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Dominguez-Valentin M, Therkildsen C, Da Silva S, Nilbert M. Familial colorectal cancer type X: genetic profiles and phenotypic features. Mod Pathol 2015; 28:30-6. [PMID: 24743215 DOI: 10.1038/modpathol.2014.49] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 12/19/2022]
Abstract
Heredity is a major cause of colorectal cancer, but although several rare high-risk syndromes have been linked to disease-predisposing mutations, the genetic mechanisms are undetermined in the majority of families suspected of hereditary cancer. We review the clinical presentation, histopathologic features, and the genetic and epigenetic profiles of the familial colorectal cancer type X (FCCTX) syndrome with the aim to delineate tumor characteristics that may contribute to refined diagnostics and optimized tumor prevention.
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Affiliation(s)
- Mev Dominguez-Valentin
- 1] HNPCC-Register, Clinical Research Centre, Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark [2] Institute of Clinical Sciences, Department of Oncology, Lund University, Lund, Sweden
| | - Christina Therkildsen
- HNPCC-Register, Clinical Research Centre, Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark
| | - Sabrina Da Silva
- Lady Davis Institute for Medical Research and Segal Cancer Centre, Sir Mortimer B. Davis-Jewish General Hospital, Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Mef Nilbert
- 1] HNPCC-Register, Clinical Research Centre, Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark [2] Institute of Clinical Sciences, Department of Oncology, Lund University, Lund, Sweden
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Win AK, Macinnis RJ, Hopper JL, Jenkins MA. Risk prediction models for colorectal cancer: a review. Cancer Epidemiol Biomarkers Prev 2011; 21:398-410. [PMID: 22169185 DOI: 10.1158/1055-9965.epi-11-0771] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Risk prediction models are important to identify individuals at high risk of developing the disease who can then be offered individually tailored clinical management, targeted screening and interventions to reduce the burden of disease. They are also useful for research purposes when attempting to identify new risk factors for the disease. In this article, we review the risk prediction models that have been developed for colorectal cancer and appraise their applicability, strengths, and weaknesses. We also discuss the factors to be considered for future development and improvement of models for colorectal cancer risk prediction. We conclude that there is no model that sufficiently covers the known risk factors for colorectal cancer that is suitable for assessment of people from across the full range of risk and that a new comprehensive model is needed.
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Affiliation(s)
- Aung Ko Win
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
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Win AK, Dowty JG, English DR, Campbell PT, Young JP, Winship I, Macrae FA, Lipton L, Parry S, Young GP, Buchanan DD, Martínez ME, Jacobs ET, Ahnen DJ, Haile RW, Casey G, Baron JA, Lindor NM, Thibodeau SN, Newcomb PA, Potter JD, Le Marchand L, Gallinger S, Hopper JL, Jenkins MA. Body mass index in early adulthood and colorectal cancer risk for carriers and non-carriers of germline mutations in DNA mismatch repair genes. Br J Cancer 2011; 105:162-9. [PMID: 21559014 PMCID: PMC3137400 DOI: 10.1038/bjc.2011.172] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/15/2011] [Accepted: 04/20/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Carriers of germline mutations in DNA mismatch repair (MMR) genes have a high risk of colorectal cancer (CRC), but the modifiers of this risk are not well established. We estimated an association between body mass index (BMI) in early adulthood and subsequent risk of CRC for carriers and, as a comparison, estimated the association for non-carriers. METHODS A weighted Cox regression was used to analyse height and weight at 20 years reported by 1324 carriers of MMR gene mutations (500 MLH1, 648 MSH2, 117 MSH6 and 59 PMS2) and 1219 non-carriers from the Colon Cancer Family Registry. RESULTS During 122,304 person-years of observation, we observed diagnoses of CRC for 659 carriers (50%) and 36 non-carriers (3%). For carriers, the risk of CRC increased by 30% for each 5 kg m(-2) increment in BMI in early adulthood (hazard ratio, HR: 1.30; 95% confidence interval, CI: 1.08-1.58; P=0.01), and increased by 64% for non-carriers (HR: 1.64; 95% CI: 1.02-2.64; P=0.04) after adjusting for sex, country, cigarette smoking and alcohol drinking (and the MMR gene that was mutated in carriers). The difference in HRs for carriers and non-carriers was not statistically significant (P=0.50). For MLH1 and PMS2 (MutLα heterodimer) mutation carriers combined, the corresponding increase was 36% (HR: 1.36; 95% CI: 1.05-1.76; P=0.02). For MSH2 and MSH6 (MutSα heterodimer) mutation carriers combined, the HR was 1.26 (95% CI: 0.96-1.65; P=0.09). There was no significant difference between the HRs for MutLα and MutSα heterodimer carriers (P=0.56). CONCLUSION Body mass index in early adulthood is positively associated with risk of CRC for MMR gene mutation carriers and non-carriers.
