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Institute
EU-Project number / Contract (GA) number
- 223175 (3)
Rolfes, Muriel ; Borde, Julika ; Möllenhoff, Kathrin ; Kayali, Mohamad ; Ernst, Corinna ; Gehrig, Andrea ; Sutter, Christian ; Ramser, Juliane ; Niederacher, Dieter ; Horváth, Judit ; Arnold, Norbert ; Meindl, Alfons ; Auber, Bernd ; Rump, Andreas ; Wang-Gohrke, Shan ; Ritter, Julia ; Hentschel, Julia ; Thiele, Holger ; Altmüller, Janine ; Nürnberg, Peter ; Rhiem, Kerstin ; Engel, Christoph ; Wappenschmidt, Barbara ; Schmutzler, Rita K. ; Hahnen, Eric ; Hauke, Jan
Male breast cancer (mBC) is associated with a high prevalence of pathogenic variants (PVs) in the BRCA2 gene; however, data regarding other BC predisposition genes are limited. In this retrospective multicenter study, we investigated the prevalence of PVs in BRCA1/2 and 23 non-BRCA1/2 genes using a sample of 614 patients with mBC, recruited through the centers of the German Consortium for Hereditary Breast and Ovarian Cancer. A high proportion of patients with mBC carried PVs in BRCA2 (23.0%, 142/614) and BRCA1 (4.6%, 28/614). The prevalence of BRCA1/2 PVs was 11.0% in patients with mBC without a family history of breast and/or ovarian cancer. Patients with BRCA1/2 PVs did not show an earlier disease onset than those without. The predominant clinical presentation of tumor phenotypes was estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, and HER2-negative (77.7%); further, 10.2% of the tumors were triple-positive, and 1.2% were triple-negative. No association was found between ER/PR/HER2 status and BRCA1/2 PV occurrence. Comparing the prevalence of protein-truncating variants (PTVs) between patients with mBC and control data (ExAC, n = 27,173) revealed significant associations of PTVs in both BRCA1 and BRCA2 with mBC (BRCA1: OR = 17.04, 95% CI = 10.54–26.82, p < 10\(^{−5}\); BRCA2: OR = 77.71, 95% CI = 58.71–102.33, p < 10\(^{−5}\)). A case-control investigation of 23 non-BRCA1/2 genes in 340 BRCA1/2-negative patients and ExAC controls revealed significant associations of PTVs in CHEK2, PALB2, and ATM with mBC (CHEK2: OR = 3.78, 95% CI = 1.59–7.71, p = 0.002; PALB2: OR = 14.77, 95% CI = 5.02–36.02, p < 10\(^{−5}\); ATM: OR = 3.36, 95% CI = 0.89–8.96, p = 0.04). Overall, our findings support the benefit of multi-gene panel testing in patients with mBC irrespective of their family history, age at disease onset, and tumor phenotype.
Engel, Christoph ; Rhiem, Kerstin ; Hahnen, Eric ; Loibl, Sibylle ; Weber, Karsten E. ; Seiler, Sabine ; Zachariae, Silke ; Hauke, Jan ; Wappenschmidt, Barbara ; Waha, Anke ; Blümcke, Britta ; Kiechle, Marion ; Meindl, Alfons ; Niederacher, Dieter ; Bartram, Claus R. ; Speiser, Dorothee ; Schlegelberger, Brigitte ; Arnold, Norbert ; Wieacker, Peter ; Leinert, Elena ; Gehrig, Andrea ; Briest, Susanne ; Kast, Karin ; Riess, Olaf ; Emons, Günter ; Weber, Bernhard H. F. ; Engel, Jutta ; Schmutzler, Rita K.
Background
There is no international consensus up to which age women with a diagnosis of triple-negative breast cancer (TNBC) and no family history of breast or ovarian cancer should be offered genetic testing for germline BRCA1 and BRCA2 (gBRCA) mutations. Here, we explored the association of age at TNBC diagnosis with the prevalence of pathogenic gBRCA mutations in this patient group.
Methods
The study comprised 802 women (median age 40 years, range 19-76) with oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor type 2 negative breast cancers, who had no relatives with breast or ovarian cancer. All women were tested for pathogenic gBRCA mutations. Logistic regression analysis was used to explore the association between age at TNBC diagnosis and the presence of a pathogenic gBRCA mutation.
