Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
Breast Cancer Res Treat. 2012 Feb;132(1):87-95. doi: 10.1007/s10549-011-1544-9. Epub 2011 May 7.
In order to adequately evaluate the clinical relevance of genetic testing in sporadic breast and ovarian cancer patients, we offered comprehensive BRCA1/2 mutation analysis in patients without a family history for the disease. We evaluated the complete coding and splice site regions of BRCA1/2 in 193 sporadic patients. In addition, a de novo mutation was further investigated with ultra deep sequencing and microsatellite marker analysis. In 17 patients (8.8%), a deleterious germline BRCA1/2 mutation was identified. The highest mutation detection ratio (3/7 = 42.9%) was obtained in sporadic patients diagnosed with breast and ovarian cancer after the age of 40. In 21 bilateral breast cancer patients, two mutations were identified (9.5%). Furthermore, 140 sporadic patients with unilateral breast cancer were investigated. Mutations were only identified in patients diagnosed with breast cancer before the age of 40 (12/128 = 9.4% vs. 0/12 with Dx > 40). No mutations were detected in 17 sporadic male breast cancer and 6 ovarian cancer patients. BRCA1 c.3494_3495delTT was identified in a patient diagnosed with breast and ovarian cancer at the age of 52 and 53, respectively, and was proven to have occurred de novo at the paternal allele. Our study shows that the mutation detection probability in specific patient subsets can be significant, therefore mutation analysis should be considered in sporadic patients. As a consequence, a family history for the disease and an early age of onset should not be used as the only criteria for mutation analysis of BRCA1/2. The relatively high mutation detection ratio suggests that the prevalence of BRCA1/2 may be underestimated, especially in sporadic patients who developed breast and ovarian cancer. In addition, although rare, the possibility of a de novo occurrence in a sporadic patient should be considered.
为了充分评估遗传检测在散发性乳腺癌和卵巢癌患者中的临床相关性,我们对无家族史的患者进行了全面的 BRCA1/2 突变分析。我们评估了 193 名散发性患者 BRCA1/2 的完整编码和剪接位点区域。此外,还通过超深度测序和微卫星标记分析进一步研究了新生突变。在 17 名患者(8.8%)中,发现了有害的种系 BRCA1/2 突变。在诊断年龄大于 40 岁的散发性乳腺癌和卵巢癌患者中,突变检测率最高(3/7=42.9%)。在 21 名双侧乳腺癌患者中,发现了两个突变(9.5%)。此外,还对 140 名单侧乳腺癌散发性患者进行了调查。仅在诊断年龄小于 40 岁的乳腺癌患者中发现了突变(12/128=9.4%,而诊断年龄大于 40 岁的患者中则未发现突变)。在 17 名散发性男性乳腺癌和 6 名卵巢癌患者中均未检测到突变。在一名分别于 52 岁和 53 岁诊断为乳腺癌和卵巢癌的患者中发现了 BRCA1 c.3494_3495delTT 突变,证实该突变是从父本等位基因中新生而来。我们的研究表明,在特定的患者亚组中,突变的检测概率可能会显著增加,因此应该考虑对散发性患者进行突变分析。因此,疾病家族史和发病年龄早不应作为 BRCA1/2 突变分析的唯一标准。较高的突变检测率表明 BRCA1/2 的患病率可能被低估,尤其是在患有乳腺癌和卵巢癌的散发性患者中。此外,尽管罕见,但应考虑散发性患者中可能发生新生突变的情况。
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