic Sciences, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) 7A, Block R3, Johar, Pakistan
- 331 Brookline Avenue, Boston, 02215 MA USA
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX Netherlands
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, 90095 CA USA
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, Erlangen, 91054 Germany
- Institute of Human Genetics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Schlossplatz 4, Erlangen, 91054 Germany
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, 10833 Le Conte Ave, Los Angeles, 90024 CA USA
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, 2200 Denmark
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 74, Herlev, 2730 Denmark
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246 Germany
- Department of Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Department of Pathology, Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS Finland
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Haartmaninkatu 8, Helsinki, FI-00029 HUS, Finland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, 20850 MD USA
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, 55905 MN USA
- Cancer Prevention Institute of California, 2201 Walnut Avenue #300, Fremont, 94538 CA USA
- Department of Health Research and Policy, Stanford University School of Medicine, 291 Campus Drive, Stanford, 94305 CA USA
- Institute of Human Genetics, Pontificia University Javeriana, Carrera 7, Bogotá, 11001000 DC Colombia
- Frauenklinik der Stadtklinik Baden-Baden, Balger Straße 50, Baden-Baden, 76532 Germany
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Moltkestraße 90, Karlsruhe, 76133 Germany
- Department of Human Genetics & Department of Pathology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
- Department of Surgical Oncology, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333 ZC Netherlands
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Centrer, Groene Hilledijk 301, EA Rotterdam, 3075 Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Einthovenweg 20, ZC Leiden, 2333 Netherlands
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ England
- Queen Mary University London, Mile End Road, London, E1 4NS England
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB UK
- Department of Molecular and Applied Biosciences, Faculty of Science and Technology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW UK
- Department of Pathology & Molecular Medicine, Juravinski Hospital, Concession St, Hamilton, L8V 1C3 Ontario Canada
- Cancer Centre, McMaster University, Hamilton, L8V 1C4 ON Canada
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5 ON Canada
- Department of Pathology, University Health Network, Toronto, M5G 2C4 ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Toronto, M5S 1A8 ON Canada
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004 Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, The University of Melbourne, Level 1, 723 Swanston Street, Melbourne, 3010 Victoria Australia
- Anatomical Pathology, The Alfred Hospital, 55 Commercial Rd, Melbourne, 3004 Victoria Australia
- Australian Breast Cancer Tissue Bank, Westmead Millennium Institute, University of Sydney, Darcy Rd, Sydney, NSW 2145 Australia
- Westmead Institute for Cancer Research, University of Sydney, Darcy Road, Sydney, NSW 2145 Australia
- Discipline of Medical Genetics, School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, University Drive, Callaghan, NSW 2305 Australia
- Division of Genetics, Hunter Area Pathology Service, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2305 Australia
- University of Tübingen, Geschwister-Scholl-Platz, Tübingen, 72074 Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstraße 112, Stuttgart, 70376 Germany
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Bürkle-de-la-Camp-Platz 1, Bochum, 44789 Germany
- Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Johanniterstraße 3, Bonn, 53113 Germany
- Department of Oncology, CRUK/YCR Sheffield Cancer Research Centre, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ UK
- Clinics of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625 Germany
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Health Science Campus, 1975 San Pablo St., Los Angeles, 90033 CA USA
- Epidemiology Program, Cancer Research Center, University of Hawaii, 701 Ilalo Street, Honolulu, 96813 HI USA
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120 Germany
- Molecular Epidemiology Group,, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, 92697 CA USA
- Department of Medical Oncology, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3008 AE Netherlands
- Department of Clinical Genetics, Family Cancer Clinic, Erasmus University Medical Center, Rotterdam, 3000 CA Netherlands
- Department of Surgical Oncology, Erasmus University Medical Center, Doctor Molewaterplein 50-60, Rotterdam, Netherlands
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
- Saarland Cancer Registry, Präsident-Baltz-Straße 5, Saarbrücken, 66119 Germany
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Aapistie 5A, Oulu, FI-90220 Finland
- Department of Oncology, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
- Department of Surgery, Oulu University Hospital, University of Oulu, Kajaanintie 50, Oulu, FI-90220 Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177 Sweden
- Human Genotyping-CEGEN Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), C/Melchor Fernández, Almagro 3, 28029 Madrid, Spain
- Servicio de Cirugía General y Especialidades, Hospital Monte Naranco, Av Doctores Fernández Vega, 107, Oviedo, 33012 Asturias, Spain
- Servicio de Oncología Médica, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046 Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Yliopistonranta 1C, Kuopio, FI-70211 Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
- Cancer Center, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70210 Finland
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Via Giacomo Venezian 1, Milan, 20133 Italy
- Cancer Research Initiatives Foundation, Sime Darby Medical Centre, 1 Jalan SS 12/1a, Ss 12, Subang Jaya, Selangor Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, 50603 Malaysia
- Department of Dermatology and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, 84112 UT USA
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12
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Wishart GC, Rakha E, Green A, Ellis I, Ali HR, Provenzano E, Blows FM, Caldas C, Pharoah PDP. Inclusion of KI67 significantly improves performance of the PREDICT prognostication and prediction model for early breast cancer. BMC Cancer 2014; 14:908. [PMID: 25472026 PMCID: PMC4265394 DOI: 10.1186/1471-2407-14-908] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND PREDICT (http://www.predict.nhs.uk) is a prognostication and treatment benefit tool for early breast cancer (EBC). The aim of this study was to incorporate the prognostic effect of KI67 status in a new version (v3), and compare performance with the Predict model that includes HER2 status (v2). METHODS The validation study was based on 1,726 patients with EBC treated in Nottingham between 1989 and 1998. KI67 positivity for PREDICT is defined as >10% of tumour cells staining positive. ROC curves were constructed for Predict models with (v3) and without (v2) KI67 input. Comparison was made using the method of DeLong. RESULTS In 1274 ER+ patients the predicted number of events at 10 years increased from 196 for v2 to 204 for v3 compared to 221 observed. The area under the ROC curve (AUC) improved from 0.7611 to 0.7676 (p=0.005) in ER+ patients and from 0.7546 to 0.7595 (p=0.0008) in all 1726 patients (ER+ and ER-). CONCLUSION Addition of KI67 to PREDICT has led to a statistically significant improvement in the model performance for ER+ patients and will aid clinical decision making in these patients. Further studies should determine whether other markers including gene expression profiling provide additional prognostic information to that provided by PREDICT.
