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Kubo T, Ikeda Y, Muramatu J, Ishikawa K, Yoshida M, Kukita K, Imamura M, Sugita S, Sakurai A, Takada K. Germline BRCA1-Mutated Synchronous and Metachronous Pancreatic Acinar Cell Carcinoma With Long-Term Survival. Cancer Rep (Hoboken) 2024; 7:e70007. [PMID: 39188100 PMCID: PMC11347749 DOI: 10.1002/cnr2.70007] [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: 04/30/2024] [Revised: 07/29/2024] [Accepted: 08/10/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Pancreatic acinar cell carcinoma (PACC) is a rare pancreatic neoplasm. Recently, molecular analysis revealed that PACC shows a high frequency of the BRCA1/2 mutation and is likely to be considered a cancer associated with hereditary breast and ovarian cancer (HBOC). Hereditary cancers, including HBOC, are characterized by multifocal and/or metachronous tumors. However, no case reports exist of germline BRCA1-mutated synchronous and metachronous PACC. CASE A 58-year-old man was diagnosed with synchronous and metachronous PACC at the age of 56 and underwent two surgeries. Ten months after the second surgery, the patient developed multiple liver metastases. Gemcitabine plus nab-paclitaxel therapy was administered as first-line chemotherapy. After seven cycles, computed tomography examination revealed progressive disease (PD). Therefore, modified FOLFIRINOX (mFFX) was administered as second- line chemotherapy. After 19 cycles of mFFX, comprehensive cancer genomic profiling (CGP) identified a BRCA1 pathogenic variant that was confirmed to be germline origin. Accordingly, we treated the patient with olaparib; however, he was diagnosed with PD after 4 months. He subsequently died 5 years and 9 months after the initial surgery, and 3 years and 10 months after chemotherapy. Based on the genetic data of the patients, his family members received genetic counseling followed by cascade testing. Consequently, the same gBRCA1 pathogenic variant was detected in the son and his surveillance for HBOC-related cancers was initiated. CONCLUSION We diagnosed a 58-year-old man with a synchronous and metachronous PACC with germline BRCA1 pathogenic variant. Considering that PACC is likely to have BRCA1/2 mutations responsible for HBOC, we need to be aware of the possible presence of multifocal and/or metachronous tumors in patients with PACC. Additionally, patients with PACC should undergo genetic examinations, which would be beneficial in determining treatment strategies and health care for blood relatives.
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MESH Headings
- Humans
- Middle Aged
- Male
- Pancreatic Neoplasms/genetics
- Pancreatic Neoplasms/pathology
- Germ-Line Mutation
- BRCA1 Protein/genetics
- Carcinoma, Acinar Cell/genetics
- Carcinoma, Acinar Cell/pathology
- Carcinoma, Acinar Cell/diagnosis
- Carcinoma, Acinar Cell/therapy
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Oxaliplatin/administration & dosage
- Leucovorin/administration & dosage
- Irinotecan/administration & dosage
- Paclitaxel/administration & dosage
- Fluorouracil/administration & dosage
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Affiliation(s)
- Tomohiro Kubo
- Department of Medical OncologySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Yuki Ikeda
- Department of Medical OncologySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Joji Muramatu
- Department of Medical OncologySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Kazuma Ishikawa
- Department of Medical OncologySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Makoto Yoshida
- Department of Medical OncologySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Kazuharu Kukita
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Masafumi Imamura
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Shintaro Sugita
- Department of Surgical PathologySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Akihiro Sakurai
- Department of Medical Genetics and GenomicsSapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Kohichi Takada
- Department of Medical OncologySapporo Medical University School of MedicineSapporoHokkaidoJapan
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2
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Idogawa M, Mariya T, Tanaka Y, Saito T, Nakase H, Tokino T, Sakurai A. The frequency and pathogenicity of BRCA1 and BRCA2 variants in the general Japanese population. J Hum Genet 2024; 69:225-230. [PMID: 38409497 DOI: 10.1038/s10038-024-01233-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Abstract
Hereditary breast and ovarian cancer syndrome (HBOC) resulting from pathogenic variants of BRCA1 or BRCA2 is the most common and well-documented hereditary tumor. Although founder variants have been identified in population-based surveys in various countries, the types of variants are not uniform across races and regions. Recently, the Tohoku Medical Megabank Organization (ToMMo) released whole-genome sequence data including approximately 54,000 individuals from the general population of the Tohoku area in Japan. We analyzed these data and comprehensively identified the prevalence of BRCA1/2 pathogenic and truncating variants. We believe that an accurate understanding of the unique distribution and characteristics of pathogenic BRCA1/2 variants in Japan through this analysis will enable better surveillance and intervention for HBOC patients, not only in Japan but also worldwide.
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Affiliation(s)
- Masashi Idogawa
- Department of Medical Genome Sciences, Cancer Research Institute, Sapporo Medical University School of Medicine, Sapporo, Japan.
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Tasuku Mariya
- Department of Medical Genetics and Genomics, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yumi Tanaka
- Department of Medical Genetics and Genomics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takashi Tokino
- Department of Medical Genome Sciences, Cancer Research Institute, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akihiro Sakurai
- Department of Medical Genetics and Genomics, Sapporo Medical University School of Medicine, Sapporo, Japan
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3
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Matsubayashi H, Kiyozumi Y, Harada R, Mukaigawa T, Sugiura T, Ishiwatari H, Sato J, Niiya F, Nakashima K, Kado N, Nishimura S, Honda G, Ohike N. A Japanese Family Meeting the Clinical Diagnostic Criteria for MEN1 with a MEN1 Variant of Uncertain Significance. Intern Med 2024; 63:1119-1123. [PMID: 37661450 PMCID: PMC11081883 DOI: 10.2169/internalmedicine.2300-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
Multiple gastroenteric, pancreatic, and pituitary neuroendocrine neoplasms (NENs) were diagnosed in a 74-year-old man with a history of primary hyperparathyroidism (PHPT). Germline testing demonstrated a variant of MEN1 (c.1694T>A, p.L565Q), whose pathogenicity was classified as a variant of uncertain significance (VUS) according to the ACMG/AMP guidelines. The same germline variant was detected in the patient's son and daughter, who also showed PHPT or hypercalcemia and met the clinical diagnostic criteria for multiple endocrine neoplasia type 1 (MEN1). During surveillance of the son, multiple pancreatic tumors suggestive of NENs were detected. The pathogenicity of the current MEN1 variant was re-evaluated as likely pathogenic, based on additional family data.
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Affiliation(s)
- Hiroyuki Matsubayashi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Japan
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Yoshimi Kiyozumi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Japan
| | - Rina Harada
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Japan
| | | | - Teichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan
| | | | - Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | | | - Kazuaki Nakashima
- Division of Breast Imaging and Breast Intervention Radiology, Shizuoka Cancer Center, Japan
| | - Nobuhiro Kado
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Japan
| | | | - Goichi Honda
- Division of Research Center, Shizuoka Cancer Center, Japan
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4
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Matsubayashi H, Todaka A, Kawakami T, Hamauchi S, Yokota T, Higashigawa S, Kiyozumi Y, Harada R, Kado N, Nishimura S, Ishiwatari H, Sato J, Niiya F, Ono H, Sugiura T, Sasaki K, Yasui H, Yamazaki K. Genetic medicine in companion diagnostics of germline BRCA testing of Japanese pancreatic cancer patients. J Hum Genet 2023; 68:81-86. [PMID: 36482120 DOI: 10.1038/s10038-022-01097-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022]
Abstract
In 2021, Japan's national health insurance made germline BRCA (g.BRCA) testing available to unresectable pancreatic cancer (PC) patients as a companion diagnostic (CD) of the PARP inhibitor. This study investigated the incidence of the g.BRCA variant (g.BRCAv.) and the status of the genetic medicine associated with its testing. A total of 110 PC patients underwent the testing, five of whom (4.5%) had a deleterious g.BRCA2v. (all truncations) but no g.BRCA1v. The turnaround time (TAT) to the doctors was 13 days, and to the patients, 17 days. A higher incidence of a BRCA-related family history and a shorter TAT were seen in the g.BRCAv. patients, but they were insignificant (p = 0.085 and p = 0.059, respectively). Genetic counseling was not performed for three g.BRCA2v. patients because two of them had no accessible relatives and one died of the cancer before the genetic report was completed. Two families underwent generic counseling and testing based on the patient's genetic data. g.BRCAv. is recognized in a small fraction of PC cases, and the following genetic counseling is done more for the relatives than for the patients. TAT was constant and did not affect much on the genetic counseling, but the earlier testing is expected for patients with a deadly cancer.
