Familial cancer syndromes and clusters

Updated Understanding of the Causes of Cancer, and a New Theoretical Perspective of Combinational Cancer Therapies, a Hypothesis

We present an integrative understanding of cancer as a metabolic multifactorial, multistage disease. We focus on underlying genetics-environmental interactions, evidenced by telomere changes. A range of genetic and epigenetic factors, including physical agents and predisposing factors such as diet and lifestyle are included. We present a structured model of the causes of cancer, methods of investigations, approaches to cancer prevention, and polypharmaceutical multidisciplinary complex treatment within a framework of personalized medicine. We searched PubMed, National Cancer Institute online, and other databases for publications regarding causes of cancer, reports of novel mitochondrial reprogramming, epigenetic, and telomerase therapies and state-of-the-art investigations. We focused on multistep treatment protocols to enhance early detection of cancer, and elimination or neutralization of the causes and factors associated with cancer formation and progression.Our aim is to suggest a model therapeutic protocol that incorporates the patient's genome, metabolism, and immune system status; stage of tumor development; and comorbidity(ies), if any. Investigation and treatment of cancer is a challenge that requires further holistic studies that improve the quality of life and survival rates, but are most likely to aid prevention.

Family history of cancer and tobacco exposure in index cases of pancreatic ductal adenocarcinoma

Aim. To examine interaction between history of cancer in first-degree relatives and tobacco smoking in index patients of pancreatic adenocarcinoma. Methods. We carried out a case-control involving 113 patients with pancreatic adenocarcinoma and 110 controls over a 12-month period at the Freeman Hospital, Newcastle upon Tyne, UK. They were all administered a detailed tobacco exposure questionnaire and a family history questionnaire. We calculated cumulative tobacco exposure and risk for pancreas cancer. Results. Both smokers (OR 3.01 (95% CI: 1.73 to 5.24)) and those with a family history of malignancy (OR 1.98 (95% CI: 1.15–3.38)) were more likely to develop pancreatic cancer. Having more than one first-degree relative with cancer did not significantly further increase the risk of pancreatic cancer. Amongst pancreatic cancer cases, cumulative tobacco exposure was significantly decreased (P = .032) in the group of smokers (current and ex-smokers) who had a family history of malignancy [mean (SD): 30.00 (24.77) pack-years versus 44.69 (28.47) pack-years with no such history]. Conclusions. Individuals with a family history of malignancy are at an increased risk of pancreatic cancer. Furthermore, individuals with a family history of malignancy and who smoke appear to require a lesser degree of tobacco exposure for the development of pancreatic cancer.

Increased risk of cancer among siblings of long-term childhood cancer survivors: a report from the childhood cancer survivor study

We determined risk of cancer among first-degree relatives of 5-year survivors of childhood leukemia, lymphoma, central nervous system tumors, sarcomas, Wilms' tumor, and neuroblastoma. Subjects were 13,703 participants in the Childhood Cancer Survivor Study. Family history was collected on 56,759 first-degree relatives using a self-reported questionnaire. Incidence was compared with age- and sex-specific rates using the U.S. Surveillance, Epidemiology and End Results program. Siblings of the survivors had an increased risk of cancer [standardized incidence ratio (SIR), 1.5; 95% confidence interval (95% CI), 1.35-1.7]. Risk was elevated for siblings of probands of leukemia (SIR, 1.3; 95% CI, 1.0-1.6), Hodgkin's disease (SIR, 1.5; 95% CI, 1.2-1.9), non-Hodgkin's lymphoma (SIR, 1.8; 95% CI, 1.3-2.5), Wilms' tumor (SIR, 1.9; 95% CI, 1.2-3.2), soft tissue sarcoma (SIR, 1.5; 95% CI, 1.0-2.2), and bone tumors (SIR, 1.6; 95% CI, 1.2-2.2). Cancer risk was elevated in siblings (SIR, 2.4; 95% CI, 1.5-3.7) and offspring (SIR, 15.0; 95% CI, 5.3-42.9) of probands with second malignant neoplasms (SMN) compared with relatives of probands without SMNs. Siblings of probands with leukemia, Hodgkin's disease, neuroblastoma, and Wilms' tumor had elevated risks for the same malignancies. Parents had no increased risk (fathers' SIR, 0.7; 95% CI, 0.7-0.8; mothers' SIR, 0.9; 95% CI, 0.9-1.0). Seventy percent of siblings' cancers developed in adulthood. These findings suggest that familial cancer syndromes may be revealed as this cohort and family members age and with accrual of more offspring and subjects with SMNs.