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Affiliation(s)
- Gordon C Wishart
- />Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge, UK
| | - Emad Rakha
- />Division of Oncology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew Green
- />Division of Oncology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ian Ellis
- />Division of Oncology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Hamid Raza Ali
- />Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN UK
| | - Elena Provenzano
- />Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN UK
| | - Fiona M Blows
- />Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN UK
| | - Carlos Caldas
- />Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN UK
| | - Paul DP Pharoah
- />Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN UK
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13
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Ali HR, Provenzano E, Dawson SJ, Blows FM, Liu B, Shah M, Earl HM, Poole CJ, Hiller L, Dunn JA, Bowden SJ, Twelves C, Bartlett JMS, Mahmoud SMA, Rakha E, Ellis IO, Liu S, Gao D, Nielsen TO, Pharoah PDP, Caldas C. Association between CD8+ T-cell infiltration and breast cancer survival in 12,439 patients. Ann Oncol 2014; 25:1536-43. [PMID: 24915873 DOI: 10.1093/annonc/mdu191] [Citation(s) in RCA: 521] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND T-cell infiltration in estrogen receptor (ER)-negative breast tumours has been associated with longer survival. To investigate this association and the potential of tumour T-cell infiltration as a prognostic and predictive marker, we have conducted the largest study of T cells in breast cancer to date. PATIENTS AND METHODS Four studies totalling 12 439 patients were used for this work. Cytotoxic (CD8+) and regulatory (forkhead box protein 3, FOXP3+) T cells were quantified using immunohistochemistry (IHC). IHC for CD8 was conducted using available material from all four studies (8978 samples) and for FOXP3 from three studies (5239 samples)-multiple imputation was used to resolve missing data from the remaining patients. Cox regression was used to test for associations with breast cancer-specific survival. RESULTS In ER-negative tumours [triple-negative breast cancer and human epidermal growth factor receptor 2 (human epidermal growth factor receptor 2 (HER2) positive)], presence of CD8+ T cells within the tumour was associated with a 28% [95% confidence interval (CI) 16% to 38%] reduction in the hazard of breast cancer-specific mortality, and CD8+ T cells within the stroma with a 21% (95% CI 7% to 33%) reduction in hazard. In ER-positive HER2-positive tumours, CD8+ T cells within the tumour were associated with a 27% (95% CI 4% to 44%) reduction in hazard. In ER-negative disease, there was evidence for greater benefit from anthracyclines in the National Epirubicin Adjuvant Trial in patients with CD8+ tumours [hazard ratio (HR) = 0.54; 95% CI 0.37-0.79] versus CD8-negative tumours (HR = 0.87; 95% CI 0.55-1.38). The difference in effect between these subgroups was significant when limited to cases with complete data (P heterogeneity = 0.04) and approached significance in imputed data (P heterogeneity = 0.1). CONCLUSIONS The presence of CD8+ T cells in breast cancer is associated with a significant reduction in the relative risk of death from disease in both the ER-negative [supplementary Figure S1, available at Annals of Oncology online] and the ER-positive HER2-positive subtypes. Tumour lymphocytic infiltration may improve risk stratification in breast cancer patients classified into these subtypes. NEAT ClinicalTrials.gov: NCT00003577.
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Affiliation(s)
- H R Ali
- Cancer Research UK Cambridge Institute Departments of Pathology Oncology, University of Cambridge, Cambridge
| | - E Provenzano
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge
| | - S-J Dawson
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - F M Blows
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - B Liu
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - M Shah
- Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge Strangeways Research Laboratory, Cambridge
| | - H M Earl
- Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - C J Poole
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - L Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - S J Bowden
- Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, The University of Birmingham, Birmingham
| | - C Twelves
- University of Leeds and Leeds Cancer Research UK Centre, St James' Institute of Oncology, Leeds, UK
| | - J M S Bartlett
- Ontario Institute for Cancer Research, Toronto, Canada and Biomarker and Companion Diagnostics, Edinburgh Cancer Research Centre, Edinburgh Department of Histopathology and School of Molecular Medical Sciences, The University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S M A Mahmoud
- Department of Pathology and Laboratory Medicine, University of British Columbia; Integrative Oncology Department, British Columbia Cancer Agency, Vancouver
| | - E Rakha
- Department of Pathology and Laboratory Medicine, University of British Columbia; Integrative Oncology Department, British Columbia Cancer Agency, Vancouver
| | - I O Ellis
- Department of Pathology and Laboratory Medicine, University of British Columbia; Integrative Oncology Department, British Columbia Cancer Agency, Vancouver
| | - S Liu
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - D Gao
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - T O Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - P D P Pharoah
- Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge Strangeways Research Laboratory, Cambridge
| | - C Caldas
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
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14
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Horne HN, Sherman ME, Garcia-Closas M, Pharoah PD, Blows FM, Yang XR, Hewitt SM, Conway CM, Lissowska J, Brinton LA, Prokunina-Olsson L, Dawson SJ, Caldas C, Easton DF, Chanock SJ, Figueroa JD. Breast cancer susceptibility risk associations and heterogeneity by E-cadherin tumor tissue expression. Breast Cancer Res Treat 2014; 143:181-7. [PMID: 24292867 PMCID: PMC4159747 DOI: 10.1007/s10549-013-2771-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/09/2013] [Indexed: 10/26/2022]
Abstract
E-cadherin is involved in cell-cell adhesion and epithelial-to-mesenchymal transitions. In cancers, loss or inactivation of E-cadherin is associated with epithelial cell proliferation and invasion. Here, we sought to determine, if risk associations for 18 breast cancer susceptibility single nucleotide polymorphisms (SNPs) differed by E-cadherin tumor tissue expression in the Polish Breast Cancer Study (PBCS), using data on 1,347 invasive breast cancer cases and 2,366 controls. E-cadherin expression (low/high) was assessed using immunohistochemical staining of tumor tissue microarrays. Replication data on 2,006 cases and 6,714 controls from the Study of Epidemiology and Risk Factors in Cancer Heredity was used to follow-up promising findings from PBCS. In PBCS, we found the rs11249433 SNP at the 1p11.2 locus to be more strongly associated with risk of E-cadherin low tumors (OR = 1.30, 95 % CI = 1.08-1.56) than with E-cadherin high tumors [OR = 1.06, 95 % CI = 0.95-1.18; case-only p-heterogeneity (p-het) = 0.05]. Findings in PBCS for rs11249433 were replicated in SEARCH. Combined analyses of the two datasets for SNP rs11249433 revealed significant heterogeneity by E-cadherin expression (combined case-only p-het = 0.004). Further, among carriers of rs11249433, the highest risk was seen for E-cadherin low tumors that were ER-positive and of lobular histology. Our results in two independent data sets suggest that rs11249433, which is located between the NOTCH2 and FCGR1B genes within the 1p11.2 locus, is more strongly associated with risk of breast tumors with low or absent E-cadherin expression, and suggest that evaluation of E-cadherin tumor tissue expression may be useful in clarifying breast cancer risk factor associations.