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Affiliation(s)
- Hiroyuki Matsubayashi
- Division of Genetic Medicine Promotion, Shizuoka, Japan. .,Division of Endoscopy, Shizuoka, Japan.
| | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka, Japan
| | | | | | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka, Japan
| | | | | | - Rina Harada
- Division of Genetic Medicine Promotion, Shizuoka, Japan
| | - Nobuhiro Kado
- Division of Genetic Medicine Promotion, Shizuoka, Japan.,Division of Gynecology, Shizuoka, Japan
| | - Seiichiro Nishimura
- Division of Genetic Medicine Promotion, Shizuoka, Japan.,Division of Breast Surgery, Shizuoka, Japan
| | | | | | | | | | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka, Japan
| | | | - Hirofumi Yasui
- Division of Genetic Medicine Promotion, Shizuoka, Japan.,Division of Gastrointestinal Oncology, Shizuoka, Japan
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5
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Carvalho CMD, Braga LDC, Silva LM, Chami AM, Silva Filho ALD. Germline Mutations Landscape in a Cohort of the State of Minas Gerais, Brazil, in Patients Who Underwent Genetic Counseling for Gynecological and Breast Cancer. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:74-81. [PMID: 36977404 PMCID: PMC10078886 DOI: 10.1055/s-0042-1757956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE The present study evaluated the profile of germline mutations present in patients who underwent genetic counseling for risk assessment for breast cancer (BC), ovarian cancer (OC), and endometrial cancer (EC) with a possible hereditary pattern. METHODS Medical records of 382 patients who underwent genetic counseling after signing an informed consent form were analyzed. A total of 55.76% of patients (213/382) were symptomatic (personal history of cancer), and 44.24% (169/382) were asymptomatic (absence of the disease). The variables analyzed were age, sex, place of birth, personal or family history of BC, OC, EC, as well as other types of cancer associated with hereditary syndromes. The Human Genome Variation Society (HGVS) nomenclature guidelines were used to name the variants, and their biological significance was determined by comparing 11 databases. RESULTS We identified 53 distinct mutations: 29 pathogenic variants, 13 variants of undetermined significance (VUS), and 11 benign. The most frequent mutations were BRCA1 c.470_471delCT, BRCA1 c.4675 + 1G > T, and BRCA2 c.2T> G. Furthermore, 21 variants appear to have been described for the first time in Brazil. In addition to BRCA1/2 mutations, variants in other genes related to hereditary syndromes that predispose to gynecological cancers were found. CONCLUSION This study allowed a deeper understanding of the main mutations identified in families in the state of Minas Gerais and demonstrates the need to assess the family history of non-gynecological cancer for risk assessment of BC, OC, and EC. Moreover, it is an effort that contributes to population studies to evaluate the cancer risk mutation profile in Brazil.
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Affiliation(s)
- Camila Martins de Carvalho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Letícia da Conceição Braga
- OncoTag Desenvolvimento de Produtos e Serviços para Saúde Humana, Belo Horizonte, MG, Brazil
- Translational Research Laboratory in Oncology, Instituto Mário Penna-Ensino, Pesquisa e Inovação, Belo Horizonte, MG, Brazil
| | - Luciana Maria Silva
- OncoTag Desenvolvimento de Produtos e Serviços para Saúde Humana, Belo Horizonte, MG, Brazil
- Cell Biology Service, Diretoria de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, Belo Horizonte, MG, Brazil
| | - Anisse Marques Chami
- School of Medicine, Campus Botucatu, Universidade Estadual Paulista, Belo Horizonte, MG, Brazil
| | - Agnaldo Lopes da Silva Filho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- School of Medicine, Campus Botucatu, Universidade Estadual Paulista, Belo Horizonte, MG, Brazil
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6
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Mori T, Okamoto Y, Mu A, Ide Y, Yoshimura A, Senda N, Inagaki‐Kawata Y, Kawashima M, Kitao H, Tokunaga E, Miyoshi Y, Ohsumi S, Tsugawa K, Ohta T, Katagiri T, Ohtsuru S, Koike K, Ogawa S, Toi M, Iwata H, Nakamura S, Matsuo K, Takata M. Lack of impact of the
ALDH2
rs671 variant on breast cancer development in Japanese
BRCA1
/2‐mutation carriers. Cancer Med 2022; 12:6594-6602. [PMID: 36345163 PMCID: PMC10067083 DOI: 10.1002/cam4.5430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/19/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
The aldehyde degrading function of the ALDH2 enzyme is impaired by Glu504Lys polymorphisms (rs671, termed A allele), which causes alcohol flushing in east Asians, and elevates the risk of esophageal cancer among habitual drinkers. Recent studies suggested that the ALDH2 variant may lead to higher levels of DNA damage caused by endogenously generated aldehydes. This can be a threat to genome stability and/or cell viability in a synthetic manner in DNA repair-defective settings such as Fanconi anemia (FA). FA is an inherited bone marrow failure syndrome caused by defects in any one of so far identified 22 FANC genes including hereditary breast and ovarian cancer (HBOC) genes BRCA1 and BRCA2. We have previously reported that the progression of FA phenotypes is accelerated with the ALDH2 rs671 genotype. Individuals with HBOC are heterozygously mutated in either BRCA1 or BRCA2, and the cancer-initiating cells in these patients usually undergo loss of the wild-type BRCA1/2 allele, leading to homologous recombination defects. Therefore, we hypothesized that the ALDH2 genotypes may impact breast cancer development in BRCA1/2 mutant carriers. We genotyped ALDH2 in 103 HBOC patients recruited from multiple cancer centers in Japan. However, we were not able to detect any significant differences in clinical stages, histopathological classification, or age at clinical diagnosis across the ALDH2 genotypes. Unlike the effects in hematopoietic cells of FA, our current data suggest that there is no impact of the loss of ALDH2 function in cancer initiation and development in breast epithelium of HBOC patients.
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Affiliation(s)
- Tomoharu Mori
- Laboratory of DNA Damage Signaling, Department of Late Effects Studies Radiation Biology Center Graduate School of Biostudies, Kyoto University Kyoto Japan
- Department of Primary Care and Emergency Medicine Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Yusuke Okamoto
- Laboratory of DNA Damage Signaling, Department of Late Effects Studies Radiation Biology Center Graduate School of Biostudies, Kyoto University Kyoto Japan
| | - Anfeng Mu
- Laboratory of DNA Damage Signaling, Department of Late Effects Studies Radiation Biology Center Graduate School of Biostudies, Kyoto University Kyoto Japan
| | - Yoshimi Ide
- Division of Breast Surgical Oncology Showa University School of Medicine Tokyo Japan
- Department of Breast Surgery Kikuna Memorial Hospital Yokohama Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology Aichi Cancer Center Hospital Nagoya Japan
| | - Noriko Senda
- Department of Breast Surgery Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yukiko Inagaki‐Kawata
- Department of Breast Surgery Graduate School of Medicine Kyoto University Kyoto Japan
| | - Masahiro Kawashima
- Department of Breast Surgery Graduate School of Medicine Kyoto University Kyoto Japan
| | - Hiroyuki Kitao
- Department of Molecular Cancer Biology Graduate School of Pharmaceutical Sciences, Kyushu University Fukuoka Japan
| | - Eriko Tokunaga
- Department of Breast Oncology National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Yasuo Miyoshi
- Division of Breast and Endocrine Surgery Department of Surgery, Hyogo College of Medicine Hyogo Japan
| | - Shozo Ohsumi
- Department of Breast Oncology National Hospital Organization Shikoku Cancer Center Matsuyama Ehime Japan
| | - Koichiro Tsugawa
- Division of Breast and Endocrine Surgery, Department of Surgery St. Marianna University School of Medicine Kawasaki Kanagawa Japan
| | - Tomohiko Ohta
- Department of Translational Oncology St. Marianna University Graduate School of Medicine Kawasaki Kanagawa Japan
| | - Toyomasa Katagiri
- Division of Genome Medicine Institute of Advanced Medical Sciences Tokushima University Tokushima Japan
| | - Shigeru Ohtsuru
- Department of Primary Care and Emergency Medicine Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology Graduate School of Medicine Kyoto University Kyoto Japan
- Department of Medicine Center for Hematology and Regenerative Medicine Karolinska Institute Solna Sweden
- Institute for the Advanced Study of Human Biology (WPI‐ASHBi) Kyoto University Kyoto Japan
| | - Masakazu Toi
- Department of Breast Surgery Graduate School of Medicine Kyoto University Kyoto Japan
| | - Hiroji Iwata
- Department of Breast Oncology Aichi Cancer Center Hospital Nagoya Japan
| | - Seigo Nakamura
- Department of Breast Surgery Kikuna Memorial Hospital Yokohama Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention Aichi Cancer Center Research Institute Nagoya Aichi Japan
- Division of Cancer Epidemiology Nagoya University Graduate School of Medicine Nagoya Aichi Japan
| | - Minoru Takata
- Laboratory of DNA Damage Signaling, Department of Late Effects Studies Radiation Biology Center Graduate School of Biostudies, Kyoto University Kyoto Japan
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7
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Akbar F, Siddiqui Z, Waheed MT, Ehsan L, Ali SI, Wiquar H, Valimohammed AT, Khan S, Vohra L, Zeeshan S, Rashid Y, Moosajee M, Jabbar AA, Zahir MN, Zahid N, Soomro R, Ullah NN, Ahmad I, Haider G, Ansari U, Rizvi A, Mehboobali A, Sattar A, Kirmani S. Spectrum of germline pathogenic variants using a targeted next generation sequencing panel and genotype-phenotype correlations in patients with suspected hereditary breast cancer at an academic medical centre in Pakistan. Hered Cancer Clin Pract 2022; 20:24. [PMID: 35710434 PMCID: PMC9204946 DOI: 10.1186/s13053-022-00232-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy in women, affecting over 1.5 million women every year, which accounts for the highest number of cancer-related deaths in women globally. Hereditary breast cancer (HBC), an important subset of breast cancer, accounts for 5-10% of total cases. However, in Low Middle-Income Countries (LMICs), the population-specific risk of HBC in different ethnicities and the correlation with certain clinical characteristics remain unexplored. METHODS Retrospective chart review of patients who visited the HBC clinic and proceeded with multi-gene panel testing from May 2017 to April 2020. Descriptive and inferential statistics were used to analyze clinical characteristics of patients. Fisher's exact, Pearson's chi-squared tests and Logistic regression analysis were used for categorical variables and Wilcoxon rank-sum test were used for quantitative variables. For comparison between two independent groups, Mann-Whitney test was performed. Results were considered significant at a p value of < 0.05. RESULTS Out of 273 patients, 22% tested positive, 37% had a VUS and 41% had a negative genetic test result. Fifty-five percent of the positive patients had pathogenic variants in either BRCA1 or BRCA2, while the remaining positive results were attributed to other genes. Patients with a positive result had a younger age at diagnosis compared to those having a VUS and a negative result; median age 37.5 years, IQR (Interquartile range) (31.5-48). Additionally, patients with triple negative breast cancer (TNBC) were almost 3 times more likely to have a positive result (OR = 2.79, CI = 1.42-5.48 p = 0.003). Of all patients with positive results, 25% of patients had a negative family history of breast and/or related cancers. CONCLUSIONS In our HBC clinic, we observed that our rate of positive results is comparable, yet at the higher end of the range which is reported in other populations. The importance of expanded, multi-gene panel testing is highlighted by the fact that almost half of the patients had pathogenic or likely pathogenic variants in genes other than BRCA1/2, and that our test positivity rate would have only been 12.8% if only BRCA1/2 testing was done. As the database expands and protocol-driven referrals are made across the country, our insight about the genetic architecture of HBC in our population will continue to increase.