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Affiliation(s)
- A K Win
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
| | - J G Dowty
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
| | - D R English
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Carlton South, Victoria, Australia
| | - P T Campbell
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
- Cancer Prevention Program, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA
| | - J P Young
- Familial Cancer Laboratory, Queensland Institute of Medical Research, Herston, Queensland, Australia
| | - I Winship
- Adult Clinical Genetics, The University of Melbourne, Parkville, Victoria, Australia
| | - F A Macrae
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - L Lipton
- Ludwig Institute for Cancer Research, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - S Parry
- New Zealand Familial Gastrointestinal Cancer Registry, Auckland City Hospital, Auckland, New Zealand
- Department of Gastroenterology, Middlemore Hospital, Auckland, New Zealand
| | - G P Young
- Flinders Centre for Cancer Prevention and Control, Flinders University, Adelaide, South Australia, Australia
| | - D D Buchanan
- Familial Cancer Laboratory, Queensland Institute of Medical Research, Herston, Queensland, Australia
| | - M E Martínez
- Arizona Cancer Centre, University of Arizona, Tucson, AZ, USA
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - E T Jacobs
- Arizona Cancer Centre, University of Arizona, Tucson, AZ, USA
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - D J Ahnen
- Denver VA Medical Center and University of Colorado Denver School of Medicine, Denver, CO, USA
| | - R W Haile
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - G Casey
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - J A Baron
- Department of Medicine and Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, USA
| | - N M Lindor
- Department of Medical Genetics, Mayo Clinic, Rochester, MN, USA
| | - S N Thibodeau
- Department of Medical Genetics, Mayo Clinic, Rochester, MN, USA
| | - P A Newcomb
- Cancer Prevention Program, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA
| | - J D Potter
- Cancer Prevention Program, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA
| | - L Le Marchand
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI, USA
| | - S Gallinger
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - J L Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
| | - M A Jenkins
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
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Win AK, Dowty JG, Antill YC, English DR, Baron JA, Young JP, Giles GG, Southey MC, Winship I, Lipton L, Parry S, Thibodeau SN, Haile RW, Gallinger S, Le Marchand L, Lindor NM, Newcomb PA, Hopper JL, Jenkins MA. Body mass index in early adulthood and endometrial cancer risk for mismatch repair gene mutation carriers. Obstet Gynecol 2011; 117:899-905. [PMID: 21422863 PMCID: PMC3084323 DOI: 10.1097/aog.0b013e3182110ea3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association of body mass index (BMI) in early adulthood and endometrial cancer risk for carriers of a germline mutation in a DNA mismatch repair gene. METHODS We estimated the association between BMI at age 18-20 years and endometrial cancer risk for mismatch repair gene mutation carriers and, as a comparison group, noncarriers using 601 female carriers of a germline mutation in a mismatch repair gene (245 MLH1, 299 MSH2, 38 MSH6, and 19 PMS2) and 533 female noncarriers from the Colon Cancer Family Registry using a weighted Cox proportional hazards regression. RESULTS During 51,693 person-years of observation, we observed diagnoses of endometrial cancer for 126 carriers and eight noncarriers. For carriers, there was no evidence of an association between BMI at age 20 years and endometrial cancer (adjusted hazard ratio 0.73 per 5 kg/m²; 95% confidence interval [CI], 0.40-1.34; P=.31). For noncarriers, endometrial cancer risk increased by 74% for each 5-kg/m² increment in BMI (adjusted hazard ratio 1.74; 95% CI 1.27-2.37; P<.001). The hazard ratio for BMI and endometrial cancer for noncarriers was greater than for carriers (P=.04). CONCLUSION The effect of body mass on endometrial cancer risk depends on the woman's mismatch repair gene mutation carrier status, suggesting obesity-independent endometrial carcinogenesis for carriers. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Aung Ko Win
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
| | - James G. Dowty
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Dallas R. English
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Australia
| | - John A. Baron
- Department of Medicine and Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire, USA
| | - Joanne P. Young
- Familial Cancer Laboratory, Queensland Institute of Medical Research, Australia
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graham G. Giles
- Familial Cancer Centre, Southern Health, Victoria, Australia
| | - Melissa C. Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Ingrid Winship
- Adult Clinical Genetics, The University of Melbourne, Victoria, Australia
| | - Lara Lipton
- Ludwig Institute for Cancer Research, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Susan Parry
- New Zealand Familial Gastrointestinal Cancer Registry, Auckland Hospital, New Zealand
- Department of Gastroenterology, Middlemore Hospital, Auckland, New Zealand