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Affiliation(s)
- Hisani N Horne
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA,
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15
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Sieh W, Köbel M, Longacre TA, Bowtell DD, deFazio A, Goodman MT, Høgdall E, Deen S, Wentzensen N, Moysich KB, Brenton JD, Clarke B, Menon U, Gilks CB, Kim A, Madore J, Fereday S, George J, Galletta L, Lurie G, Wilkens LR, Carney ME, Thompson PJ, Matsuno RK, Kjær SK, Jensen A, Høgdall C, Kalli KR, Fridley BL, Keeney GL, Vierkant RA, Cunningham JM, Brinton LA, Yang HP, Sherman ME, Garcia-Closas M, Lissowska J, Odunsi K, Morrison C, Lele S, Bshara W, Sucheston L, Jimenez-Linan M, Blows FM, Alsop J, Mack M, McGuire V, Rothstein JH, Rosen BP, Bernardini MQ, Mackay H, Oza A, Wozniak EL, Benjamin E, Gentry-Maharaj A, Gayther SA, Tinker AV, Prentice LM, Chow C, Anglesio MS, Johnatty SE, Chenevix-Trench G, Whittemore AS, Pharoah PDP, Goode EL, Huntsman DG, Ramus SJ. Hormone-receptor expression and ovarian cancer survival: an Ovarian Tumor Tissue Analysis consortium study. Lancet Oncol 2013; 14:853-62. [PMID: 23845225 PMCID: PMC4006367 DOI: 10.1016/s1470-2045(13)70253-5] [Citation(s) in RCA: 312] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few biomarkers of ovarian cancer prognosis have been established, partly because subtype-specific associations might be obscured in studies combining all histopathological subtypes. We examined whether tumour expression of the progesterone receptor (PR) and oestrogen receptor (ER) was associated with subtype-specific survival. METHODS 12 studies participating in the Ovarian Tumor Tissue Analysis consortium contributed tissue microarray sections and clinical data to our study. Participants included in our analysis had been diagnosed with invasive serous, mucinous, endometrioid, or clear-cell carcinomas of the ovary. For a patient to be eligible, tissue microarrays, clinical follow-up data, age at diagnosis, and tumour grade and stage had to be available. Clinical data were obtained from medical records, cancer registries, death certificates, pathology reports, and review of histological slides. PR and ER statuses were assessed by central immunohistochemistry analysis done by masked pathologists. PR and ER staining was defined as negative (<1% tumour cell nuclei), weak (1 to <50%), or strong (≥50%). Associations with disease-specific survival were assessed. FINDINGS 2933 women with invasive epithelial ovarian cancer were included: 1742 with high-grade serous carcinoma, 110 with low-grade serous carcinoma, 207 with mucinous carcinoma, 484 with endometrioid carcinoma, and 390 with clear-cell carcinoma. PR expression was associated with improved disease-specific survival in endometrioid carcinoma (log-rank p<0·0001) and high-grade serous carcinoma (log-rank p=0·0006), and ER expression was associated with improved disease-specific survival in endometrioid carcinoma (log-rank p<0·0001). We recorded no significant associations for mucinous, clear-cell, or low-grade serous carcinoma. Positive hormone-receptor expression (weak or strong staining for PR or ER, or both) was associated with significantly improved disease-specific survival in endometrioid carcinoma compared with negative hormone-receptor expression, independent of study site, age, stage, and grade (hazard ratio 0·33, 95% CI 0·21-0·51; p<0·0001). Strong PR expression was independently associated with improved disease-specific survival in high-grade serous carcinoma (0·71, 0·55-0·91; p=0·0080), but weak PR expression was not (1·02, 0·89-1·18; p=0·74). INTERPRETATION PR and ER are prognostic biomarkers for endometrioid and high-grade serous ovarian cancers. Clinical trials, stratified by subtype and biomarker status, are needed to establish whether hormone-receptor status predicts response to endocrine treatment, and whether it could guide personalised treatment for ovarian cancer. FUNDING Carraresi Foundation and others.
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MESH Headings
- Adenocarcinoma, Clear Cell/metabolism
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Biomarkers, Tumor/metabolism
- Carcinoma, Endometrioid/metabolism
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/pathology
- Case-Control Studies
- Cystadenocarcinoma, Serous/metabolism
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Female
- Follow-Up Studies
- Humans
- Immunoenzyme Techniques
- Middle Aged
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Staging
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovary/metabolism
- Ovary/pathology
- Prognosis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Survival Rate
- Tissue Array Analysis
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Affiliation(s)
- Weiva Sieh
- Department of Health Research and Policy, Division of Epidemiology, Stanford University, Stanford, CA, USA
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
| | | | - David D. Bowtell
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Anna deFazio
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, New South Wales, Australia
| | - Marc T. Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Estrid Høgdall
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Suha Deen
- Department of Histopathology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Kirsten B. Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - James D. Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Blaise Clarke
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Usha Menon
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, London, UK
| | - C. Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Genetic Pathology Evaluation Centre, Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Andre Kim
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason Madore
- Centre For Translational and Applied Genomics, British Columbia Cancer Agency, Vancouver, Canada
| | - Sian Fereday
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Joshy George
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Laura Galletta
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Galina Lurie
- Cancer Center, University of Hawaii, Honolulu, HI, USA
| | | | | | - Pamela J. Thompson
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Susanne Krüger Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Claus Høgdall
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen, Denmark
| | | | - Brooke L. Fridley
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gary L. Keeney
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Robert A. Vierkant
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Julie M. Cunningham
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, USA
| | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Hannah P. Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark E. Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Jolanta Lissowska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Kunle Odunsi
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Carl Morrison
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shashikant Lele
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Wiam Bshara
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Lara Sucheston
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Mercedes Jimenez-Linan
- Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
- Department of Pathology, University of Cambridg, Cambridge, UK
| | - Fiona M. Blows
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Jennifer Alsop
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Marie Mack
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Valerie McGuire
- Department of Health Research and Policy, Division of Epidemiology, Stanford University, Stanford, CA, USA
| | - Joseph H. Rothstein
- Department of Health Research and Policy, Division of Epidemiology, Stanford University, Stanford, CA, USA
| | - Barry P. Rosen
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | | | - Helen Mackay
- Department of Medicine, Division of Medical Oncology, University of Toronto, Ontario, Canada
| | - Amit Oza
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Eva L. Wozniak
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, London, UK
| | - Elizabeth Benjamin
- Department of Pathology, Cancer Institute, University College London, London, UK
| | | | - Simon A. Gayther
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Anna V. Tinker
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Leah M. Prentice
- Centre For Translational and Applied Genomics, British Columbia Cancer Agency, Vancouver, Canada
| | - Christine Chow
- Genetic Pathology Evaluation Centre, Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Michael S. Anglesio
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Sharon E. Johnatty
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Australia
| | | | - Alice S. Whittemore
- Department of Health Research and Policy, Division of Epidemiology, Stanford University, Stanford, CA, USA
| | - Paul D. P. Pharoah
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ellen L. Goode
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - David G. Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Centre For Translational and Applied Genomics, British Columbia Cancer Agency, Vancouver, Canada
| | - Susan J. Ramus
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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Ali HR, Irwin M, Morris L, Dawson SJ, Blows FM, Provenzano E, Mahler-Araujo B, Pharoah PD, Walton NA, Brenton JD, Caldas C. Astronomical algorithms for automated analysis of tissue protein expression in breast cancer. Br J Cancer 2013; 108:602-12. [PMID: 23329232 PMCID: PMC3593538 DOI: 10.1038/bjc.2012.558] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/15/2012] [Accepted: 11/19/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND High-throughput evaluation of tissue biomarkers in oncology has been greatly accelerated by the widespread use of tissue microarrays (TMAs) and immunohistochemistry. Although TMAs have the potential to facilitate protein expression profiling on a scale to rival experiments of tumour transcriptomes, the bottleneck and imprecision of manually scoring TMAs has impeded progress. METHODS We report image analysis algorithms adapted from astronomy for the precise automated analysis of IHC in all subcellular compartments. The power of this technique is demonstrated using over 2000 breast tumours and comparing quantitative automated scores against manual assessment by pathologists. RESULTS All continuous automated scores showed good correlation with their corresponding ordinal manual scores. For oestrogen receptor (ER), the correlation was 0.82, P<0.0001, for BCL2 0.72, P<0.0001 and for HER2 0.62, P<0.0001. Automated scores showed excellent concordance with manual scores for the unsupervised assignment of cases to 'positive' or 'negative' categories with agreement rates of up to 96%. CONCLUSION The adaptation of astronomical algorithms coupled with their application to large annotated study cohorts, constitutes a powerful tool for the realisation of the enormous potential of digital pathology.