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Affiliation(s)
- Fizza Akbar
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Lubaina Ehsan
- Medical College, Aga Khan University, Karachi, Pakistan
- School of Medicine, Western Michigan University Stryker, Kalamazoo, MI, USA
| | - Syed Ibaad Ali
- School of Medicine, Western Michigan University Stryker, Kalamazoo, MI, USA
| | - Hajra Wiquar
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Shaista Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Lubna Vohra
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Sana Zeeshan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Yasmin Rashid
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Munira Moosajee
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | | | | | - Naila Zahid
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Rufina Soomro
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | - Imran Ahmad
- Cancer Foundation Hospital, Karachi, Pakistan
| | | | - Uzair Ansari
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arif Mehboobali
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Abida Sattar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
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8
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Higashigawa S, Matsubayashi H, Kiyozumi Y, Kado N, Nishimura S, Oishi T, Sugino T, Fushiki K, Shirasu H, Yasui H, Mamesaya N, Fukuzaki N, Kunitomo K, Horiuchi Y, Kenmotsu H, Serizawa M. Present status of germline findings in precision medicine for Japanese cancer patients: issues in the current system. Jpn J Clin Oncol 2022; 52:599-608. [PMID: 35411369 DOI: 10.1093/jjco/hyac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/11/2021] [Accepted: 03/07/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Since 2019, precision cancer medicine has been covered by national insurance in Japan; however, to date, germline findings have not been fully reported. The aim of this study was to evaluate the current status and raise a problem of germline finding analysis and disclosure in Japanese precision cancer medicine. METHODS Germline findings of 52 genes were examined in 296 cases with advanced cancer by a case series study. RESULTS Six (2.0%) cases were examined by the Oncoguide™ NCC Oncopanel with germline testing, but no germline findings were reported. The remaining 290 (98.0%) cases were analyzed by FoundationOne® CDx (tumor-only testing), which recognized 404 pathogenic variants; those of BRCA1/2 were recognized in 16 (5.5%) tumors. Our institutional algorithm suggested 39 candidate germline findings in 34 cases, while the public algorithm listed at least 91 candidate germline findings. Four germline findings had been previously identified (BRCA1: 3 and ATM: 1). Nine of 30 cases with candidate germline findings excluding these known germline findings refused or deferred germline testing. Only 4 of 16 cases that received counseling underwent germline testing, and those 4 revealed 3 germline findings (BRCA2, CDK4 and RAD51C); in total, 8 (2.7%) germline findings were revealed. Reasons for refusing genetic counseling and/or germline testing included extra hospital visits, added expense for germline testing due to limited national insurance coverage, poor patient physical condition and no known family members associated with the possible germline finding. CONCLUSIONS In current Japanese precision cancer medicine, only a small fraction of the patients undergoes germline testing and demonstrated germline finding. The current results suggested a need for earlier indications for precision cancer medicine, broader insurance coverage and more efficient germline finding prediction algorithms, to increase the number of germline testings and to improve the following managements.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Yasue Horiuchi
- Division of Genetic Medicine Promotion.,Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | | | - Masakuni Serizawa
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
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9
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Genetic medicine is accelerating in Japan. Breast Cancer 2022; 29:659-665. [PMID: 35191009 PMCID: PMC9225975 DOI: 10.1007/s12282-022-01342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Abstract
Background In 2018, BRACAnalysis® was covered by medical insurance in Japan as a companion diagnostic test for the poly ADP-ribose polymerase inhibitor olaparib. In April 2020, eligibility for BRCA1/2 genetic testing was expanded to the diagnosis of hereditary breast and ovarian cancer syndrome, and medical management including prophylactic surgery and surveillance were covered by public insurance for BRCA1/2 mutation carriers who developed breast or ovarian cancer. The amount of BRCA1/2 genetic testing has been increasing recently, but the number of subjects and the impact of testing for patients’ outcomes remain unclear. Patients and methods This study explored the potential number of patients who will be eligible for new insurance coverage for BRCA1/2 genetic testing. We analyzed 868 patients from 938 surgeries between January 2014 and September 2020 from our database. Results Overall, 372 patients (43%) were eligible for new insurance coverage for BRCA1/2 genetic testing. The most common category was family history of breast or ovarian cancer within third-degree relatives. We found that 202 patients (23%) had family history of breast or ovarian cancer. In addition, the progression-free survival was significantly lower in triple-negative breast cancer patients aged 60 years or younger compared with the other patients (P = 0.0005). Conclusion The genetic medicine for primary breast cancer patients with BRCA1/2 germline mutation is accelerating rapidly in Japan. Therefore, establishing a system for the genetic medicine would be urgent. Supplementary Information The online version contains supplementary material available at 10.1007/s12282-022-01342-4.
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Impact of BRCA mutation on the survival and risk of contralateral breast cancer in Asian breast cancer patients. Breast Cancer Res Treat 2022; 192:629-637. [PMID: 35113257 DOI: 10.1007/s10549-021-06446-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/12/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Breast cancer is increasing around the globe, including Asia. We aimed to examine the survival and risk of contralateral breast cancer (CBC) in Asian breast cancer patients with BRCA mutations. METHODS A total of 128 breast cancer patients with germline BRCA mutations and 4,754 control breast cancer patients were enrolled. Data on clinical-pathologic characteristics, survival, and CBC were collected from the medical record. The rates of survival and CBC were estimated by Kaplan-Meier method. RESULTS The mean age of onset in BRCA mutation carriers was significantly younger than control patients (BRCA vs. Non-BRCA: 43.9 vs. 53.2 years old). BRCA mutation carriers had a higher proportion of triple-negative breast cancer (TNBC) (52%) than control patients (12%, p < 0.001). The risk of CBC was significantly higher in BRCA mutation patients than in control cases (hazard ratio (HR) = 3.95, 95% CI 2.71-5.75); when stratified by genotype, the HRs (95%CI) were 4.84 (3.00-7.82) for BRCA1 and 3.13 (1.78-5.49) for BRCA2 carriers, respectively. Moreover, BRCA1 mutation patients with triple-negative breast cancer (TNBC) as their first breast cancer had the highest risk of CBC (HR = 5.55, 95% CI 3.29-9.34). However, we did not observe any differences in relapse-free survival and overall survival between mutation carriers and control patients. CONCLUSION Our study suggest that BRCA patients had a significantly higher risk of developing CBC, particularly for BRCA1 mutation carriers with TNBC as the first breast cancer.
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Correlation between the risk of ovarian cancer and BRCA recurrent pathogenic variants in Japan. J Hum Genet 2022; 67:267-272. [PMID: 34983974 DOI: 10.1038/s10038-021-01002-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/29/2021] [Indexed: 11/08/2022]
Abstract
We previously reported that L63X and Q934X are BRCA1 common founder variants in Japan. So far, there have been no reports of a correlation between such BRCA common variants and the risk of BRCA-related cancers. In this analysis, we investigated the correlation between the risk of ovarian cancer (OC) and BRCA recurrent pathogenic variants. We examined the database of the Japanese organization of hereditary breast and ovarian cancer. The database contained 3517 probands who underwent BRCA genetic testing. Among them, 11.1% (392/3517) had germline BRCA1 pathogenic variant, and 8.3% (293/3517) had BRCA2 pathogenic variant. We calculated the OC prevalence, breast cancer (BC) prevalence, and the ratio of OC to BC within second-degree relatives. The ratio of OC to BC in Q934X family members was significantly higher than that in the overall BRCA1 family members (0.80 vs.0.52: p = 0.038), and the ratio in STOP799 was 0.42, which was relatively lower than the overall BRCA1 value. Both Q934X and STOP799 are located in the ovarian cancer cluster region (OCCR), however there seems to be a difference in the risk of OC. R2318X family members had a significant higher ratio of OC to BC at 0.32 than the overall BRCA2 value of 0.13 (p = 0.012). R2318X is known to be located in the OCCR. This is the first report to investigate the correlation between BRCA recurrent variants and the risk of OC in Japan. The family members of probands with Q934X or R2318X have a higher risk of OC than that with other BRCA variants.