Single-nucleotide polymorphisms in the p53 pathway

A cell culture assay has been developed that detects and validates single-nucleotide polymorphisms (SNPs) in genes that populate the p53 pathway. One hundred thirteen EBV-transformed human B-lymphocyte cell lines obtained from a diverse population were employed to measure the apoptotic response to gamma radiation. Each cell line undergoes a reproducible, characteristic frequency of apoptosis, and the response of the population forms a normal distribution around a median of 35.5% apoptosis with a range from 12% to 58% apoptosis. Polymorphisms in the AKT1 and Perp genes significantly affect the frequency of apoptosis. The assay can detect both racial and sexual dimorphisms in these genes and has the ability to demonstrate epistatic relationships within the p53 pathway. The cell lines used in this assay provide biological materials to explore the molecular basis of the polymorphisms.

Oncogenes and tumor suppressor genes in breast cancer: potential diagnostic and therapeutic applications

Carcinogenesis is a multistep process characterized by genetic alterations that influence key cellular pathways involved in growth and development. Oncogenes refer to those genes whose alterations cause gain-of-function effects, while tumor suppressor genes cause loss-of-function effects that contribute to the malignant phenotype. The effects of these alterations are complex due to the high number of changes in a typical case of breast cancer and the interactions of the biological pathways involved. This review focuses on the more common abnormalities in oncogenes and tumor suppressor genes in human breast cancer and their known associations with clinical outcome in terms of tumor classification, prognosis, and response to specific therapies. A better understanding of these relationships has led to new therapeutic applications. Agents that target oncogenes and their associated pathways are now in clinical use, with many more undergoing preclinical and clinical testing. The availability of antibodies, small synthetic molecules, cyotokines, gene therapy techniques, and even natural compounds that are screened for specific biological properties has greatly increased the number of candidate drugs. Nevertheless, clinical successes have been limited because of the redundancy of many cancer-related pathways as well as the high degree of variability in genotype and phenotype among individual tumors. Likewise, strategies to replace tumor suppressor gene functions face numerous technical hurdles. This review summarizes the current achievements and future prospects for the therapeutic targeting of oncogenes and tumor suppressor genes and new technology to better classify tumors and accurately predict responses to standard and novel agents.

Breast cancer genetics: unsolved questions and open perspectives in an expanding clinical practice

Breast cancer is the most common cause of cancer death in the United Kingdom, with a lifetime risk of one in nine in women. Only 5-10% of all cancers is thought to be due to strongly penetrant inherited predisposing genes, such as BRCA1 and BRCA2. However, other less penetrant genes, including some autosomal recessive genes, are likely to be of etiological importance in other families. This review addresses the current knowledge of breast cancer susceptibility genes and explores the possibilities for future developments. Features of tumor pathology, prognosis, and the scope for targeted treatments in mutation carriers are discussed, and the management of known carriers and those at increased risk for developing breast cancer are evaluated. Genetic testing for cancer susceptibility may become widely available in the future, and has important ethical and management implications.

Molecular biology and genetics of breast cancer development: a clinical perspective

Understanding the molecular and genetic events affecting breast cancer development not only helps oncologists address important questions commonly asked by their patients but also helps clinicians gain insights into the biology of the disease. Although the molecular and genetic determinants of most sporadic breast cancer remain unknown, significant advances in the understanding of events that contribute to breast cancer formation have been made. It is now recognized that mutations in some tumor suppressor genes, such as p53, BRCA1, BRCA2, PTEN, or ATM, or epigenetic functional inactivation of other tumor suppressor genes, such as SYK and NES1, appear to play important early roles in the formation of some breast cancers. In addition, alterations in proto-oncogenes, such as HER2/neu, may contribute to the development of some breast cancer. The goal of this article is to further introduce clinicians to molecular and genetic pathways that contribute to breast cancer formation. By participating in the study of breast cancer development at the molecular as well as the histopathological level, oncologists can help develop novel prevention, diagnostic, and therapeutic approaches for the future.