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Affiliation(s)
- H R Ali
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
| | - M Irwin
- Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA, UK
| | - L Morris
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
| | - S-J Dawson
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
| | - F M Blows
- Strangeways Research Laboratories, University of Cambridge, Cambridge CB1 9RN, UK
| | - E Provenzano
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
- Cambridge Experimental Cancer Medicine Centre (ECMC), Cambridge, UK
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 2QQ, UK
| | - B Mahler-Araujo
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
- Cambridge Experimental Cancer Medicine Centre (ECMC), Cambridge, UK
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 2QQ, UK
| | - P D Pharoah
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Strangeways Research Laboratories, University of Cambridge, Cambridge CB1 9RN, UK
- Cambridge Experimental Cancer Medicine Centre (ECMC), Cambridge, UK
| | - N A Walton
- Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge CB3 0HA, UK
| | - J D Brenton
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
| | - C Caldas
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
- Cambridge Experimental Cancer Medicine Centre (ECMC), Cambridge, UK
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Horne HN, Sherman ME, Garcia-Closas M, Pharoah PD, Blows FM, Yang XR, Lissowska J, Brinton LA, Chanock SJ, Figueroa JD. Abstract P3-08-02: Common variants at 10p14 and 1p11.2 display heterogeneity in breast cancer associations by E-cadherin tumor tissue expression in two independent datasets. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-08-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: E-cadherin is a tumor suppressor gene involved in cell-cell adhesion, epithelial-to-mesenchymal transitions (EMT) and invasion. Loss of E-cadherin expression is strongly associated with lobular breast cancers, which exhibit single cell patterns of infiltration and are often estrogen receptor positive. We sought to determine if relative risk estimates for 19 established breast cancer susceptibility loci were modified by E-cadherin breast tumor tissue expression.
Methods: Case-control analyses included up to 1885 invasive breast cancer cases and 2366 age and site matched controls aged 20–74 years from the Polish Breast Cancer Study (PBCS), a population based case-control study conducted in Poland from 2000–2003. Genotyping of the 19 single nucleotide polymorphisms (SNPs) was performed using TaqMan® assays. Tissue expression of E-cadherin was assessed using immunohistochemical (IHC) staining of tissue microarrays and IHC results were scored as the product of percent positive tumor cells × intensity. Tumors having a score of <10 were classified as E-cadherin low and those with a score ≥10 as E-cadherin high. Polytomous logistic regression models adjusted for age and study site were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for each breast cancer subtype, defined by E-cadherin expression levels, compared to controls. Case-only data from the PBCS (N = 797) and the Study of Epidemiology and Risk Factors in Cancer Heredity, SEARCH (N = 2155) was used in logistic regression models to test for heterogeneity of SNPs by E-cadherin expression.
Results: Three SNPs suggested significant heterogeneity by E-cadherin expression in the PBCS: rs2046210 at 6q25.1(ESR1) [per-allele ORs (95% CI); 1.53 (1.19–1.98) for E-cadherin low tumors and 0.99 (0.86–1.14) for E-cadherin high tumors, P-heterogeneity = 0.002]; rs1045485 at 10p14 (CASP8) [per-allele ORs (95% CI); 0.62 (0.41–0.93) for E-cadherin low tumors and 0.98 (0.81–1.18) for E-cadherin high tumors, P-heterogeneity = 0.04]; and rs11249433 at 1p11.2 (NOTCH2/FCGR1B) [per-allele ORs (95% CI); 1.29 (1.02–1.64) for E-cadherin low tumors and 1.01 (0.88–1.15) for E-cadherin high tumors, P-heterogeneity = 0.06]. Combined case-only analysis of PBCS and SEARCH for these three SNPs showed significant heterogeneity by E-cadherin expression for rs11249433 [Interaction OR (95% CI); 1.19 (1.05–1.36), P-heterogeneity = 0.007] and rs1045485 [Interaction OR (95% CI); 0.69 (0.53–0.90), P-heterogeneity = 0.007]. The association with rs2046210 [Interaction OR (95% CI); 1.12 (0.61–2.03), P-heterogeneity = 0.73] did not remain significant in combined analyses.
Conclusion: Our findings provide evidence that associations for breast cancer susceptibility loci vary by E-cadherin tumor tissue expression, which has not been described previously. Specifically, our results suggest that the genetic markers rs11249433 and rs1045485 may preferentially modify risk for tumors with low or absent E-cadherin expression in two independent data sets.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-08-02.
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Affiliation(s)
- HN Horne
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - ME Sherman
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - M Garcia-Closas
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - PD Pharoah
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - FM Blows
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - XR Yang
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - J Lissowska
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - LA Brinton
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - SJ Chanock
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - JD Figueroa
- National Cancer Institute, Rockville, MD; The Institute of Cancer Research, Sutton, Surrey, United Kingdom; University of Cambridge, United Kingdom; M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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Warren H, Dudbridge F, Fletcher O, Orr N, Johnson N, Hopper JL, Apicella C, Southey MC, Mahmoodi M, Schmidt MK, Broeks A, Cornelissen S, Braaf LM, Muir KR, Lophatananon A, Chaiwerawattana A, Wiangnon S, Fasching PA, Beckmann MW, Ekici AB, Schulz-Wendtland R, Sawyer EJ, Tomlinson I, Kerin M, Burwinkel B, Marme F, Schneeweiss A, Sohn C, Guénel P, Truong T, Laurent-Puig P, Mulot C, Bojesen SE, Nielsen SF, Flyger H, Nordestgaard BG, Milne RL, Benítez J, Arias-Pérez JI, Zamora MP, Anton-Culver H, Ziogas A, Bernstein L, Dur CC, Brenner H, Müller H, Arndt V, Langheinz A, Meindl A, Golatta M, Bartram CR, Schmutzler RK, Brauch H, Justenhoven C, Brüning T, Chang-Claude J, Wang-Gohrke S, Eilber U, Dörk T, Schürmann P, Bremer M, Hillemanns P, Nevanlinna H, Muranen TA, Aittomäki K, Blomqvist C, Bogdanova N, Antonenkova N, Rogov Y, Bermisheva M, Prokofyeva D, Zinnatullina G, Khusnutdinova E, Lindblom A, Margolin S, Mannermaa A, Kosma VM, Hartikainen JM, Kataja V, Chenevix-Trench G, Beesley J, Chen X, Lambrechts D, Smeets A, Paridaens R, Weltens C, Flesch-Janys D, Buck K, Behrens S, Peterlongo P, Bernard L, Manoukian S, Radice P, Couch FJ, Vachon C, Wang X, Olson J, Giles G, Baglietto L, McLean CA, Severi G, John EM, Miron A, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Grip M, Andrulis IL, Knight JA, Mulligan AM, Weerasooriya N, Devilee P, Tollenaar RAEM, Martens JWM, Seynaeve CM, Hooning MJ, Hollestelle A, Jager A, Tilanus-Linthorst MMA, Hall P, Czene K, Liu J, Li J, Cox A, Cross SS, Brock IW, Reed MWR, Pharoah P, Blows FM, Dunning AM, Ghoussaini M, Ashworth A, Swerdlow A, Jones M, Schoemaker M, Easton DF, Humphreys M, Wang Q, Peto J, dos-Santos-Silva I. 9q31.2-rs865686 as a susceptibility locus for estrogen receptor-positive breast cancer: evidence from the Breast Cancer Association Consortium. Cancer Epidemiol Biomarkers Prev 2012; 21:1783-91. [PMID: 22859399 DOI: 10.1158/1055-9965.epi-12-0526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Our recent genome-wide association study identified a novel breast cancer susceptibility locus at 9q31.2 (rs865686). METHODS To further investigate the rs865686-breast cancer association, we conducted a replication study within the Breast Cancer Association Consortium, which comprises 37 case-control studies (48,394 cases, 50,836 controls). RESULTS This replication study provides additional strong evidence of an inverse association between rs865686 and breast cancer risk [study-adjusted per G-allele OR, 0.90; 95% confidence interval (CI), 0.88; 0.91, P = 2.01 × 10(-29)] among women of European ancestry. There were ethnic differences in the estimated minor (G)-allele frequency among controls [0.09, 0.30, and 0.38 among, respectively, Asians, Eastern Europeans, and other Europeans; P for heterogeneity (P(het)) = 1.3 × 10(-143)], but no evidence of ethnic differences in per allele OR (P(het) = 0.43). rs865686 was associated with estrogen receptor-positive (ER(+)) disease (per G-allele OR, 0.89; 95% CI, 0.86-0.91; P = 3.13 × 10(-22)) but less strongly, if at all, with ER-negative (ER(-)) disease (OR, 0.98; 95% CI, 0.94-1.02; P = 0.26; P(het) = 1.16 × 10(-6)), with no evidence of independent heterogeneity by progesterone receptor or HER2 status. The strength of the breast cancer association decreased with increasing age at diagnosis, with case-only analysis showing a trend in the number of copies of the G allele with increasing age at diagnosis (P for linear trend = 0.0095), but only among women with ER(+) tumors. CONCLUSIONS This study is the first to show that rs865686 is a susceptibility marker for ER(+) breast cancer. IMPACT The findings further support the view that genetic susceptibility varies according to tumor subtype.