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Sekine M, Enomoto T, Arai M, Den H, Nomura H, Ikeuchi T, Nakamura S. Differences in age at diagnosis of ovarian cancer for each BRCA mutation type in Japan: optimal timing to carry out risk-reducing salpingo-oophorectomy. J Gynecol Oncol 2022; 33:e46. [PMID: 35557031 PMCID: PMC9250856 DOI: 10.3802/jgo.2022.33.e46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/10/2021] [Accepted: 03/05/2022] [Indexed: 12/04/2022] Open
Abstract
Objective BRCA1 and BRCA2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) by age 40 and 45, respectively. However, the carriers have a different way of thinking about their life plan. We aimed to investigate the distribution of age at diagnosis of ovarian cancer (OC) patients to examine the optimal timing of RRSO in the carriers. Methods We examined a correlation between age at diagnosis of OC and common mutation types in 3,517 probands that received BRCA genetic testing. Among them, germline BRCA1 mutation (gBRCA1m), germline BRCA2 mutation (gBRCA2m) and germline BRCA wild-type (gBRCAwt) were found in 185, 42 and 241 OC patients, respectively. Results The average age at diagnosis of OC in gBRCA1m and gBRCA2m was 51.3 and 58.3 years, respectively, and the difference from gBRCAwt (53.8 years) was significant. The gBRCA2m carriers did not develop OC under the age of 40. The average age was 50.1 years for L63X and 52.8 years for Q934X in BRCA1, and 55.1 years for R2318X and 61.1 years for STOP1861 in BRCA2. The age at diagnosis in L63X or R2318X carriers was relatively younger than other BRCA1 or BRCA2 carriers, however their differences were not significant. With L63X and R2318X carriers, 89.4% (42/47) and 100% (7/7) of women were able to prevent the development of OC, respectively, when RRSO was performed at age 40. Conclusion There appears to be no difference in the age at diagnosis of OC depending on the type of BRCA common mutation. Further analysis would be needed. This is the first report to present the optimal timing of risk-reducing salpingo-oophorectomy for each BRCA mutation type in Japan. The average age at diagnosis of ovarian cancer (OC) in germline BRCA2 mutation (gBRCA2m) is higher than that in germline BRCA wild-type. The gBRCA2m carriers did not develop OC under the age of 40. The average age at diagnosis in L63X or R2318X carriers was relatively younger than other BRCA mutation carriers, though the differences were not significant.
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Affiliation(s)
- Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masami Arai
- Clinical Genetics, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Den
- Department of Hygiene, Public Health, and Preventative Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hiroyuki Nomura
- Department of Obstetrics and Gynecology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
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Aoki S, Fujita S. Self-Transcendence of Japanese Female Breast Cancer Patients with Hereditary Breast and Ovarian Cancer Syndrome. Asia Pac J Oncol Nurs 2021; 8:670-678. [PMID: 34790851 PMCID: PMC8522594 DOI: 10.4103/apjon.apjon-218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The present study examined self-transcendence of Japanese female breast cancer patients with hereditary breast and ovarian cancer (HBOC) syndrome. Methods Semi-structured interviews were conducted with 13 women with HBOC in their thirties to sixties, who consented to participate in the study. The obtained data were analyzed using a modified grounded theory approach. Results The analysis yielded seven categories of self-transcendence in women with HBOC: (1) the ability to face oneself while seeking optimal strategies to continue living; (2) the ability to come to terms with blood conditions inherited from previous generations; (3) the ability to use one's own experiences as a patient with HBOC to help others; (4) the ability to share mutual support with others; (5) the ability to accept the diverse views on HBOC; (6) the ability to break free from fixed ideas and live with HBOC; and (7) the ability to live with future perspectives. Conclusions The self-transcendence of Japanese female breast cancer patients with HBOC can be described as not giving up; confronting one's lineage, which is passed down from generation to generation, even as one is haunted and emotionally affected by the lifelong risk of developing cancer or facing death; and valuing not just oneself but also others through interactions with them. These abilities formed the foundation for the self-transcendence of the women in this study. In addition, because the women with this condition started valuing not just themselves but also others, they developed the ability to accept the diverse views surrounding HBOC and to coexist with their condition while being forward-looking.
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Affiliation(s)
- Sanae Aoki
- Faculty of Nursing, Kansai Medical University, Osaka, Japan
| | - Sawa Fujita
- Faculty of Nursing, University of Kochi, Kochi, Japan
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Nomura H, Ikki A, Fusegi A, Omi M, Aoki Y, Netsu S, Tanigawa T, Matoda M, Okamoto S, Omatsu K, Nakajima T, Ueki A, Tonooka A, Kanao H. Clinical and pathological outcomes of risk-reducing salpingo-oophorectomy for Japanese women with hereditary breast and ovarian cancer. Int J Clin Oncol 2021; 26:2331-2337. [PMID: 34453642 DOI: 10.1007/s10147-021-02020-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To clarify the clinical as well as pathological outcomes in Japanese women with germline pathogenic BRCA1/2 variants who underwent risk-reducing salpingo-oophorectomy (RRSO). METHODS This prospective study examined the rate of occult cancer and primary peritoneal cancer after RRSO at our institution in the period from 2011 to 2020. Clinical records of genetically confirmed patients with germline pathogenic BRCA1/2 variants who desired to undergo RRSO were reviewed. Specimens obtained during RRSO were pathologically diagnosed as per SEE-FIM protocol. All the participants underwent magnetic resonance imaging (MRI) about 1 month preoperatively. RESULTS One hundred and seventeen women underwent RRSO during this period. Of these, the numbers of women with germline pathogenic BRCA1 and BRCA2 variants were 72 and 45, respectively. The mean observational time after RRSO was 35.8 months. Despite negative preoperative screening results, three (2.6%) serous tubal intraepithelial carcinoma and three (2.6%) invasive carcinomas were identified. Of the three invasive carcinomas cases, two were International Federation of Gynecology and Obstetrics (FIGO) stage I primary fallopian tube cancer, and the third case was double cancer (ovarian cancer and fallopian tube cancer) with FIGO stage IC3. CONCLUSIONS The rate of occult neoplasms was similar to those reported by studies performed in other countries. Although women with occult cancer were diagnosed with FIGO stage I, the MRI performed 1 month preoperatively did not show any such malignant findings. Thus, RRSO is the only promising method that can improve the prognosis in women with germline pathogenic BRCA1/2 variants.
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Affiliation(s)
- Hidetaka Nomura
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan.
| | - Ai Ikki
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Atsushi Fusegi
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Makiko Omi
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Yoichi Aoki
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Sachiho Netsu
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Terumi Tanigawa
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Maki Matoda
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Sanshiro Okamoto
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Kohei Omatsu
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
| | - Takeshi Nakajima
- Department of Clinical Genetics, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, Japan
| | - Arisa Ueki
- Department of Clinical Genetics, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, Japan
| | - Akiko Tonooka
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto City, Tokyo, 135-8550, Japan
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Hirayama T, Inayama Y, Odajima S, Yamanaka A, Sekine M, Terao Y, Koide K, Kuwabara Y, Yahata H, Yanaihara N, Nagase S, Kobayashi Y, Sekizawa A. A report on the 73th Annual Congress of the Japan Society of Obstetrics and Gynecology International Workshop for Junior Fellows: Risk-reducing surgery for hereditary breast and ovarian cancer. J Obstet Gynaecol Res 2021; 47:3761-3766. [PMID: 34333832 DOI: 10.1111/jog.14952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022]
Abstract
At the 73rd Annual Congress of the Japan Society of Obstetrics and Gynecology, young doctors from Japan and South Korea made presentations on the present condition of risk-reducing surgery for hereditary breast and ovarian cancer (RRSO) in their respective country. RRSO was insured in Japan in April 2020, whereas in South Korea, it was insured 7 years earlier in 2013. In Japan, certification criteria have been set for facilities that perform RRSO, and the number of facilities is increasing, but regional disparities still exist in its distribution. The number of gBRCA1/2 testing facilities is larger, and the cost is more affordable in South Korea than in Japan. Additionally, South Korea provides genetic counseling to a wider range of relatives compared to Japan. In the future, as the indications for the gBRCA1/2 test have expanded as a companion diagnostic for the use of PARP inhibitors, it is expected that the number of candidates for the gBRCA1/2 mutation test and RRSO will increase in Japan. It is important to increase the number of BRCA tests while maintaining the quality of genetic counseling in order to provide adequate information on BRCA mutations and RRSO for patients to support their decision. For the development of hereditary breast and ovarian cancer (HBOC) medical care, it is necessary to publish a nationwide database in Japan and continue to analyze and discuss the data based on the results.
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Affiliation(s)
- Takashi Hirayama
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Yoshihide Inayama
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Suguru Odajima
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akina Yamanaka
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Masayuki Sekine
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Yasuhisa Terao
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Keiko Koide
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Kuwabara
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Hideaki Yahata
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Gynecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nozomu Yanaihara
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoru Nagase
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yoichi Kobayashi
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Board of education, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.,Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Saied MH, Elkaffash D, Fadl R, Haleem RA, Refeat A, Ibrahim I, Tahoun M, Elkayal A, Tayae E. Preliminary results of targeted sequencing of BRCA1 and BRCA2 in a cohort of breast cancer families: New insight into pathogenic variants in patients and at‑risk relatives. Mol Med Rep 2021; 24:678. [PMID: 34296289 DOI: 10.3892/mmr.2021.12317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/24/2021] [Indexed: 11/06/2022] Open
Abstract
Breast cancer (BC) is the most commonly diagnosed cancer worldwide and a major health concern in Egypt. There is a known association between pathogenic variants identified in breast cancer susceptibility gene (BRCA)1 and 2 and the risk of developing BC. However, the number of studies investigating mutations in BRCA1 and BRCA2 in Egypt remains limited. Thus, the aim of the present study was to investigate the frequency of BRCA1 and BRCA2 variants in patients with BC and their relatives. For this purpose, 11 families (11 patients and 16 relatives) were included in the present study. BRCA1 and BRCA2 variants were investigated using the Ion S5 next‑generation sequencer. It was found that pathogenic variants were more frequent in patients with familial BC (FBC) than in those with sporadic BC, with 71% of variants in BRCA2, including the first reported identification of c.9089del, c.5583_5584dup, c.8243G>A and c.7976G>A pathogenic variants in Egyptian patients with BC. Pathogenic variants in relatives were confined to FBC c.1278delA, c.1960_1961del, and c.1224delT, with a higher incidence of variants of uncertain significance (VUS), such as BRCA2 intron 2 c.68‑16delT. Of note, two cold spot benign variants, c.3113A>G and c.4837A>G, were repeatedly found (67%) in patients and relatives. In conclusion, to the best of our knowledge, novel pathogenic variants and VUS in Egyptian patients with BC and their high‑risk relatives were identified for the first time in the present study. These findings should be integrated with other genomic data concerning Egyptian families and carefully interpreted during genetic counseling.
