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Chatterjee A, Hüneburg R, Yang Q, Morrison S, Bettzüge A, Marwitz T, Aretz S, Spier I, Ripperger T, Redler S, Kachanov M, Volk AE, Vangala DB, Daum S, Holinski-Feder E, Steinke-Lange V, Bahlke K, Strassburg CP, MejiaPerez LK, O'Malley MM, LaGuardia L, Liska D, Macaron C, Sommovilla J, Burke CA, Nattermann J. Colonoscopy findings in CDH1 carriers from a multicenter international study. Fam Cancer 2025; 24:44. [PMID: 40323501 PMCID: PMC12052908 DOI: 10.1007/s10689-025-00466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Accepted: 04/14/2025] [Indexed: 05/08/2025]
Abstract
Germline (likely-)pathogenic variants (PV) in CDH1 predispose carriers to hereditary diffuse gastric cancer and lobular breast cancer. Previous studies from the United States suggest CDH1 variant carriers have an increased risk for adenomas or sessile serrated lesions (SSL), yet data linking CDH1 PVs and colorectal neoplasia are scarce. We aimed to investigate colonoscopy findings in CDH1 PVs. Adults carrying a PV/LPV in CDH1 with ≥ 1 colonoscopy between 01/01/2004-12/31/2023 were included. Patients were sourced from the David G. Jagelman Inherited Colorectal Cancer Registries at Cleveland Clinic and the German Consortium for Familial Intestinal Cancer. 103 CDH1 PV carriers were included. Most were female (66%) and white (93.1%). The median age at first colonoscopy was 47 years. The adenoma detection rate (ADR) was 29.4% (95% CI:19.9-41.1%) in the German cohort and 48.6% (95% CI: 33.0-64.4%) in the Cleveland cohort (p = 0.055) and significantly correlated with age (< 45 years, 13.6% (95% CI: 6.40-26.7%); 45-49 years, 52.4% (95% CI: 32.4-71.7%); ≥50 years, 52.6% (95% CI: 37.3-67.5%); p < 0.001). The ADR in Cleveland was higher than the U.S. average ADR but the difference was not statistically significant (48.6% vs. 35.6%, p = 0.08), and the ADR in the German cohort (29.4%) was similar to the national German average risk screening cohort (31.3% in men, p = 0.84; 20.1% in women, p = 0.08). In our screening cohort with CDH1 PV carriers, we demonstrated an ADR of 13.5% in individuals under 45 years, similar to the ADR in patients aged 25-40 years with a family history of CRC. Overall, SSL detection rate was 9.7%. Colorectal cancer was diagnosed in 3 patients (3.2%), 2/3 with an early age of onset before the age of 50 years. This first international study provides preliminary evidence of a higher ADR in U.S. CDH1 PV carriers compared to the general population, with a high number of adenomas detected before the age of 50. This may indicate an increased CRC risk that should be explored in larger studies.
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Affiliation(s)
- Arjun Chatterjee
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Hüneburg
- Department of Internal Medicine, University Hospital Bonn, Bonn, Germany
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
| | - Qijun Yang
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Shannon Morrison
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anna Bettzüge
- Department of Internal Medicine, University Hospital Bonn, Bonn, Germany
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
| | - Tim Marwitz
- Department of Internal Medicine, University Hospital Bonn, Bonn, Germany
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
| | - Stefan Aretz
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Isabel Spier
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Tim Ripperger
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Silke Redler
- Institute of Human Genetics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mykyta Kachanov
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
- Institute for Human Genetics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander E Volk
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
- Institute for Human Genetics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Deepak B Vangala
- Genetics, Department of Cancer Genetics, Ruhr-University Bochum, Bochum, Germany
| | - Severin Daum
- Medical Department, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité University Medicine Berlin, Campus Benjamin Franklin (CBF), Berlin, Germany
| | - Elke Holinski-Feder
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
- MGZ - Medizinisch Genetisches Zentrum, Munich, Germany
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Verena Steinke-Lange
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
- MGZ - Medizinisch Genetisches Zentrum, Munich, Germany
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Kathrin Bahlke
- Institute for Human Genetics, University Hospital Münster, Münster, Germany
| | - Christian P Strassburg
- Department of Internal Medicine, University Hospital Bonn, Bonn, Germany
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
| | | | | | - Lisa LaGuardia
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - David Liska
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Carole Macaron
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Joshua Sommovilla
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA.
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Desk A30, Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Jacob Nattermann
- Department of Internal Medicine, University Hospital Bonn, Bonn, Germany
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
- European Reference Network for Genetic Tumor Risk Syndromes (ERN Genturis), Nijmegen, The Netherlands
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