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Affiliation(s)
- Helen Warren
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
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Ali HR, Dawson SJ, Blows FM, Provenzano E, Pharoah PD, Caldas C. Aurora kinase A outperforms Ki67 as a prognostic marker in ER-positive breast cancer. Br J Cancer 2012; 106:1798-806. [PMID: 22538974 PMCID: PMC3365239 DOI: 10.1038/bjc.2012.167] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Proliferation has emerged as a major prognostic factor in luminal breast cancer. The immunohistochemical (IHC) proliferation marker Ki67 has been most extensively investigated but has not gained widespread clinical acceptance. Methods: We have conducted a head-to-head comparison of a panel of proliferation markers, including Ki67. Our aim was to establish the marker of the greatest prognostic utility. Tumour samples from 3093 women with breast cancer were constructed as tissue microarrays. We used IHC to detect expression of mini-chromosome maintenance protein 2, Ki67, aurora kinase A (AURKA), polo-like kinase 1, geminin and phospho-histone H3. We used a Cox proportional-hazards model to investigate the association with 10-year breast cancer-specific survival (BCSS). Missing values were resolved using multiple imputation. Results: The prognostic significance of proliferation was limited to oestrogen receptor (ER)-positive breast cancer. Aurora kinase A emerged as the marker of the greatest prognostic significance in a multivariate model adjusted for the standard clinical and molecular covariates (hazard ratio 1.3; 95% confidence interval 1.1–1.5; P=0.005), outperforming all other markers including Ki67. Conclusion: Aurora kinase A outperforms other proliferation markers as an independent predictor of BCSS in ER-positive breast cancer. It has the potential for use in routine clinical practice.
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Affiliation(s)
- H R Ali
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK.
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Ali HR, Dawson SJ, Blows FM, Provenzano E, Pharoah PD, Caldas C. Cancer stem cell markers in breast cancer: pathological, clinical and prognostic significance. Breast Cancer Res 2011; 13:R118. [PMID: 22112299 PMCID: PMC3326560 DOI: 10.1186/bcr3061] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The cancer stem cell (CSC) hypothesis states that tumours consist of a cellular hierarchy with CSCs at the apex driving tumour recurrence and metastasis. Hence, CSCs are potentially of profound clinical importance. We set out to establish the clinical relevance of breast CSC markers by profiling a large cohort of breast tumours in tissue microarrays (TMAs) using immunohistochemistry (IHC). METHODS We included 4, 125 patients enrolled in the SEARCH population-based study with tumours represented in TMAs and classified into molecular subtype according to a validated IHC-based five-marker scheme. IHC was used to detect CD44/CD24, ALDH1A1, aldehyde dehydrogenase family 1 member A3 (ALDH1A3) and integrin alpha-6 (ITGA6). A 'Total CSC' score representing expression of all four CSC markers was also investigated. Association with breast cancer specific survival (BCSS) at 10 years was assessed using a Cox proportional-hazards model. This study was complied with REMARK criteria. RESULTS In ER negative cases, multivariate analysis showed that ITGA6 was an independent prognostic factor with a time-dependent effect restricted to the first two years of follow-up (hazard ratio (HR) for 0 to 2 years follow-up, 2.4; 95% confidence interval (95% CI), 1.2 to 4.8; P = 0.009). The composite 'Total CSC' score carried independent prognostic significance in ER negative cases for the first four years of follow-up (HR for 0 to 4 years follow-up, 1.3; 95% CI, 1.1 to 1.6; P = 0.006). CONCLUSIONS Breast CSC markers do not identify identical subpopulations in primary tumours. Both ITGA6 and a composite Total CSC score show independent prognostic significance in ER negative disease. The use of multiple markers to identify tumours enriched for CSCs has the greatest prognostic value. In the absence of more specific markers, we propose that the effective translation of the CSC hypothesis into patient benefit will necessitate the use of a panel of markers to robustly identify tumours enriched for CSCs.
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Affiliation(s)
- H Raza Ali
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK.
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Stevens KN, Vachon CM, Lee AM, Slager S, Lesnick T, Olswold C, Fasching PA, Miron P, Eccles D, Carpenter JE, Godwin AK, Ambrosone C, Winqvist R, Schmidt MK, Cox A, Cross SS, Sawyer E, Hartmann A, Beckmann MW, Schulz-Wendtland R, Ekici AB, Tapper WJ, Gerty SM, Durcan L, Graham N, Hein R, Nickels S, Flesch-Janys D, Heinz J, Sinn HP, Konstantopoulou I, Fostira F, Pectasides D, Dimopoulos AM, Fountzilas G, Clarke CL, Balleine R, Olson JE, Fredericksen Z, Diasio RB, Pathak H, Ross E, Weaver J, Rüdiger T, Försti A, Dünnebier T, Ademuyiwa F, Kulkarni S, Pylkäs K, Jukkola-Vuorinen A, Ko YD, Van Limbergen E, Janssen H, Peto J, Fletcher O, Giles GG, Baglietto L, Verhoef S, Tomlinson I, Kosma VM, Beesley J, Greco D, Blomqvist C, Irwanto A, Liu J, Blows FM, Dawson SJ, Margolin S, Mannermaa A, Martin NG, Montgomery GW, Lambrechts D, dos Santos Silva I, Severi G, Hamann U, Pharoah P, Easton DF, Chang-Claude J, Yannoukakos D, Nevanlinna H, Wang X, Couch FJ. Common breast cancer susceptibility loci are associated with triple-negative breast cancer. Cancer Res 2011; 71:6240-9. [PMID: 21844186 PMCID: PMC3327299 DOI: 10.1158/0008-5472.can-11-1266] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Triple-negative breast cancers are an aggressive subtype of breast cancer with poor survival, but there remains little known about the etiologic factors that promote its initiation and development. Commonly inherited breast cancer risk factors identified through genome-wide association studies display heterogeneity of effect among breast cancer subtypes as defined by the status of estrogen and progesterone receptors. In the Triple Negative Breast Cancer Consortium (TNBCC), 22 common breast cancer susceptibility variants were investigated in 2,980 Caucasian women with triple-negative breast cancer and 4,978 healthy controls. We identified six single-nucleotide polymorphisms, including rs2046210 (ESR1), rs12662670 (ESR1), rs3803662 (TOX3), rs999737 (RAD51L1), rs8170 (19p13.1), and rs8100241 (19p13.1), significantly associated with the risk of triple-negative breast cancer. Together, our results provide convincing evidence of genetic susceptibility for triple-negative breast cancer.