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Affiliation(s)
- Marwa H Saied
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Dalal Elkaffash
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Reham Fadl
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Reham Abdel Haleem
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Amal Refeat
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Inas Ibrahim
- Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Mona Tahoun
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Alyaa Elkayal
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Eman Tayae
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
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Decision-making for Risk-reducing Salpingo-oophorectomy (RRSO) in Southeast Asian BRCA Mutation Carriers With Breast Cancer: A Qualitative Study. Int J Behav Med 2021; 29:1-13. [PMID: 33791992 DOI: 10.1007/s12529-021-09984-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The uptake of risk-reducing salpingo-oophorectomy (RRSO) in Asian countries is variable despite being the most effective option for ovarian cancer risk reduction in BRCA mutation carriers. Exploration of factors which may impact the RRSO decision-making of BRCA mutation carriers from Malaysia, a developing country in Southeast Asia, was undertaken. METHODS In-depth interviews with 28 Malaysian BRCA mutation carriers with a history of breast cancer were conducted in addition to observing their RRSO decision-making consultations in the clinic. RESULTS The decision-making considerations among the carriers were centered around the overarching theme of "Negotiating cancer risk and womanhood priorities," with the following themes: (1) risk perception, (2) self-preservation, (3) motherhood obligation, and (4) the preciousness of marriage. Cognitive knowledge of BRCA risk was often conceptualized based on personal and family history of cancer, personal beliefs, and faith. Many women reported fears that RRSO would affect them physically and emotionally, worrying about the post-surgical impact on their motherhood responsibilities. Nevertheless, some reported feeling obliged to choose RRSO for the sake of their children. For some, their husband's support and approval were critical, with emotional well-being and sexuality reportedly perceived as important to sustaining married life. Despite reporting hesitancy toward RRSO, women's decisions about choosing this option evolved as their priorities changed at different stages of life. CONCLUSIONS Recognizing during clinic encounters with Malaysian women that RRSO decision-making involves negotiating the likelihood of developing cancer with the societal priorities of being a woman, mother, and wife may serve to support their decision-making.
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Kuji S, Kondo H, Ohara T, Deura I, Tozawa-Ono A, Migita O, Kawamoto H, Tsugawa K, Chosokabe M, Koike J, Maeda I, Suzuki N. Value of adjuvant chemotherapy and informed microscopic examination for occult gynecologic cancer detected upon risk-reducing salpingo-oophorectomy after chemotherapy for BRCA1/2-associated breast cancer: a case report. Jpn J Clin Oncol 2021; 51:492-497. [PMID: 33377156 DOI: 10.1093/jjco/hyaa239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
BRCA1/2 mutation carriers are at high risk for type II ovarian, fallopian tube or peritoneal cancer. Although risk-reducing salpingo-oophorectomy plays an important role in the prevention of these BRCA1/2-associated gynecological cancers, occult ovarian, fallopian tube, or peritoneal cancer is discovered upon risk-reducing salpingo-oophorectomy in 1-4% of BRCA1/2 mutation carriers. Notably, around 30% of BRCA1/2 mutation carriers who undergo risk-reducing salpingo-oophorectomy have undergone adjuvant chemotherapy for breast cancer. We describe the discovery and treatment of occult cancer at the edge of the left fimbria in a BRCA1 mutation carrier who had, just a short time previously, undergone neoadjuvant paclitaxel plus carboplatin (TC) chemotherapy for triple-negative breast cancer. During subsequent risk-reducing salpingo-oophorectomy, a 5.5-mm nodule was observed at the edge of the left fimbria. Microscopic examination of the tumour tissue revealed high-grade serous carcinoma with degenerate tumour cells and fibrosis. Peritoneal fluid was negative for cancer cells. Two months later, hysterectomy, omentectomy and retroperitoneal lymphadenectomy were performed. The final diagnosis was stage FIGO IA fallopian tube cancer. Adjuvant chemotherapy (TC administered every 3 weeks) was applied, and there has been no evidence of recurrence for 5 years. In applying gynecologic surgery and adjuvant chemotherapy, we followed the general recommendation for stage IA fallopian tube cancer. There is no standard strategy for the treatment of occult fallopian tube cancer detected after chemotherapy for BRCA1-associated triple-negative breast cancer. According to our experience in this case, we believe the clinical value of staging laparotomy in cases of a small occult BRCA1/2-associated gynecological cancer should be further investigated.
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Affiliation(s)
- Shiho Kuji
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Haruhiro Kondo
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Tatsuru Ohara
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Imari Deura
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Akiko Tozawa-Ono
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Ohsuke Migita
- Department of Clinical Genetics, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Hisanori Kawamoto
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Kawasaki-shi, Japan.,St. Marianna University Breast & Imaging Center, Kawasaki-shi, Japan
| | - Koichiro Tsugawa
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Motohiro Chosokabe
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Junki Koike
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki-shi, Japan
| | - Ichiro Maeda
- Department of Diagnostic Pathology, Kitasato University Kitasato Institute Hospital, Tokyo Japan.,Department of Pathology, Kitasato University School of Medicine, Sagamihara-shi, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki-shi, Japan
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Fujisawa F, Tamaki Y, Inoue T, Nakayama T, Yagi T, Kittaka N, Yoshinami T, Nishio M, Matsui S, Kusama H, Kamiura S. Prevalence of BRCA1 and BRCA2 mutations in Japanese patients with triple-negative breast cancer: A single institute retrospective study. Mol Clin Oncol 2021; 14:96. [PMID: 33767865 PMCID: PMC7976388 DOI: 10.3892/mco.2021.2258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Numerous databases for risk assessment of BRCA1/2 gene mutations contain insufficient data about Asians. Furthermore, few studies have reported the prevalence of germline BRCA1/2 mutations in Japanese patients, particularly those with triple-negative breast cancer (TNBC). The present study was a retrospective analysis of data from patients with TNBC who underwent BRCA1/2 mutation testing at Osaka International Cancer Institute (Osaka, Japan) between October 2014 and March 2020. A total of 65 patients with TNBC underwent a test for BRCA1/2 mutations, and 13 (20.0%) had deleterious mutations in the BRCA1 or BRCA2 genes. Furthermore, 12 out of 29 patients with a family history of breast or ovarian cancer had deleterious BRCA1/2 mutations, and only 1 of 34 without a family history had a mutation (41.4 vs. 2.9%; P=0.014). No patients aged >60 years had BRCA1/2 mutations; however, the age of diagnosis was not a significant risk factor for BRCA1/2 mutations (P=0.60). The prevalence of BRCA1/2 mutations in the present cohort of Japanese patients with TNBC was slightly higher than those reported in other larger studies from Europe and North America. Further data from large prospective studies are required to more precisely define the prevalence of BRCA1/2 mutations.
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Affiliation(s)
- Fumie Fujisawa
- Department of Medical Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Yasuhiro Tamaki
- Division of Familial Cancer Clinic, Department of Genetic Medicine, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan.,Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Tazuko Inoue
- Division of Familial Cancer Clinic, Department of Genetic Medicine, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Toshinari Yagi
- Department of Medical Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Nobuyoshi Kittaka
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Tetsuhiro Yoshinami
- Department of Medical Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Minako Nishio
- Department of Medical Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Saki Matsui
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Hiroki Kusama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Shoji Kamiura
- Department of Gynecology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
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20
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Sunar V, Korkmaz V, Topcu V, Cavdarli B, Arik Z, Ozdal B, Ustun YE. Frequency of germline BRCA1/2 mutations and association with clinicopathological characteristics in Turkish women with epithelial ovarian cancer. Asia Pac J Clin Oncol 2021; 18:84-92. [PMID: 33629534 DOI: 10.1111/ajco.13520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aims to determine the frequency of germline BRCA 1/2 mutations in Turkish women with epithelial ovarian cancer (EOC) and evaluate its relationship with clinicopathological characteristics. METHODS In this cross-sectional study, all women with recently diagnosed EOC presenting to Zekai Tahir Burak Women's Health Training and Research Hospital Medical Oncology Clinic between 2016 and 2019 were referred for BRCA testing. Peripheral blood samples were obtained from 76 patients applying to Medical Genetics and BRCA1/2 genes were sequenced using next-generation sequencing. The American College of Medical Genetics and Genomics 2015 criteria were followed for classification of genetic variants. RESULTS Twenty-four women (31.6%) had pathogenic germline BRCA1/2 mutations. Of these, 17 patients (22.4%) harbored germline BRCA1 mutations and 7 (9.2%) had BRCA2 mutations. When we compared the patients with and without BRCA mutations, there was significant difference in terms of family history (41.7% vs 9.6%, respectively, P = .001). Among all patients, 15 (19.7%) had history of breast or ovarian cancer in first- or second-degree relatives. Germline BRCA1/2 mutations were detected in 66.7% of patients with family history, while these mutations were found in 22.9% of patients without family history (P = .001). CONCLUSION In this sample 31.6% of Turkish women with EOC harbored germline BRCA1/2 mutations, which seems higher compared to other ethnic groups except for the Ashkenazi Jews population. All women with EOC should be referred for BRCA testing regardless of family history, age at diagnosis, and histological subtype.