Gene mutation as a target for early detection in cancer diagnosis

The increasing number of genetic aberrations implicated in the development of human cancer has prompted a search to detect them at the earliest possible stage of their formation. Of the many such genetic changes identified thus far, relatively few meet the standard for markers in early diagnosis and prognosis, namely that the genetic modifications occur during the early onset phase of cancer development. Parallel to the increasing number of such genes is the growing availability of technologies using more powerful and cost-efficient methods that enable mass screening for genetic alterations. The purpose of this review is to summarize the currently available genes that can serve as markers for early detection of cancers and methods that allow their detection.

Hereditary breast cancer: a review

Breast cancer is the most common female malignancy and a major cause of death in middle-aged women. A positive family history of breast cancer is one of the strongest risk factors for the disease. In addition, many afflicted breast cancer families are characterized by early onset and bilateral tumors, and also, in some cases, associated malignancies, most commonly ovarian cancer. It is estimated that 5-10% of all breast cancer cases are due to autosomal dominant genes segregating with the disease. Mutations in the BRCA1 and BRCA2 genes are known to predispose to breast and ovarian cancer in many families. Other genes are only involved in very rare syndromes, and additional genes remain to be disclosed.

Familial cancers in a nationwide family cancer database: age distribution and prevalence

We calculated sex- and age-specific familial relative risks (FRRs) of cancer in offspring of cancer probands at 19 male and 20 female cancer sites, based on the nationwide Family Cancer Database from Sweden. The proportion of familial cancers among all cancers was also determined. The database contained 550,000 primary cancers. The familial risk at known sites: colon, breast, ovary, testis, skin (melanoma), nervous system, thyroid and other endocrine glands were confirmed. The FRR of thyroid cancer exceeded any other cancer and was over twice as high for male as for female offspring, and appeared to constitute an early- and late-onset component. Novel register-based findings were familial risks in cervical and uterine cancer, and in male offspring of male probands kidney and skin (mainly squamous cell) cancer. Familial risks were noted also for lung cancer, lymphoma and leukaemia but they may have largely environmental causes. The proportion of familial cancers depended on the site, ranging from 11% in prostate to 8.7% in female breast and to well below 1% at many sites.

Tumor suppressor genes and breast cancer

The genetic determinants for most breast cancer cases remain elusive. However, a mutation in a tumor suppressor gene, such as p53, BRCA1, BRCA2, or ATM, has been determined to be one mechanism of breast carcinogenesis. It has been established that inherited mutations in p53, BRCA1, and BRCA2 significantly contribute to breast cancer risk, although the importance of an inherited ATM mutation is controversial. Sporadic mutations in p53 are also common in breast cancer cells. The precise deficiencies that result from these genetic mutations have yet to be fully described. Although the functions of these genes are different, they are all involved in the maintenance of genomic stability after DNA damage. Mutations that impair the function of these four genes may adversely affect the manner in which DNA damage is processed. It is likely that the risk of breast cancer development is increased through this mechanism. In this article, we review the relevancy of p53, BRCA1, BRCA2, and ATM mutations to breast cancer development, and review the in vitro, in vivo, and clinical data exploring the mechanisms by which these mutations affect genomic integrity and DNA damage repair.

Familial cancer risks in offspring from discordant parental cancers

Analysis of familial cancer risks between discordant sites provides etiologic understanding on genetic and environmental risks factors of site-specific cancers. We used the Swedish nation-wide Family-Cancer Database to analyze familial risks in discordant cancers of offspring and parents. Familial risk ratios (FRRs) were calculated for cancer in offspring aged 15 to 53 years at 22 sites, discordant from parental sites. We confirmed many reported associations. Consistent novel findings associated parental-offspring sites of pancreas-breast, breast-testis and uterus-nervous system. For these, the FRRs were modest, 1.2 to 1.5 in the whole Database, but the FRRs increased in those whose parents were diagnosed before age 50. Pancreas and liver cancers showed FRRs of 2.5 to 3.3 in offspring of women and of 1.3 in offspring of men. One or both of these cancers was/were associated with cancers of stomach, colon, breast, uterus, ovary and prostate. Melanoma was associated with pancreas, breast, skin and nervous-system cancers and with leukemias. Myeloma showed a concordant FRR of about 4.0 and was associated with prostate cancer and non-thyroid endocrine-gland cancers. Mutations in known cancer-related genes may explain some of these findings, but new susceptibility genes are yet to be found. For melanoma, pancreatic and liver cancer, environmental factors are important etiologic factors and may contribute to the familial effects observed.