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Affiliation(s)
| | - Celine M. Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Adam M. Lee
- Department of Pharmacology, Mayo Clinic, Rochester, MN, USA
| | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Timothy Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Curtis Olswold
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Peter A. Fasching
- University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of hematology and Oncology, Los Angeles, CA, USA
| | | | - Diana Eccles
- University of Southampton, Faculty of Medicine, Southampton University Hospitals NHS Trust, Southampton UK
| | - Jane E. Carpenter
- Australian Breast Cancer Tissue Bank, University of Sydney at the Westmead Millennium Institute, Westmead, NSW, Australia
| | - Andrew K. Godwin
- Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Lawrence, KS, USA
| | - Christine Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Robert Winqvist
- Laboratory of Cancer Genetics, Department of Clinical Genetics and Biocenter Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Hiltrud Brauch on behalf of the GENICA consortium
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, and University Tübingen,Germany
- Gene Environment Interaction and Breast Cancer in Germany (GENICA): Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, and University Tübingen, Germany (HB, Christina Justenhoven); Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany (Ute Hamann); Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany (YDK, Christian Baisch); Institute of Pathology, Medical Faculty of the University of Bonn, Germany (Hans-Peter Fischer); Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Bochum, Germany (Thomas Bruening, Beate Pesch, Volker Harth, Sylvia Rabstein)
| | - Marjanka K. Schmidt
- Division of Experimental Therapy and Molecular Pathology and Division of Epidemiology (MKS), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Angela Cox
- Institute for Cancer Studies, Department of Oncology , Faculty of Medicine, Dentistry & Health, University of Sheffield, UK
| | - Simon S. Cross
- Academic Unit of Pathology, Department of Neuroscience, Faculty of Medicine, Dentistry & Health, University of Sheffield, UK
| | - Elinor Sawyer
- National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre, Guy's & St. Thomas’ NHS Foundation Trust, London, UK
| | - Arndt Hartmann
- Friedrich-Alexander University Erlangen-Nuremberg, Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Matthias W. Beckmann
- Friedrich-Alexander University Erlangen-Nuremberg , University Hospital Erlangen, University Breast Center Franconia, Department of Gynecology and Obstetrics, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Friedrich-Alexander University Erlangen-Nuremberg, Institute of Diagnostic Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Arif B. Ekici
- Friedrich-Alexander University Erlangen-Nuremberg, Institute of Human Genetics, Erlangen, Germany
| | - William J Tapper
- University of Southampton, Faculty of Medicine, Southampton University Hospitals NHS Trust, Southampton UK
| | - Susan M Gerty
- University of Southampton, Faculty of Medicine, Southampton University Hospitals NHS Trust, Southampton UK
| | - Lorraine Durcan
- University of Southampton, Faculty of Medicine, Southampton University Hospitals NHS Trust, Southampton UK
| | - Nikki Graham
- University of Southampton, Faculty of Medicine, Southampton University Hospitals NHS Trust, Southampton UK
| | - Rebecca Hein
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Stephan Nickels
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Dieter Flesch-Janys
- Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Heinz
- Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Irene Konstantopoulou
- Molecular Diagnostics Laboratory IRRP, National Centre for Scientific Research “Demokritos”, Athens, Greece
| | - Florentia Fostira
- Molecular Diagnostics Laboratory IRRP, National Centre for Scientific Research “Demokritos”, Athens, Greece
| | - Dimitrios Pectasides
- Department of Internal Medicine, Oncology Section, “Hippokration” Hospital; Athens, Greece
| | - Athanasios M. Dimopoulos
- Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens School of Medicine, Athens, Greece
| | - George Fountzilas
- Department of Medical Oncology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Christine L. Clarke
- Australian Breast Cancer Tissue Bank, University of Sydney at the Westmead Millennium Institute, Westmead, NSW, Australia
| | - Rosemary Balleine
- Dept of Translational Oncology, Westmead Hospital, Western Sydney Local Health Network, Westmead, NSW, Australia
| | - Janet E. Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Harsh Pathak
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eric Ross
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - JoEllen Weaver
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Thomas Rüdiger
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany and Center for Primary Health Care Research, University of Lund, Malmö, Sweden
| | - Thomas Dünnebier
- Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Foluso Ademuyiwa
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Swati Kulkarni
- Dept of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Katri Pylkäs
- Laboratory of Cancer Genetics, Department of Clinical Genetics and Biocenter Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | | | - Yon-Dschun Ko
- Department of Internal Medicine, Evangelische Kliniken Johanniter- und Waldkrankenhaus Bonn gGmbH, Bonn, Germany
| | - Erik Van Limbergen
- Multidisciplinary Breast Center, University Hospital Gasthuisberg, Leuven, Belgium
| | - Hilde Janssen
- Multidisciplinary Breast Center, University Hospital Gasthuisberg, Leuven, Belgium
| | - Julian Peto
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Olivia Fletcher
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Graham G. Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia & Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Australia
| | - Laura Baglietto
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia & Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Australia
| | - Senno Verhoef
- Family Cancer Clinic (SV), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ian Tomlinson
- Wellcome Trust Centre for Human Genetics and Oxford Comprehensive Biomedical Research Centre, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Veli-Matti Kosma
- Institute of Clinical Medicine, Department of Pathology, University of Eastern Finland and Kuopio University Hospital; Biocenter Kuopio, Kuopio, Finland
| | - Jonathan Beesley
- Genetics and Population Health Division, Queensland Institute of Medical Research, Brisbane, Australia
| | - Dario Greco
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, , Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Astrid Irwanto
- Human Genetics Division, Genome Institute of Singapore, Singapore
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore
| | - Fiona M. Blows
- Department of Oncology and Department of Public Health and Primary Care University of Cambridge, Cambridge, UK
| | - Sarah-Jane Dawson
- Department of Oncology and Department of Public Health and Primary Care University of Cambridge, Cambridge, UK
| | - Sara Margolin
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Arto Mannermaa
- Institute of Clinical Medicine, Department of Pathology, University of Eastern Finland and Kuopio University Hospital; Biocenter Kuopio, Kuopio, Finland
| | - Nicholas G. Martin
- QIMR GWAS Collective, Queensland Institute of Medical Research, Brisbane, Australia
| | - Grant W Montgomery
- QIMR GWAS Collective, Queensland Institute of Medical Research, Brisbane, Australia