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Affiliation(s)
- Veli Sunar
- Department of Medical Oncology, Zekai Tahir Burak Women's Health Research and Education Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Research and Education Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Vehap Topcu
- Department of Medical Genetics, Zekai Tahir Burak Women's Health Research and Education Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Büşranur Cavdarli
- Department of Medical Genetics, Ankara Numune Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Bülent Ozdal
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Research and Education Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yaprak Engin Ustun
- Department of Gynecology and Obstetrics, Zekai Tahir Burak Women's Health Research and Education Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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21
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Hao W, Zhang Y, Li Z, Zhang E, Gao S, Yin C, Yue W. International trends in ovarian cancer incidence from 1973 to 2012. Arch Gynecol Obstet 2021; 303:1589-1597. [PMID: 33616706 DOI: 10.1007/s00404-021-05967-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Ovarian cancer is the 7th leading cancer diagnosis and the 8th leading cause of cancer death in women worldwide. We conducted this study to investigate the incidence of ovarian cancer internationally. METHODS The trends in ovarian cancer incidence were analyzed through the latest data of CI5 over the 40-year period from 21 populations in 4 continents using Joinpoint analysis, ASRs and proportions of different histological subtypes in those populations were also analyzed using volume XI of CI5. RESULTS ASRs of ovarian cancer were from 7.0 to 11.6 per 100,000 in non-Asia populations during 2008-2012. In Asia, the ASR in Israel (Jews) were the highest, up to 8.1 per 100,000 in the same period. The international trends from 1973 to 2012 showed that ASRs of ovarian cancer were decreasing in 8 of 21 selected populations, whereas ASRs in Slovakia, Spain (Navarra) and China (Shanghai) were increasing. Meanwhile, there are certain differences in the main pathological classification patterns within different regions. In Asia, China (Hong Kong) and Japan both have a higher ASRs and proportions for clear cell and endometrioid carcinomas, while Japan has the highest ASRs and proportions for mucinous carcinomas. CONCLUSION Although the reasons for those trends were not entirely clear, environmental, reproductive and genetic factors were likely to have led to these patterns. Meanwhile, more attention and further study should be given to the etiological factors of histology-specific ovarian cancer.
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Affiliation(s)
- Wende Hao
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Yue Zhang
- Department of Research Management, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Zhefeng Li
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Enjie Zhang
- Office of Major Projects, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Shen Gao
- Office of Major Projects, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Chenghong Yin
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
| | - Wentao Yue
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
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22
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Sa'at H, Lee YK, Yoon SY, Wong SW, Woo YL, Barlow-Stewart K, Mohd Taib NA. The needs of Southeast Asian BRCA mutation carriers considering risk-reducing salpingo-oophorectomy: a qualitative study. Fam Cancer 2021; 21:21-33. [PMID: 33604745 DOI: 10.1007/s10689-021-00232-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/28/2021] [Indexed: 12/28/2022]
Abstract
The decision to have risk-reducing salpingo-oophorectomy (RRSO) by BRCA mutation carriers to reduce the risk of ovarian cancer is difficult. The choice involves trade-offs in terms of its risks and benefits. To date, understanding the decision-making needs of RRSO among Southeast Asian BRCA mutation carriers is limited. This study aimed to explore the decision-making needs of Malaysian BRCA mutation carriers as an exemplar for the Southeast Asian community. In-depth interviews and clinic observations were conducted with 31 BRCA mutation carriers and analysed thematically. The core theme identified was 'Coping with complex information and alleviating uncertainties' with the following subthemes: (1) the need for an adjustment period, (2) information support, (3) social support and, (4) religious support. We found that women required time to accept their BRCA mutation status before they were ready to make a risk-reducing choice; that understanding complex genetic information and multiple risk management options can be an overwhelming experience; and obtaining further information and a second opinion were challenging. Many described the need for experiential information from other peer-carriers who had undergone RRSO. Support from their spouse and family members was thought to be essential for them to feel reassured with their decision. Many relied on religion to positively cope with cancer risk and cancer worry; Muslim BRCA carriers sought religious guidance through prayers and Islamic fatwas to feel more certain about their RRSO decision. These findings underscore the importance of the provision of resources and support that includes input from peers, husband, family members and religion to underpin the decision-making needs of Malaysian BRCA mutation carriers considering RRSO.
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Affiliation(s)
- Hamizah Sa'at
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yew-Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sook-Yee Yoon
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Siu Wan Wong
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Yin Ling Woo
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- University of Malaya Cancer Institute, University of Malaya, Kuala Lumpur, Malaysia.
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23
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Novel candidates of pathogenic variants of the BRCA1 and BRCA2 genes from a dataset of 3,552 Japanese whole genomes (3.5KJPNv2). PLoS One 2021; 16:e0236907. [PMID: 33428613 PMCID: PMC7799847 DOI: 10.1371/journal.pone.0236907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Identification of the population frequencies of definitely pathogenic germline variants in two major hereditary breast and ovarian cancer syndrome (HBOC) genes, BRCA1/2, is essential to estimate the number of HBOC patients. In addition, the identification of moderately penetrant HBOC gene variants that contribute to increasing the risk of breast and ovarian cancers in a population is critical to establish personalized health care. A prospective cohort subjected to genome analysis can provide both sets of information. Computational scoring and prospective cohort studies may help to identify such likely pathogenic variants in the general population. We annotated the variants in the BRCA1 and BRCA2 genes from a dataset of 3,552 whole-genome sequences obtained from members of a prospective cohorts with genome data in the Tohoku Medical Megabank Project (TMM) with InterVar software. Computational impact scores (CADD_phred and Eigen_raw) and minor allele frequencies (MAFs) of pathogenic (P) and likely pathogenic (LP) variants in ClinVar were used for filtration criteria. Familial predispositions to cancers among the 35,000 TMM genome cohort participants were analyzed to verify the identified pathogenicity. Seven potentially pathogenic variants were newly identified. The sisters of carriers of these moderately deleterious variants and definite P and LP variants among members of the TMM prospective cohort showed a statistically significant preponderance for cancer onset, from the self-reported cancer history. Filtering by computational scoring and MAF is useful to identify potentially pathogenic variants in BRCA genes in the Japanese population. These results should help to follow up the carriers of variants of uncertain significance in the HBOC genes in the longitudinal prospective cohort study.
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24
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Mitamura T, Sekine M, Arai M, Shibata Y, Kato M, Yokoyama S, Yamashita H, Watari H, Yabe I, Nomura H, Enomoto T, Nakamura S. Risk factors for lymph node metastasis of ovarian, fallopian tube and primary peritoneal cancer in hereditary breast and ovarian cancer syndrome. Jpn J Clin Oncol 2021; 50:1380-1385. [PMID: 32676635 DOI: 10.1093/jjco/hyaa124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/24/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To establish an individualized surgical strategy for lymphadenectomy in ovarian cancer patients with the germline BRCA1 and BRCA2 pathogenic variants (BRCA1+ and BRCA2+), we investigated the clinicopathological characteristics that are involved in the increased risk of lymph node metastasis. METHODS We retrospectively reviewed the data of Japanese women registered in the database of the Japanese Hereditary Breast and Ovarian Cancer Consortium, who underwent BRCA1 and BRCA2 genetic testing. RESULTS We evaluated the predictors of lymph node metastasis in all patients with the information of age at the diagnosis, disease site, histological subtype, 2014 FIGO stage, personal breast cancer history and family history; 233, 153 and 32 patients in the BRCA- (no pathogenic variant), BRCA1+ and BRCA2+ groups, respectively. The prevalence of lymph node metastasis was not markedly different between BRCA- (20.0%), BRCA1+ (18.4%) and BRCA2+ (26.2%). Multivariate analysis revealed an absence of a family history of ovarian cancer as an independent predictor for an increased risk of lymph node metastasis in BRCA1+, and the prevalence of lymph node metastasis was 11.7 and 42.0% in the groups with and without a family history of ovarian cancer, respectively. This subgroup without a family history of ovarian cancer did not show any correlation with a particular variant of BRCA1, including two common variants of c.188 T > A and c.2800C > T. CONCLUSIONS This study suggested that certain genetic factors related to the penetrance of hereditary breast and ovarian cancer syndrome altered the frequency of lymph node metastasis in BRCA1+ ovarian cancer, and family history may be useful to personalize the indication of lymphadenectomy.
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Affiliation(s)
- Takashi Mitamura
- Department of Obstetrics and Gynecology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo.,Division of Clinical Genetics, Hokkaido University Hospital, Sapporo
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Masami Arai
- Clinical Genetics, Juntendo University, Graduate School of Medicine, Tokyo
| | - Yuka Shibata
- Division of Clinical Genetics, Hokkaido University Hospital, Sapporo
| | - Momoko Kato
- Division of Clinical Genetics, Hokkaido University Hospital, Sapporo
| | - Shiro Yokoyama
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo
| | - Hiroko Yamashita
- Department of Breast Surgery, Hokkaido University Hospital, Sapporo
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo
| | - Ichiro Yabe
- Division of Clinical Genetics, Hokkaido University Hospital, Sapporo
| | - Hiroyuki Nomura
- Department of Obstetrics and Gynecology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo
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25
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Okano M, Nomizu T, Tachibana K, Nagatsuka M, Matsuzaki M, Katagata N, Ohtake T, Yokoyama S, Arai M, Nakamura S. The relationship between BRCA-associated breast cancer and age factors: an analysis of the Japanese HBOC consortium database. J Hum Genet 2020; 66:307-314. [PMID: 33046835 DOI: 10.1038/s10038-020-00849-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023]
Abstract
BRCA1/2 pathogenic variant prevalence in Japanese breast cancer is unclear. Here, we analyzed BRCA1/2 pathogenic variant prevalence with a particular focus on age factors, using the Japanese HBOC consortium database. All registered subjects were Japanese individuals who underwent BRCA1/2 genetic testing from January 1996 to July 2017 according to the Japanese HBOC consortium database. Cases were extracted and analyzed for each evaluation item. Overall BRCA1 and BRCA2 pathogenic variant prevalence was 11.2% and 9.0% in the cohort of 2366 proband patients, respectively. The age at onset of breast cancer for patients with BRCA1/2 pathogenic variants was significantly lower than that for patients without a BRCA1/2 pathogenic variant. In both BRCA1/2 patients, ages at onset were not statistically significantly different between two subtype groups (ER-positive vs. TNBC). We analyzed the BRCA1/2 pathogenic variant prevalence among age groups in patients with no family history of breast or ovarian cancer. In the TNBC group, the rate of genetic variants was more frequent among younger patients. Our results demonstrated that early breast cancer onset is associated with a BRCA1/2 pathogenic variant in the Japanese population. Younger TNBC patients were more likely to have a BRCA1/2 pathogenic variant irrespective of a family history of breast or ovarian cancer.