Results
A total of 127 women with TNBC(15.8%) were gBRCA mutation carriers (BRCA1: n = 118, 14.7%; BRCA2: n = 9, 1. 1%). The mutation prevalence was 32.9% in the age group 20-29 years compared to 6.9% in the age group 60-69 years. Logistic regression analysis revealed a significant increase of mutation frequency with decreasing age at diagnosis (odds ratio 1.87 per 10 year decrease, 95% CI 1.50-2.32, p < 0.001). gBRCA mutation risk was predicted to be > 10% for women diagnosed below approximately 50 years.
Conclusions
Based on the general understanding that a heterozygous mutation probability of 10% or greater justifies gBRCA mutation screening, women with TNBC diagnosed before the age of 50 years and no familial history of breast and ovarian cancer should be tested for gBRCA mutations. In Germany, this would concern approximately 880 women with newly diagnosed TNBC per year, of whom approximately 150 are expected to be identified as carriers of a pathogenic gBRCA mutation.
Dumont, Martine ; Weber-Lassalle, Nana ; Joly-Beauparlant, Charles ; Ernst, Corinna ; Droit, Arnaud ; Feng, Bing-Jian ; Dubois, Stéphane ; Collin-Deschesnes, Annie-Claude ; Soucy, Penny ; Vallée, Maxime ; Fournier, Frédéric ; Lemaçon, Audrey ; Adank, Muriel A. ; Allen, Jamie ; Altmüller, Janine ; Arnold, Norbert ; Ausems, Margreet G. E. M. ; Berutti, Riccardo ; Bolla, Manjeet K. ; Bull, Shelley ; Carvalho, Sara ; Cornelissen, Sten ; Dufault, Michael R. ; Dunning, Alison M. ; Engel, Christoph ; Gehrig, Andrea ; Geurts-Giele, Willemina R. R. ; Gieger, Christian ; Green, Jessica ; Hackmann, Karl ; Helmy, Mohamed ; Hentschel, Julia ; Hogervorst, Frans B. L. ; Hollestelle, Antoinette ; Hooning, Maartje J. ; Horváth, Judit ; Ikram, M. Arfan ; Kaulfuß, Silke ; Keeman, Renske ; Kuang, Da ; Luccarini, Craig ; Maier, Wolfgang ; Martens, John W. M. ; Niederacher, Dieter ; Nürnberg, Peter ; Ott, Claus-Eric ; Peters, Annette ; Pharoah, Paul D. P. ; Ramirez, Alfredo ; Ramser, Juliane ; Riedel-Heller, Steffi ; Schmidt, Gunnar ; Shah, Mitul ; Scherer, Martin ; Stäbler, Antje ; Strom, Tim M. ; Sutter, Christian ; Thiele, Holger ; van Asperen, Christi J. ; van der Kolk, Lizet ; van der Luijt, Rob B. ; Volk, Alexander E. ; Wagner, Michael ; Waisfisz, Quinten ; Wang, Qin ; Wang-Gohrke, Shan ; Weber, Bernhard H. F. ; Devilee, Peter ; Tavtigian, Sean ; Bader, Gary D. ; Meindl, Alfons ; Goldgar, David E. ; Andrulis, Irene L. ; Schmutzler, Rita K. ; Easton, Douglas F. ; Schmidt, Marjanka K. ; Hahnen, Eric ; Simard, Jacques
Rare variants in at least 10 genes, including BRCA1, BRCA2, PALB2, ATM, and CHEK2, are associated with increased risk of breast cancer; however, these variants, in combination with common variants identified through genome-wide association studies, explain only a fraction of the familial aggregation of the disease. To identify further susceptibility genes, we performed a two-stage whole-exome sequencing study. In the discovery stage, samples from 1528 breast cancer cases enriched for breast cancer susceptibility and 3733 geographically matched unaffected controls were sequenced. Using five different filtering and gene prioritization strategies, 198 genes were selected for further validation. These genes, and a panel of 32 known or suspected breast cancer susceptibility genes, were assessed in a validation set of 6211 cases and 6019 controls for their association with risk of breast cancer overall, and by estrogen receptor (ER) disease subtypes, using gene burden tests applied to loss-of-function and rare missense variants. Twenty genes showed nominal evidence of association (p-value < 0.05) with either overall or subtype-specific breast cancer. Our study had the statistical power to detect susceptibility genes with effect sizes similar to ATM, CHEK2, and PALB2, however, it was underpowered to identify genes in which susceptibility variants are rarer or confer smaller effect sizes. Larger sample sizes would be required in order to identify such genes.