| | - Diether Lambrechts
- Vesalius Research Center, VIB, Leuven, Belgium
- Vesalius Research Center, University of Leuven, Leuven, Belgium
| | - Isabel dos Santos Silva
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gianluca Severi
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia & Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Australia
| | - Ute Hamann
- Division of Molecular Genetic Epidemiology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany and Center for Primary Health Care Research, University of Lund, Malmö, Sweden
| | - Paul Pharoah
- Department of Oncology and Department of Public Health and Primary Care University of Cambridge, Cambridge, UK
| | - Douglas F. Easton
- Department of Genetic Epidemiology, Cancer Research UK Genetic Epidemiology Unit, Strangeways Research Laboratory, Cambridge, UK
| | - Jenny Chang-Claude
- Friedrich-Alexander University Erlangen-Nuremberg, Institute of Human Genetics, Erlangen, Germany
| | | | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, , Helsinki, Finland
| | - Xianshu Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Ali HR, Dawson SJ, Blows FM, Provenzano E, Leung S, Nielsen T, Pharoah PD, Caldas C. A Ki67/BCL2 index based on immunohistochemistry is highly prognostic in ER-positive breast cancer. J Pathol 2011; 226:97-107. [DOI: 10.1002/path.2976] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 07/08/2011] [Accepted: 07/19/2011] [Indexed: 02/04/2023]
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Ali AMG, Dawson SJ, Blows FM, Provenzano E, Ellis IO, Baglietto L, Huntsman D, Caldas C, Pharoah PD. Comparison of methods for handling missing data on immunohistochemical markers in survival analysis of breast cancer. Br J Cancer 2011; 104:693-9. [PMID: 21266980 PMCID: PMC3049587 DOI: 10.1038/sj.bjc.6606078] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/03/2010] [Accepted: 12/07/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Tissue micro-arrays (TMAs) are increasingly used to generate data of the molecular phenotype of tumours in clinical epidemiology studies, such as studies of disease prognosis. However, TMA data are particularly prone to missingness. A variety of methods to deal with missing data are available. However, the validity of the various approaches is dependent on the structure of the missing data and there are few empirical studies dealing with missing data from molecular pathology. The purpose of this study was to investigate the results of four commonly used approaches to handling missing data from a large, multi-centre study of the molecular pathological determinants of prognosis in breast cancer. PATIENTS AND METHODS We pooled data from over 11,000 cases of invasive breast cancer from five studies that collected information on seven prognostic indicators together with survival time data. We compared the results of a multi-variate Cox regression using four approaches to handling missing data - complete case analysis (CCA), mean substitution (MS) and multiple imputation without inclusion of the outcome (MI-) and multiple imputation with inclusion of the outcome (MI+). We also performed an analysis in which missing data were simulated under different assumptions and the results of the four methods were compared. RESULTS Over half the cases had missing data on at least one of the seven variables and 11 percent had missing data on 4 or more. The multi-variate hazard ratio estimates based on multiple imputation models were very similar to those derived after using MS, with similar standard errors. Hazard ratio estimates based on the CCA were only slightly different, but the estimates were less precise as the standard errors were large. However, in data simulated to be missing completely at random (MCAR) or missing at random (MAR), estimates for MI+ were least biased and most accurate, whereas estimates for CCA were most biased and least accurate. CONCLUSION In this study, empirical results from analyses using CCA, MS, MI- and MI+ were similar, although results from CCA were less precise. The results from simulations suggest that in general MI+ is likely to be the best. Given the ease of implementing MI in standard statistical software, the results of MI+ and CCA should be compared in any multi-variate analysis where missing data are a problem.
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Affiliation(s)
- A M G Ali
- Strangeways Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, Wort's Causeway, Cambridge CB1 8RN, UK.
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Dawson SJ, Makretsov N, Blows FM, Driver KE, Provenzano E, Le Quesne J, Baglietto L, Severi G, Giles GG, McLean CA, Callagy G, Green AR, Ellis I, Gelmon K, Turashvili G, Leung S, Aparicio S, Huntsman D, Caldas C, Pharoah P. Erratum: BCL2 in breast cancer: a favourable prognostic marker across molecular subtypes and independent of adjuvant therapy received. Br J Cancer 2010. [PMCID: PMC2965882 DOI: 10.1038/sj.bjc.6605921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dawson SJ, Makretsov N, Blows FM, Driver KE, Provenzano E, Le Quesne J, Baglietto L, Severi G, Giles GG, McLean CA, Callagy G, Green AR, Ellis I, Gelmon K, Turashvili G, Leung S, Aparicio S, Huntsman D, Caldas C, Pharoah P. BCL2 in breast cancer: a favourable prognostic marker across molecular subtypes and independent of adjuvant therapy received. Br J Cancer 2010; 103:668-75. [PMID: 20664598 PMCID: PMC2938244 DOI: 10.1038/sj.bjc.6605736] [Citation(s) in RCA: 219] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 05/10/2010] [Accepted: 05/16/2010] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Breast cancer is heterogeneous and the existing prognostic classifiers are limited in accuracy, leading to unnecessary treatment of numerous women. B-cell lymphoma 2 (BCL2), an antiapoptotic protein, has been proposed as a prognostic marker, but this effect is considered to relate to oestrogen receptor (ER) status. This study aimed to test the clinical validity of BCL2 as an independent prognostic marker. METHODS Five studies of 11 212 women with early-stage breast cancer were analysed. Individual patient data included tumour size, grade, lymph node status, endocrine therapy, chemotherapy and mortality. BCL2, ER, progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) levels were determined in all tumours. A Cox model incorporating the time-dependent effects of each variable was used to explore the prognostic significance of BCL2. RESULTS In univariate analysis, ER, PR and BCL2 positivity was associated with improved survival and HER2 positivity with inferior survival. For ER and PR this effect was time dependent, whereas for BCL2 and HER2 the effect persisted over time. In multivariate analysis, BCL2 positivity retained independent prognostic significance (hazard ratio (HR) 0.76, 95% confidence interval (CI) 0.66-0.88, P<0.001). BCL2 was a powerful prognostic marker in ER- (HR 0.63, 95% CI 0.54-0.74, P<0.001) and ER+ disease (HR 0.56, 95% CI 0.48-0.65, P<0.001), and in HER2- (HR 0.55, 95% CI 0.49-0.61, P<0.001) and HER2+ disease (HR 0.70, 95% CI 0.57-0.85, P<0.001), irrespective of the type of adjuvant therapy received. Addition of BCL2 to the Adjuvant! Online prognostic model, for a subset of cases with a 10-year follow-up, improved the survival prediction (P=0.0039). CONCLUSIONS BCL2 is an independent indicator of favourable prognosis for all types of early-stage breast cancer. This study establishes the rationale for introduction of BCL2 immunohistochemistry to improve prognostic stratification. Further work is now needed to ascertain the exact way to apply BCL2 testing for risk stratification and to standardise BCL2 immunohistochemistry for this application.