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Affiliation(s)
- Maiko Okano
- Department of Surgery, Hoshi General Hospital, Fukushima, Japan. .,Department of Breast Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Tadashi Nomizu
- Department of Surgery, Hoshi General Hospital, Fukushima, Japan
| | - Kazunoshin Tachibana
- Department of Surgery, Hoshi General Hospital, Fukushima, Japan.,Department of Breast Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Miki Nagatsuka
- Department of Surgery, Hoshi General Hospital, Fukushima, Japan
| | | | - Naoto Katagata
- Department of Surgery, Hoshi General Hospital, Fukushima, Japan
| | - Toru Ohtake
- Department of Breast Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Masami Arai
- Diagnostics and Therapeutics of Intractable Diseases, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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26
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Yoshimura A, Yokoyama S, Iwata H, Takaiso N, Nomizu T, Arai M, Nakamura S. Incidence of contralateral and ipsilateral breast cancers and prognosis in BRCA1/2 pathogenic variant carriers based on the Japanese HBOC Consortium registration. J Hum Genet 2020; 66:379-387. [PMID: 33037391 DOI: 10.1038/s10038-020-00850-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/22/2020] [Accepted: 09/14/2020] [Indexed: 11/09/2022]
Abstract
This study aimed to clarify the breast cancer prognosis in Japanese patients with BRCA1/2 pathogenic variant. We analyzed 2235 women with breast cancer who underwent BRCA1/2 genetic testing between 1996 and 2018 using data from the Japanese hereditary breast and ovarian cancer syndrome registry. The cumulative risk for contralateral and ipsilateral breast cancers and time to death since the first breast cancer were stratified based on the BRCA1/2 variant status. The median follow-up was 3.0 years (0.1-34.1 years) after the first breast cancer. The annual average risks of contralateral breast cancer in BRCA1 and BRCA2 and non-BRCA1/2 pathogenic variant carriers were 4.0%, 2.9%, and 1.9%, respectively (P = 0.001). The annual average risks of ipsilateral breast cancer in the three groups were 2.7%, 1.4%, and 1.1%, respectively (P = 0.06). BRCA1 pathogenic variant carriers had significantly higher risks of contralateral (hazard ratio 1.91, P < 0.001) and ipsilateral (hazard ratio 2.00, P = 0.02) breast cancers than non-BRCA1/2 pathogenic variant carriers. The time to death by the BRCA1/2 variant status was not significantly difference (P = 0.28). The prognosis of breast cancer patients who received standard treatment was comparable regardless of the BRCA1/2 variant status.
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Affiliation(s)
- Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusaku, Nagoya, 464-8681, Japan.
| | | | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Nobue Takaiso
- Risk Assessment Center, Aichi Cancer Center, Nagoya, Japan
| | - Tadashi Nomizu
- Department of Surgery, Hoshi General Hospital, Fukushima, Japan
| | - Masami Arai
- Genome Medical Center, Juntendo University Hospital, Tokyo, Japan
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27
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Inuzuka M, Watanabe C, Yokoyama S, Kuwayama T, Akashi-Tanaka S, Arai M, Nakamura S. A Retrospective Analysis of the Relationship Between the Result of BRCA1/2 Genetic Testing and Surgical Method Selection in Japan. Clin Breast Cancer 2020; 21:e48-e52. [PMID: 32928640 DOI: 10.1016/j.clbc.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We studied the extent of BRCA1/2 genetic testing to help select the surgical approach for patients with breast cancer in Japan remains unclear. PATIENTS AND METHODS The study subjects were female patients with primary unilateral invasive breast cancer considered as candidates for breast-conserving surgery who underwent preoperative BRCA1/2 genetic testing. A retrospective analysis was performed on the results of BRCA1/2 genetic testing and surgical method selection using national registration data from the Japanese Hereditary Breast and Ovarian Cancer Syndrome Consortium. RESULTS Our study included 318 female patients. Among these patients, 23.7% of patients with BRCA1/2 mutations and 61.8% of patients without these variants underwent breast-conserving surgery (P < .01). Among the patients with BRCA1/2 mutations, those who chose breast-conserving surgery tended not to undergo risk-reducing salpingo-oophorectomy (P < .05). Among the patients with BRCA1/2 mutations who underwent mastectomy for the affected side, 31.8% received contralateral risk-reducing mastectomy. Patients diagnosed with breast cancer under the age of 50 years were more likely to have contralateral risk-reducing mastectomy than patients over the age 50 years (P < .05). CONCLUSIONS Patients with BRCA1/2 mutations tend to choose mastectomy. However, it is speculated that the final surgical method selection is made in consideration of not only the test results but also with careful consideration of the patient, taking into account other factors including individual values for risk-reducing surgeries and the age of breast cancer onset.
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Affiliation(s)
- Mayuko Inuzuka
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan.
| | - Chie Watanabe
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan; Department of Nursing, School of Nursing and Rehabilitation Sciences, Showa University, Tokyo, Japan
| | - Shiro Yokoyama
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Kuwayama
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Sadako Akashi-Tanaka
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Masami Arai
- Diagnostics and Therapeutics of Intractable Diseases, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Seigo Nakamura
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan; The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
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28
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Tozaki M, Nakamura S. Current status of breast cancer screening in high-risk women in Japan. Breast Cancer 2020; 28:1181-1187. [PMID: 32627143 DOI: 10.1007/s12282-020-01103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
Overseas, the importance for breast MRI screening for high-risk groups has been shown. However, the evidence among Japanese population was lacking. Therefore, we collaborated with the "Study on clinical and genetic characterization of hereditary breast and ovarian cancer and improvement in prognosis using genetic information in Japan" group, as part of the Comprehensive Research Project on the Promotion of Cancer Control, Health and Labour Sciences Research, and have been conducting the study entitled, "Study of the usefulness of MRI surveillance of BRCA1/2 mutation carriers" since 2014. In addition, we found that in the Japanese population also, the pathological and imaging characteristics differ between BRCA1 and BRCA2 mutation carriers, like in non-Japanese populations by the several reports. In high-risk females, risk categories such as BRCA1 or BRCA2 mutation carriers are very important. Furthermore, in the future, the optimal surveillance modalities and examination intervals would also vary according to the age, thinness of the breast (constitution), breast density (individual differences on mammography), etc.; this would be "personalized surveillance", and quality-assured MRI examination is of the essence. This review will present clinical trial data of prospective MRI surveillance in Japan, and summarize the current status of breast cancer screening in high-risk Japanese women.
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Affiliation(s)
- Mitsuhiro Tozaki
- Department of Radiology, Sagara Hospital, 3-31 Matsubara-cho, Kagoshima, Kagoshima, Japan.
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
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29
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Kaneyasu T, Mori S, Yamauchi H, Ohsumi S, Ohno S, Aoki D, Baba S, Kawano J, Miki Y, Matsumoto N, Nagasaki M, Yoshida R, Akashi-Tanaka S, Iwase T, Kitagawa D, Masuda K, Hirasawa A, Arai M, Takei J, Ide Y, Gotoh O, Yaguchi N, Nishi M, Kaneko K, Matsuyama Y, Okawa M, Suzuki M, Nezu A, Yokoyama S, Amino S, Inuzuka M, Noda T, Nakamura S. Prevalence of disease-causing genes in Japanese patients with BRCA1/2-wildtype hereditary breast and ovarian cancer syndrome. NPJ Breast Cancer 2020; 6:25. [PMID: 32566746 PMCID: PMC7293299 DOI: 10.1038/s41523-020-0163-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 04/30/2020] [Indexed: 12/30/2022] Open
Abstract
Panel sequencing of susceptibility genes for hereditary breast and ovarian cancer (HBOC) syndrome has uncovered numerous germline variants; however, their pathogenic relevance and ethnic diversity remain unclear. Here, we examined the prevalence of germline variants among 568 Japanese patients with BRCA1/2-wildtype HBOC syndrome and a strong family history. Pathogenic or likely pathogenic variants were identified on 12 causal genes for 37 cases (6.5%), with recurrence for 4 SNVs/indels and 1 CNV. Comparisons with non-cancer east-Asian populations and European familial breast cancer cohorts revealed significant enrichment of PALB2, BARD1, and BLM mutations. Younger onset was associated with but not predictive of these mutations. Significant somatic loss-of-function alterations were confirmed on the wildtype alleles of genes with germline mutations, including PALB2 additional somatic truncations. This study highlights Japanese-associated germline mutations among patients with BRCA1/2 wildtype HBOC syndrome and a strong family history, and provides evidence for the medical care of this high-risk population.