Apoptotic repair of genotoxic tissue damage and the role of p53 gene

The spontaneous mutation rate per replication per genome is nearly invariant in microbes; however, the rate of spontaneous genomic mutations in higher eukaryotes is much higher. Furthermore, the mutation rates per locus per generation among Drosophila, mice and humans are similar, despite the large differences in generation time. A simple explanation for these findings is that mice and humans have a specific antimutagenic mechanism that is lacking in Drosophila. I propose that apoptotic repair-deletion of genotoxic damage-bearing cells-operates in mammalian germ cells and that it works more accurately in humans than in mice because of a slower rate of cell turnover and a longer generation time. It has been a long-standing puzzle that germline mutation frequencies decrease markedly as the dose-rate of radiation is lowered in mice but not in Drosophila. This can be readily explained by p53-dependent apoptotic repair, because the p53 gene is absent from the genome of Drosophila. Fetuses of p53+/+ mice have proficient apoptotic repair capacity for X-ray-induced teratogenic damage, but p53-null fetuses completely lack this capacity. Further, I propose that the primary role of the p53 gene is to guard germ cells and embryos from genotoxic damage. This implies that the tumour suppressor function of the p53 gene results from p53-dependent apoptotic deletion of cells with genotoxic damage. The reasoning behind this proposal is given by reviewing reports that Drosophila larvae are insensitive to tumour formation after irradiation. Finally, I discuss the genetic effects of radiation in humans.

Gliomas in families: chromosomal analysis by comparative genomic hybridization

Gliomas that aggregate in otherwise unremarkable families may have a heritable genetic basis. To determine the spectrum of genetic alterations in glioma-susceptible families, we examined tumor DNA from familial cases for regions of chromosomal gain or loss using comparative genomic hybridization (CGH). We compared chromosomal alterations within and among glioma families to those found in sporadic gliomas. A specific chromosomal abnormality common to the tumors of multiple unrelated probands with glioma or a specific chromosomal abnormality common to multiple affected persons in a single glioma-prone family would support the hypothesis of an inherited predisposition to glioma and at the same time identify specific regions of the genome harboring putative glioma susceptibility genes. Tumor DNA from 11 patients from seven families with two or more individuals with glioma was analyzed, including three members of a remarkable family having 10 affected individuals. We found no chromosomal abnormality common to all tumors of all probands nor did we find family-specific abnormalities in two of three glioma-prone kindreds. There were frequent copy number aberrations (CNAs) on chromosomes 7, 10, 19, and the sex chromosomes; other CNAs included +3q(13.3-29), -4q, +5q, -9q34, +12, -13q(21-->33), -15, -16p, +17qter, -18, -21, and -22. Amplifications occurred at +2 7p(11.1-->12), +2 7q(21.2-->33), +2 12q(13.2-->14), and +2 12p(11-->12). Although there were several novel CNAs [-16p, and +2 12p(11-p12)], none could readily explain the inheritance of these tumors.

Hereditary multifocal renal cystadenocarcinomas and nodular dermatofibrosis in 51 German shepherd dogs

The clinical findings in German shepherd dogs with hereditary multifocal renal cystadenocarcinomas and nodular dermatofibrosis are presented. Between 1978 and 1996, 51 cases were examined. Eight cases were detected after being offered a clinical examination because the disease was present in a parent. The remaining 43 dogs were diagnosed after an unsolicited visit to a clinic because of a specific problem. Skin lesions were the main reason (37 per cent) the owners presented their dog for examination. The mean age at diagnosis of renal cystadenocarcinomas and nodular dermatofibrosis was 8.2 years. The male-to-female ratio was 1.1, while the corresponding figure for a reference population was 1.25. Enlarged and abnormally shaped kidneys were palpated in 60 per cent of the dogs and were detected by radiography in 86 per cent of cases. The renal lesions, including metastases, were the main reason for euthanasia and death. The mean age at death was 9.3 years, and the mean age at the first detection of nodular dermatofibrosis was 6.4 years.

