TY  - JOUR
A1  - Harter, Philipp
A1  - Hauke, Jan
A1  - Heitz, Florian
A1  - Reuss, Alexander
A1  - Kommoss, Stefan
A1  - Marmé, Frederik
A1  - Heimbach, André
A1  - Prieske, Katharina
A1  - Richters, Lisa
A1  - Burges, Alexander
A1  - Neidhardt, Guido
A1  - de Gregorio, Nikolaus
A1  - El-Balat, Ahmed
A1  - Hilpert, Felix
A1  - Meier, Werner
A1  - Kimmig, Rainer
A1  - Kast, Karin
A1  - Sehouli, Jalid
A1  - Baumann, Klaus
A1  - Jackisch, Christian
A1  - Park-Simon, Tjoung-Won
A1  - Hanker, Lars
A1  - Kröber, Sandra
A1  - Pfisterer, Jacobus
A1  - Gevensleben, Heidrun
A1  - Schnelzer, Andreas
A1  - Dietrich, Dimo
A1  - Neunhöffer, Tanja
A1  - Krockenberger, Mathias
A1  - Brucker, Sara Y.
A1  - Nürnberg, Peter
A1  - Thiele, Holger
A1  - Altmüller, Janine
A1  - Lamla, Josefin
A1  - Elser, Gabriele
A1  - du Bois, Andreas
A1  - Hahnen, Eric
A1  - Schmutzler, Rita
T1  - Prevalence of deleterious germline variants in risk genes including \(BRCA1/2\) in consecutive ovarian cancer patients (AGO-TR-1)
T2  - PLoS ONE
N2  - Background
Identification of families at risk for ovarian cancer offers the opportunity to consider prophylactic surgery thus reducing ovarian cancer mortality. So far, identification of potentially affected families in Germany was solely performed via family history and numbers of affected family members with breast or ovarian cancer. However, neither the prevalence of deleterious variants in \(BRCA1/2\) in ovarian cancer in Germany nor the reliability of family history as trigger for genetic counselling has ever been evaluated.

Methods
Prospective counseling and germline testing of consecutive patients with primary diagnosis or with platinum-sensitive relapse of an invasive epithelial ovarian cancer. Testing included 25 candidate and established risk genes. Among these 25 genes, 16 genes (\(ATM\), \(BRCA1\), \(BRCA2\), \(CDH1\), \(CHEK2\), \(MLH1\), \(MSH2\), \(MSH6\), \(NBN\), \(PMS2\), \(PTEN\), \(PALB2\), \(RAD51C\), \(RAD51D\), \(STK11\), \(TP53\)) were defined as established cancer risk genes. A positive family history was defined as at least one relative with breast cancer or ovarian cancer or breast cancer in personal history.

Results
In total, we analyzed 523 patients: 281 patients with primary diagnosis of ovarian cancer and 242 patients with relapsed disease. Median age at primary diagnosis was 58 years (range 16–93) and 406 patients (77.6%) had a high-grade serous ovarian cancer. In total, 27.9% of the patients showed at least one deleterious variant in all 25 investigated genes and 26.4% in the defined 16 risk genes. Deleterious variants were most prevalent in the \(BRCA1\) (15.5%), \(BRCA2\) (5.5%), \(RAD51C\) (2.5%) and \(PALB2\) (1.1%) genes. The prevalence of deleterious variants did not differ significantly between patients at primary diagnosis and relapse. The prevalence of deleterious variants in \(BRCA1/2\) (and in all 16 risk genes) in patients <60 years was 30.2% (33.2%) versus 10.6% (18.9%) in patients \(\geq\)60 years. Family history was positive in 43% of all patients. Patients with a positive family history had a prevalence of deleterious variants of 31.6% (36.0%) versus 11.4% (17.6%) and histologic subtype of high grade serous ovarian cancer versus other showed a prevalence of deleterious variants of 23.2% (29.1%) and 10.2% (14.8%), respectively. Testing only for \(BRCA1/2\) would miss in our series more than 5% of the patients with a deleterious variant in established risk genes.

Conclusions
26.4% of all patients harbor at least one deleterious variant in established risk genes. The threshold of 10% mutation rate which is accepted for reimbursement by health care providers in Germany was observed in all subgroups analyzed and neither age at primary diagnosis nor histo-type or family history sufficiently enough could identify a subgroup not eligible for genetic counselling and testing. Genetic testing should therefore be offered to every patient with invasive epithelial ovarian cancer and limiting testing to \(BRCA1/2\) seems to be
not sufficient.
KW  - medicine
KW  - Genetic causes of cancer
KW  - ovarian cancer
KW  - cancer risk factors
KW  - histology
KW  - cancer detection and diagnosis
KW  - breast cancer
KW  - genetic testing
KW  - human genetics
Y1  - 2017
UR  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/17355
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-173553
VL  - 12
IS  - 10
ER  -