| | | | - Robert W. Haile
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Steven Gallinger
- Cancer Care Ontario, Toronto, Ontario, Canada
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Loïc Le Marchand
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, Hawaii, USA
| | | | - Polly A. Newcomb
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - John L. Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark A. Jenkins
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
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Immunohistochemistry as first-line screening for detecting colorectal cancer patients at risk for hereditary nonpolyposis colorectal cancer syndrome: a 2-antibody panel may be as predictive as a 4-antibody panel. Am J Surg Pathol 2009; 33:1639-45. [PMID: 19701074 DOI: 10.1097/pas.0b013e3181b15aa2] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The utility of immunohistochemical detection of DNA mismatch repair proteins in screening colorectal cancer for hereditary nonpolyposis colorectal cancer (HNPCC) is being widely investigated. Currently, in both research and clinical settings, a 4-antibody panel that includes the 4 most commonly affected proteins (MLH1, MSH2, MSH6, and PMS2) is being used generally. On the basis of the biochemical properties of these proteins, we hypothesized that a 2-antibody panel, comprising MSH6 and PMS2, would be sufficient to detect abnormalities in all 4 proteins. We tested this hypothesis on a series of 232 colorectal carcinoma samples derived from 2 patient cohorts: (1) a prospectively accrued series of patients who were judged to carry a higher-than-average risk for HNPCC based on the revised Bethesda guidelines (n=190); and (2) a retrospective series of patients who were 40 years of age or younger (n=42). Immunohistochemical stains were regarded as negative (protein lost), when there was no nuclear labeling in tumor cells (with positive internal control). Overall, 70 of the 232 tumors demonstrated loss of at least one protein. The most common abnormality was concurrent loss of MLH1 and PMS2 (observed in 17% of the cases), followed by concurrent loss of MSH2 and MSH6 (6%). All MLH1 and MSH2-abnormal cases were also abnormal for PMS2 and MSH6, respectively, whereas 9 of 50 (18%) PMS2 and 6 of 20 (30%) MSH6-abnormal cases showed only isolated loss of PMS2 or MSH6 (with normal staining for MLH1 and MSH2). As such, our findings provide evidence that a 2-antibody panel (PMS2 and MSH6) is as effective as the current 4-antibody panel in detecting DNA mismatch repair protein abnormalities. Such a cost-effective approach carries significant implication, as immunohistochemistry is being widely used as first-line screening for HNPCC.
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Milne RL, Osorio A, Cajal TRY, Vega A, Llort G, de la Hoya M, Díez O, Alonso MC, Lazaro C, Blanco I, Sánchez-de-Abajo A, Caldés T, Blanco A, Graña B, Durán M, Velasco E, Chirivella I, Cardeñosa EE, Tejada MI, Beristain E, Miramar MD, Calvo MT, Martínez E, Guillén C, Salazar R, San Román C, Antoniou AC, Urioste M, Benítez J. The average cumulative risks of breast and ovarian cancer for carriers of mutations in BRCA1 and BRCA2 attending genetic counseling units in Spain. Clin Cancer Res 2008; 14:2861-9. [PMID: 18451254 DOI: 10.1158/1078-0432.ccr-07-4436] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE It is not clear that the published estimates of the breast and ovarian cancer penetrances of mutations in BRCA1 and BRCA2 can be used in genetic counseling in countries such as Spain, where the incidence of breast cancer in the general population is considerably lower, the prevalence of BRCA2 mutations seems to be higher, and a distinct spectrum of recurrent mutations exists for both genes. We aimed to estimate these penetrances for women attending genetic counseling units in Spain. EXPERIMENTAL DESIGN We collected phenotype and genotype data on 155 BRCA1 and 164 BRCA2 mutation carrier families from 12 centers across the country. Average age-specific cumulative risks of breast cancer and ovarian cancer were estimated using a modified segregation analysis method. RESULTS The estimated average cumulative risk of breast cancer to age 70 years was estimated to be 52% [95% confidence interval (95% CI), 26-69%] for BRCA1 mutation carriers and 47% (95% CI, 29-60%) for BRCA2 mutation carriers. The corresponding estimates for ovarian cancer were 22% (95% CI, 0-40%) and 18% (95% CI, 0-35%), respectively. There was some evidence (two-sided P = 0.09) that 330A>G (R71G) in BRCA1 may have lower breast cancer penetrance. CONCLUSIONS These results are consistent with those from a recent meta-analysis of practically all previous penetrance studies, suggesting that women with BRCA1 and BRCA2 mutations attending genetic counseling services in Spain have similar risks of breast and ovarian cancer to those published for other Caucasian populations. Carriers should be fully informed of their mutation- and age-specific risks to make appropriate decisions regarding prophylactic interventions such as oophorectomy.
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Affiliation(s)
- Roger L Milne
- Unidad de Genotipación-CEGEN and Grupo de Genética Humana, Programa de Genética del Cáncer Humano, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain.
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