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Rosenblum RE, Ang C, Suckiel SA, Soper ER, Sigireddi MR, Cullina S, Belbin GM, Lucas AL, Kenny EE, Abul-Husn NS. Lynch Syndrome-Associated Variants and Cancer Rates in an Ancestrally Diverse Biobank. JCO Precis Oncol 2020; 4:PO.20.00290. [PMID: 33283134 PMCID: PMC7713527 DOI: 10.1200/po.20.00290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Limited data are available on the prevalence and clinical impact of Lynch syndrome (LS)-associated genomic variants in non-European ancestry populations. We identified and characterized individuals harboring LS-associated variants in the ancestrally diverse BioMe Biobank in New York City. PATIENTS AND METHODS Exome sequence data from 30,223 adult BioMe participants were evaluated for pathogenic, likely pathogenic, and predicted loss-of-function variants in MLH1, MSH2, MSH6, and PMS2. Survey and electronic health record data from variant-positive individuals were reviewed for personal and family cancer histories. RESULTS We identified 70 individuals (0.2%) harboring LS-associated variants in MLH1 (n = 12; 17%), MSH2 (n = 13; 19%), MSH6 (n = 16; 23%), and PMS2 (n = 29; 41%). The overall prevalence was 1 in 432, with higher prevalence among individuals of self-reported African ancestry (1 in 299) than among Hispanic/Latinx (1 in 654) or European (1 in 518) ancestries. Thirteen variant-positive individuals (19%) had a personal history, and 19 (27%) had a family history of an LS-related cancer. LS-related cancer rates were highest in individuals with MSH6 variants (31%) and lowest in those with PMS2 variants (7%). LS-associated variants were associated with increased risk of colorectal (odds ratio [OR], 5.0; P = .02) and endometrial (OR, 30.1; P = 8.5 × 10-9) cancers in BioMe. Only 2 variant-positive individuals (3%) had a documented diagnosis of LS. CONCLUSION We found a higher prevalence of LS-associated variants among individuals of African ancestry in New York City. Although cancer risk is significantly increased among variant-positive individuals, the majority do not harbor a clinical diagnosis of LS, suggesting underrecognition of this disease.
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Affiliation(s)
- Rachel E. Rosenblum
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Celina Ang
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sabrina A. Suckiel
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emily R. Soper
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Meenakshi R. Sigireddi
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sinead Cullina
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gillian M. Belbin
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aimee L. Lucas
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eimear E. Kenny
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noura S. Abul-Husn
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Galmor L, Bernstein-Molho R, Sklair-Levy M, Madoursky-Feldman D, Zippel D, Laitman Y, Friedman E. Time trends in uptake rates of risk-reducing mastectomy in Israeli asymptomatic BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat 2020; 185:391-399. [PMID: 33000375 DOI: 10.1007/s10549-020-05949-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The rate of risk-reducing bilateral mastectomy (RRBM) among cancer-free Israeli female BRCA1/BRCA2 mutation carriers was reportedly 13% in 2010. Current RRBM rates in Israel and factors seemingly associated with opting for RRBM were reevaluated. METHODS Israeli female cancer-free BRCA1/BRCA2 mutation carriers, who were followed at the high-risk clinic at Sheba Medical Center between January 2011 and April 2020 were eligible. Univariate Cox regression and log-rank test were used to study the crude association between potential predictors and performance of RRBM. RESULTS Overall, 427 cancer-free BRCA1 (n = 218) or BRCA2 (n = 209) mutation carriers were included. Median age at genotyping was 33.6 years (interquartile range 26.8-41.8 years), median follow-up 4.4 years (range 0.1-7.6 years). Overall, 41/427 (9.6%) participants underwent RRBM, all of them within 5 years of genotyping. Being married (HR-2.57, p = 0.017) and having a first degree relative with breast cancer (BC) (HR-2.19, p = 0.017) were positively associated with RRBM, whereas any previous benign breast biopsy was negatively associated (HR-0.48, p = 0.029) with performing RRBM. CONCLUSIONS RRBM is still infrequently elected by Israeli BRCA1/BRCA2 mutation carriers, with married women with one relative with BC who have not undergone previous breast biopsy more likely to opt for RRBM.
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Affiliation(s)
- Lee Galmor
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rinat Bernstein-Molho
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Miri Sklair-Levy
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Meirav High-Risk Clinic-Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Dov Zippel
- The Meirav High-Risk Clinic-Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yael Laitman
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel
| | - Eitan Friedman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- The Meirav High-Risk Clinic-Chaim Sheba Medical Center, Tel-Hashomer, Israel.