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Affiliation(s)
- S-J Dawson
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
| | - N Makretsov
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
| | - F M Blows
- Strangeways Research Laboratories, University of Cambridge, Cambridge CB1 9RN, UK
| | - K E Driver
- Strangeways Research Laboratories, University of Cambridge, Cambridge CB1 9RN, UK
| | - E Provenzano
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
| | - J Le Quesne
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
| | - L Baglietto
- Cancer Epidemiology Centre, The Cancer Council Victoria, Carlton, Victoria 3053, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - G Severi
- Cancer Epidemiology Centre, The Cancer Council Victoria, Carlton, Victoria 3053, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - G G Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Carlton, Victoria 3053, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - C A McLean
- Department of Anatomical Pathology, The Alfred Hospital, Melbourne, Victoria 3181, Australia
| | - G Callagy
- Department of Pathology, NUI, Galway, Ireland
| | - A R Green
- Department of Histopathology, Nottingham City Hospital, Nottingham NG5 1PB, UK
| | - I Ellis
- Department of Histopathology, Nottingham City Hospital, Nottingham NG5 1PB, UK
| | - K Gelmon
- Genetic Pathology Evaluation Centre of the Department of Pathology and Prostate Research Centre, Vancouver General Hospital, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada V6H 3Z6
| | - G Turashvili
- Genetic Pathology Evaluation Centre of the Department of Pathology and Prostate Research Centre, Vancouver General Hospital, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada V6H 3Z6
| | - S Leung
- Genetic Pathology Evaluation Centre of the Department of Pathology and Prostate Research Centre, Vancouver General Hospital, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada V6H 3Z6
| | - S Aparicio
- Genetic Pathology Evaluation Centre of the Department of Pathology and Prostate Research Centre, Vancouver General Hospital, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada V6H 3Z6
| | - D Huntsman
- Genetic Pathology Evaluation Centre of the Department of Pathology and Prostate Research Centre, Vancouver General Hospital, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada V6H 3Z6
| | - C Caldas
- Department of Oncology, University of Cambridge, Cambridge CB1 9RN, UK
- Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 ORE, UK
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
| | - P Pharoah
- Strangeways Research Laboratories, University of Cambridge, Cambridge CB1 9RN, UK
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
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Blows FM, Driver KE, Schmidt MK, Broeks A, van Leeuwen FE, Wesseling J, Cheang MC, Gelmon K, Nielsen TO, Blomqvist C, Heikkilä P, Heikkinen T, Nevanlinna H, Akslen LA, Bégin LR, Foulkes WD, Couch FJ, Wang X, Cafourek V, Olson JE, Baglietto L, Giles GG, Severi G, McLean CA, Southey MC, Rakha E, Green AR, Ellis IO, Sherman ME, Lissowska J, Anderson WF, Cox A, Cross SS, Reed MWR, Provenzano E, Dawson SJ, Dunning AM, Humphreys M, Easton DF, García-Closas M, Caldas C, Pharoah PD, Huntsman D. Subtyping of breast cancer by immunohistochemistry to investigate a relationship between subtype and short and long term survival: a collaborative analysis of data for 10,159 cases from 12 studies. PLoS Med 2010; 7:e1000279. [PMID: 20520800 PMCID: PMC2876119 DOI: 10.1371/journal.pmed.1000279] [Citation(s) in RCA: 660] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 04/12/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunohistochemical markers are often used to classify breast cancer into subtypes that are biologically distinct and behave differently. The aim of this study was to estimate mortality for patients with the major subtypes of breast cancer as classified using five immunohistochemical markers, to investigate patterns of mortality over time, and to test for heterogeneity by subtype. METHODS AND FINDINGS We pooled data from more than 10,000 cases of invasive breast cancer from 12 studies that had collected information on hormone receptor status, human epidermal growth factor receptor-2 (HER2) status, and at least one basal marker (cytokeratin [CK]5/6 or epidermal growth factor receptor [EGFR]) together with survival time data. Tumours were classified as luminal and nonluminal tumours according to hormone receptor expression. These two groups were further subdivided according to expression of HER2, and finally, the luminal and nonluminal HER2-negative tumours were categorised according to expression of basal markers. Changes in mortality rates over time differed by subtype. In women with luminal HER2-negative subtypes, mortality rates were constant over time, whereas mortality rates associated with the luminal HER2-positive and nonluminal subtypes tended to peak within 5 y of diagnosis and then decline over time. In the first 5 y after diagnosis the nonluminal tumours were associated with a poorer prognosis, but over longer follow-up times the prognosis was poorer in the luminal subtypes, with the worst prognosis at 15 y being in the luminal HER2-positive tumours. Basal marker expression distinguished the HER2-negative luminal and nonluminal tumours into different subtypes. These patterns were independent of any systemic adjuvant therapy. CONCLUSIONS The six subtypes of breast cancer defined by expression of five markers show distinct behaviours with important differences in short term and long term prognosis. Application of these markers in the clinical setting could have the potential to improve the targeting of adjuvant chemotherapy to those most likely to benefit. The different patterns of mortality over time also suggest important biological differences between the subtypes that may result in differences in response to specific therapies, and that stratification of breast cancers by clinically relevant subtypes in clinical trials is urgently required.
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Affiliation(s)
- Fiona M. Blows
- Department of Oncology, University of Cambridge, United Kingdom
| | | | | | | | | | | | - Maggie C. Cheang
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada
| | - Karen Gelmon
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada
| | - Torsten O. Nielsen
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland
| | - Tuomas Heikkinen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Lars A. Akslen
- The Gade Institute, Section for Pathology, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Louis R. Bégin
- Department of Pathology, McGill University and Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - William D. Foulkes
- Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Xianshu Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Vicky Cafourek
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Janet E. Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Laura Baglietto
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | - Graham G. Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | - Gianluca Severi
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | | | - Melissa C. Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Australia
| | - Emad Rakha
- Departments of Histopathology and Surgery, The Breast Unit, Nottingham City Hospital NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Andrew R. Green
- Departments of Histopathology and Surgery, The Breast Unit, Nottingham City Hospital NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Ian O. Ellis
- Departments of Histopathology and Surgery, The Breast Unit, Nottingham City Hospital NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Mark E. Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Jolanta Lissowska
- M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
| | - William F. Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Angela Cox
- Institute for Cancer Studies, University of Sheffield School of Medicine, Sheffield, United Kingdom
| | - Simon S. Cross
- Academic Unit of Pathology, University of Sheffield School of Medicine, Sheffield, United Kingdom
| | - Malcolm W. R. Reed
- Academic Unit of Surgical Oncology, University of Sheffield School of Medicine, Sheffield, United Kingdom
| | | | | | - Alison M. Dunning
- Department of Oncology, University of Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Manjeet Humphreys
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Douglas F. Easton
- Department of Oncology, University of Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Montserrat García-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Carlos Caldas
- Department of Oncology, University of Cambridge, United Kingdom
| | - Paul D. Pharoah
- Department of Oncology, University of Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - David Huntsman
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada
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Sherman ME, Howatt W, Blows FM, Pharoah P, Hewitt SM, Garcia-Closas M. Molecular pathology in epidemiologic studies: a primer on key considerations. Cancer Epidemiol Biomarkers Prev 2010; 19:966-72. [PMID: 20332257 DOI: 10.1158/1055-9965.epi-10-0056] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The development of molecular pathologic components in epidemiologic studies offers opportunities to relate etiologic factors to specific tumor types, which in turn may allow the development of better overall risk prediction and provide clues about mechanisms that mediate risk factors. In addition, this research may help identify or validate tissue biomarkers related to prognosis and prediction of treatment responses. In this mini review, we highlight specific considerations related to the incorporation of pathology in epidemiologic studies, using breast cancer research as a model. Issues related to ensuring the representativeness of cases for which research tissue is available and understanding limitations resulting from variable procedures for tissue collection, fixation, and processing are discussed. The growing importance of molecular pathology in clinical medicine has led to increased emphasis on optimized tissue preparation, which should enhance this type of research. In addition, the availability of new technologies including tissue microarrays, image scanning, and automated analysis to achieve high-throughput standardized assessment of immunohistochemical markers, and potentially other assays, is enabling consistent scoring of a growing list of markers in large studies. Concurrently, methodologic research to extend the range of assays that can be done on fixed tissues is expanding possibilities for molecular pathologic studies in epidemiologic research.
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Affiliation(s)
- Mark E Sherman
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD, 6120 Executive Boulevard, Rockville, MD 20852-7234, USA.
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