Germline WT1 mutations in Wilms' tumor patients: preliminary results

We conducted a comparative study of the prevalence of germline WT1 mutations in patients with Wilms' tumor. Patients in Group 1 have familial Wilms' tumor, bilateral disease, associated urogenital anomalies, and/or second cancers. Those in Group 2 are unilateral, sporadic Wilms' patients without other associated conditions. Patients with aniridia or Denys-Drash syndrome are known to have WT1 alterations, and are excluded from this study. Preliminary results on 96 subjects show that the overall germline WT1 mutation frequency is low (< 5%). The work to date establishes the feasibility of identifying patients with germline WT1 mutations and, in the future, offering genetic predisposition testing to at-risk relatives. However, genetic predisposition testing of children for WT1 mutations raises many ethical, legal, and psychosocial issues; research is needed to evaluate risks and benefits.

Genomania of p53 protein in gastric cancer

The role of oncogenes and tumor suppressor genes in the pathogenesis of gastric cancer has recently received considerable attention. p53 is a tumor suppressor gene that is essential in the cell cycle; it prevents G1/S phase transition, after exposure to ionizing radiation or DNA-damaging chemotherapy. This allows the cell to repair its DNA or, if the damage is irreversible, to elicit apoptotic cell death. p53 mutations are seen in many human tumors including gastric carcinoma. Evidence suggests that mutant p53 is associated with shorter life expectancy in gastric, breast, lung, and colorectal cancer. A number of studies have shown cellular resistance to chemotherapy in the presence of mutant p53. Currently, increasing interest has been devoted to the potential role of mutant p53 as a screening tool.

Adenocarcinoma of the cardia in a young man: detection of somatic p53 mutation by immunohistochemistry and automated direct sequencing

We describe the unusual case of early-onset adenocarcinoma of the cardia in a 22-year-old male. The patient died within less than one year after diagnosis was established. By immunohistochemistry, p53 expression was observed in the tumor cells. Automated direct sequencing of polymerase chain reaction (PCR) amplified DNA revealed a homozygous transition in p53 codon 280 (AGA to GGA) as the molecular basis of p53 accumulation. Previous studies suggest that gastric carcinomas with mutations in the p53 tumor-suppressor gene are associated with particularly poor prognosis when compared with tumors without p53 mutations. Since carriers of p53 mutations in the germline have a 50 percent likelihood of developing cancer before the age of 30, we examined tumor-free tissue for the presence of a germline mutation in codon 280, but none was found.

Inheritance of histiocytosis in Bernese mountain dogs

One hundred and twenty-seven cases of histiocytosis in Bernese mountain dogs (BMD) were evaluated to determine if the tumour is inherited. Family data ruled out autosomal recessive, autosomal dominant and sex-linked modes of inheritance. The trait was determined to be inherited with a polygenic mode of inheritance. The salient points permitting this conclusion are: pedigrees developed from independently selected propositi link up allowing the tracing of all cases through several generations; multiple cases occur in the same litter; multiple cases have been produced by given dams and sires; there is a higher frequency of the disease among offspring of affected parents when compared to offspring of normal parents that produced histiocytosis and all offspring in the general population of BMDs; the fact that histiocytosis is common in BMDs and rare in eight other breeds and accounts for 25.4 per cent of the 500 tumours studied in this breed. The heritability of this trait was calculated to be 0.298.

Expression of fragile sites in patients with retinoblastoma, their parents, and unaffected siblings: a study of ten families

The expression of fragile sites (FS) in the blood lymphocytes of 54 individuals, including 11 retinoblastoma (Rb) patients, their clinically healthy family members, and corresponding age- and sex-matched controls is presented. 5-fluorodeoxyuridine (5-FdU) and caffeine were used for FS induction. Enhanced expression of fra(13)(q13.2) was observed in the patient group as compared with controls. One of the patients had a constitutional del(13)(q14.2q21.2). In this individual, only the nondeleted homologue expressed the fra(13)(q13.2). Expression of fra(13)(q13.2) in two of the patients' unaffected younger siblings of different families showed statistically significant values. The possible relation between enhanced expression of FS and the inheritance of a genetic predisposition to Rb requires further examination.

p53: a cellular Achilles' heel revealed

Many human cancers result from the inactivation of p53, a protein central to DNA repair. Recent papers reporting the structures of two p53 domains help to rationalize the wealth of information about this protein.