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
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Buchanan AH, Lester Kirchner H, Schwartz MLB, Kelly MA, Schmidlen T, Jones LK, Hallquist MLG, Rocha H, Betts M, Schwiter R, Butry L, Lazzeri AL, Frisbie LR, Rahm AK, Hao J, Willard HF, Martin CL, Ledbetter DH, Williams MS, Sturm AC. Clinical outcomes of a genomic screening program for actionable genetic conditions. Genet Med 2020; 22:1874-1882. [PMID: 32601386 PMCID: PMC7605431 DOI: 10.1038/s41436-020-0876-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 01/07/2023] Open
Abstract
Purpose Three genetic conditions—hereditary breast and ovarian cancer syndrome, Lynch syndrome, and familial hypercholesterolemia—have tier 1 evidence for interventions that reduce morbidity and mortality, prompting proposals to screen unselected populations for these conditions. We examined the impact of genomic screening on risk management and early detection in an unselected population. Methods Observational study of electronic health records (EHR) among individuals in whom a pathogenic/likely pathogenic variant in a tier 1 gene was discovered through Geisinger’s MyCode project. EHR of all eligible participants was evaluated for a prior genetic diagnosis and, among participants without such a diagnosis, relevant personal/family history, postdisclosure clinical diagnoses, and postdisclosure risk management. Results Eighty-seven percent of participants (305/351) did not have a prior genetic diagnosis of their tier 1 result. Of these, 65% had EHR evidence of relevant personal and/or family history of disease. Of 255 individuals eligible to have risk management, 70% (n = 179) had a recommended risk management procedure after results disclosure. Thirteen percent of participants (41/305) received a relevant clinical diagnosis after results disclosure. Conclusion Genomic screening programs can identify previously unrecognized individuals at increased risk of cancer and heart disease and facilitate risk management and early cancer detection.
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Affiliation(s)
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | | | | | - Tara Schmidlen
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Laney K Jones
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Megan Betts
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | - Loren Butry
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | | | | | - Jing Hao
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Huntington F Willard
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Genome Medical, Durham, NC, USA
| | - Christa L Martin
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Autism and Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - David H Ledbetter
- Genomic Medicine Institute, Geisinger, Danville, PA, USA.,Autism and Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | | | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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Dong H, Chandratre K, Qin Y, Zhang J, Tian X, Rong C, Wang N, Guo M, Zhao G, Wang SM. Prevalence of BRCA1/ BRCA2 pathogenic variation in Chinese Han population. J Med Genet 2020; 58:565-569. [PMID: 32467295 DOI: 10.1136/jmedgenet-2020-106970] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pathogenic variation in BRCA1 and BRCA2 (BRCA) is one of the most frequent genetic predispositions for hereditary breast cancer. The identification of the variant carriers plays an important role in prevention and treatment of cancer. Despite a population size of 1.4 billion and a quarter million annual new breast cancer cases, knowledge regarding the prevalence of BRCA variation in the Chinese population remains elusive. METHODS In this study, we used BRCA-targeted sequencing and bioinformatics approaches to screen for BRCA variants in 11 386 Chinese Han individuals, including 9331 females and 2055 males. RESULTS We identified 1209 BRCA variants, 34 of which were pathogenic, including 11 in BRCA1 and 23 in BRCA2. These variants were distributed among 43 individuals (37 females and 6 males), with 13 carrying BRCA1 and 30 carrying BRCA2 variants. Based on these data, we determined a prevalence of 0.38%, or 1 carrier of a BRCA pathogenic variant out of every 265 Chinese Han individuals, and 5.1 million carriers among the Chinese Han population of 1.3 billion. CONCLUSION Our study provides basic knowledge about the prevalence of BRCA pathogenic variation in the Chinese Han population. This information should be valuable for BRCA-related cancer prevention and treatment in the population.
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Affiliation(s)
- Hui Dong
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Yue Qin
- Nanjing Shenyou Institute of Genome Research, Nanjing, China
| | - Jing Zhang
- Nanjing Shenyou Institute of Genome Research, Nanjing, China
| | - Xiaoqing Tian
- Nanjing Shenyou Institute of Genome Research, Nanjing, China
| | - Ce Rong
- iKang Guobin Healthcare Group Co., Ltd, Beijing, China
| | - Ning Wang
- iKang Guobin Healthcare Group Co., Ltd, Beijing, China
| | - Maoni Guo
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Guoping Zhao
- Institute of Plant Physiology and Ecology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - San Ming Wang
- Faculty of Health Sciences, University of Macau, Macau, China
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Affiliation(s)
- Heidi L Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Cambridge Street, Boston, MA, 02114, USA.
- Medical and Population Genetics, Broad Institute of MIT and Harvard, Main Street, Cambridge, MA, 02142, USA.
- Department of Pathology, Harvard Medical School, Shattuck Street, Boston, MA, 02115, USA.
| | - Douglas M Fowler
- Department of Genome Sciences, University of Washington, 15th Avenue NE, Seattle, WA, 98195-5065, USA.
- Canadian Institute for Advanced Research, University Avenue, Toronto, ON, M5G 1M1, Canada.
- Department of Bioengineering, University of Washington, 15th Avenue NE, Seattle, WA, 98195-5061, USA.
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