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Affiliation(s)
- Tomoko Kaneyasu
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Seiichi Mori
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke’s International Hospital, 10-1 Akashi-cho, Chuo-ku Tokyo, Japan
| | - Shozo Ohsumi
- National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics & Gynecology, Keio University School of Medicine, 35 Shinano-cho, Shinjuku-ku Tokyo, Japan
| | - Shinichi Baba
- Sagara Hospital, 3-31 Matsubara-cho, Kagoshima, Japan
| | - Junko Kawano
- Sagara Hospital, 3-31 Matsubara-cho, Kagoshima, Japan
| | - Yoshio Miki
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-ku Yokohama, Japan
| | - Masao Nagasaki
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi Japan
| | - Reiko Yoshida
- Department of Clinical Genetic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Sadako Akashi-Tanaka
- Division of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku Tokyo, Japan
| | - Takuji Iwase
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Dai Kitagawa
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Kenta Masuda
- Department of Obstetrics & Gynecology, Keio University School of Medicine, 35 Shinano-cho, Shinjuku-ku Tokyo, Japan
| | - Akira Hirasawa
- Department of Obstetrics & Gynecology, Keio University School of Medicine, 35 Shinano-cho, Shinjuku-ku Tokyo, Japan
| | - Masami Arai
- Department of Clinical Genetic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Junko Takei
- Department of Breast Surgical Oncology, St. Luke’s International Hospital, 10-1 Akashi-cho, Chuo-ku Tokyo, Japan
| | - Yoshimi Ide
- Division of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku Tokyo, Japan
| | - Osamu Gotoh
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Noriko Yaguchi
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Mitsuyo Nishi
- Sagara Hospital, 3-31 Matsubara-cho, Kagoshima, Japan
| | - Keika Kaneko
- National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime Japan
| | - Yumi Matsuyama
- National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime Japan
| | - Megumi Okawa
- Department of Breast Surgical Oncology, St. Luke’s International Hospital, 10-1 Akashi-cho, Chuo-ku Tokyo, Japan
| | - Misato Suzuki
- Department of Breast Surgical Oncology, St. Luke’s International Hospital, 10-1 Akashi-cho, Chuo-ku Tokyo, Japan
| | - Aya Nezu
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Shiro Yokoyama
- Division of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku Tokyo, Japan
| | - Sayuri Amino
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Mayuko Inuzuka
- Division of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku Tokyo, Japan
| | - Tetsuo Noda
- Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku Tokyo, Japan
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Consolidated BRCA1/2 Variant Interpretation by MH BRCA Correlates with Predicted PARP Inhibitor Efficacy Association by MH Guide. Int J Mol Sci 2020; 21:ijms21113895. [PMID: 32486089 PMCID: PMC7312854 DOI: 10.3390/ijms21113895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022] Open
Abstract
BRCA1/2 variants are prognostic biomarkers for hereditary breast and/or ovarian cancer (HBOC) syndrome and predictive biomarkers for PARP inhibition. In this study, we benchmarked the classification of BRCA1/2 variants from patients with HBOC-related cancer using MH BRCA, a novel computational technology that combines the ACMG guidelines with expert-curated variant annotations. Evaluation of BRCA1/2 variants (n = 1040) taken from four HBOC studies showed strong concordance within the pathogenic (98.1%) subset. Comparison of MH BRCA’s ACMG classification to ClinVar submitter content from ENIGMA, the international consortium of investigators on the clinical significance of BRCA1/2 variants, the ARUP laboratories, a clinical testing lab of the University of UTAH, and the German Cancer Consortium showed 99.98% concordance (4975 out of 4976 variants) in the pathogenic subset. In our patient cohort, refinement of patients with variants of unknown significance reduced the uncertainty of cancer-predisposing syndromes by 64.7% and identified three cases with potential family risk to HBOC due to a likely pathogenic variant BRCA1 p.V1653L (NM_007294.3:c.4957G > T; rs80357261). To assess whether classification results predict PARP inhibitor efficacy, contextualization with functional impact information on DNA repair activity were performed, using MH Guide. We found a strong correlation between treatment efficacy association and MH BRCA classifications. Importantly, low efficacy to PARP inhibition was predicted in 3.95% of pathogenic variants from four examined HBOC studies and our patient cohort, indicating the clinical relevance of the consolidated variant interpretation.
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Kour A, Sambyal V, Guleria K, Singh NR, Uppal MS, Manjari M, Sudan M. Screening of BRCA1 variants c.190T>C, 1307delT, g.5331G>A and c.2612C>T in breast cancer patients from North India. Genet Mol Biol 2020; 43:e20190014. [PMID: 32453341 PMCID: PMC7250277 DOI: 10.1590/1678-4685-gmb-2019-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/22/2019] [Indexed: 12/01/2022] Open
Abstract
The polymorphic variants of BRCA1, which lead to amino acid
substitutions, have a known pathogenic role in breast cancer. The present study
investigated in North Indian breast cancer patients the association of risk with
four reported pathogenic variants of BRCA1: c.190T>C
(p.Cys64Arg), 1307delT, g.5331G>A (p.G1738R) and c.2612C>T (p.Pro871Leu).
Genotyping was done by PCR-RFLP method in 255 clinically confirmed breast cancer
patients and 255 age and gender matched healthy individuals. For c.190T>C,
1307delT and g.5331G>A, all the patients and controls had the wild-type
genotype indicating no association with breast cancer risk. For c.2612C>T
polymorphism, the frequency of the CC, CT, and TT genotypes was 14.5 vs 15.7%,
59.6 vs 53.7% and 25.9 vs 30.6% in breast cancer patients and controls
respectively. The frequency of heterozygotes (CT genotype) was higher in cases
than controls but the difference was not statistically significant. Genetic
model analysis showed no association of the four analyzed BRCA1
variants with breast cancer risk with any model. The studied variants were not
associated with the risk of breast cancer in Punjab, North west India,
suggesting a need for further screening of other BRCA1
variants. It is the first reported study on these 4 variants from India.
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Affiliation(s)
- Akeen Kour
- Guru Nanak Dev University, Department of Human Genetics, Human Cytogenetics Laboratory, Amritsar, Punjab, India
| | - Vasudha Sambyal
- Guru Nanak Dev University, Department of Human Genetics, Human Cytogenetics Laboratory, Amritsar, Punjab, India
| | - Kamlesh Guleria
- Guru Nanak Dev University, Department of Human Genetics, Human Cytogenetics Laboratory, Amritsar, Punjab, India
| | - Neeti Rajan Singh
- Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah,Department of Surgery, Amritsar, Punjab, India
| | - Manjit Singh Uppal
- Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah,Department of Surgery, Amritsar, Punjab, India
| | - Mridu Manjari
- Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah,Department of Pathology, Amritsar, Punjab, India
| | - Meena Sudan
- Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Department of Radiotherapy, Amritsar, Punjab, India
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Wang N, Li K, Huang W, Kong W, Liu X, Shi W, Xie F, Jiang H, Song G, Di L, Wang Q, Yu J, Li H. Efficacy of platinum in advanced triple-negative breast cancer with germline BRCA mutation determined by next generation sequencing. Chin J Cancer Res 2020; 32:149-162. [PMID: 32410793 PMCID: PMC7219102 DOI: 10.21147/j.issn.1000-9604.2020.02.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective To compare the efficacy of platinum- and non-platinum-based regimens as first-line treatment for advanced triple-negative breast cancer (TNBC) and analyze the relationship between their efficacy and BRCA gene status.
Methods Retrospectively analyze clinical data of 220 patients diagnosed pathologically with advanced TNBC and treated at the Department of Breast Oncology, Peking University Cancer Hospital from 2013 to 2018 and evaluate the efficacy of chemotherapy. A total of 114 patients had BRCA1/2 gene tested by next generation sequencing (NGS) using peripheral blood, and we analyzed the correlation between their efficacy and BRCA1/2 gene status.
Results Non-platinum-based chemotherapy (NPCT) was administered to 129 and platinum-based chemotherapy (PBCT) to 91 study patients. The clinical benefit rate (CBR) and median progression-free survival (PFS) were not statistically different between NPCT and PBCT groups. The median overall survival (OS) was 30.0 and 22.5 months for PBCT and NPCT group, respectively [P=0.090, hazard ratios (HR)=0.703]. BRCA status was assessed in 114 patients, 14 of whom had deleterious germline BRCA1/2 (gBRCA) mutations (seven in each group). In PBCT group, the CBR was 85.7% and 35.1% for patients with and without deleterious gBRCA mutations, respectively (P=0.039). The median PFS were 14.9 and 5.3 months and median OS were 26.5 and 15.5 months for patients with and without deleterious gBRCA mutations, respectively (P=0.001, P=0.161, respectively). Patients in PBCT group had significantly greater rates of grade 3−4 anemia (5.5%vs. 0%) and thrombocytopenia (8.8% vs. 0%), whereas palmar-plantar erythrodysesthesia (12.4% vs. 0%) and peripheral neuropathy (8.6% vs. 1.1%) occurred more frequently in NPCT group.
Conclusions Platinum-based regimens are more effective in patients with deleterious gBRCA mutations, but no difference in patients without BRCA gene mutations, so non-platinum is an option in patients without BRCA gene mutations considering the toxicity and side effect. And we recommend that patients with advanced TNBC should have BRCA gene test.
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Affiliation(s)
- Nan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Kun Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Wenfa Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Weiyao Kong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xiaoran Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Weijie Shi
- Huidu Shanghai Medical Sciences, Shanghai 201499, China
| | - Feng Xie
- Huidu Shanghai Medical Sciences, Shanghai 201499, China
| | - Hanfang Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Guohong Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Lijun Di
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Quanren Wang
- Jiangsu Hengrui Medicine, Shanghai 200120, China
| | - Jianjun Yu
- Huidu Shanghai Medical Sciences, Shanghai 201499, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
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Chao A, Lin YH, Yang LY, Wu RC, Chang WY, Chang PY, Chang SC, Lin CY, Huang HJ, Lin CT, Chou HH, Huang KG, Kuo WL, Chang TC, Lai CH. BRCA1/2 mutation status in patients with metachronous breast and ovarian malignancies: clues towards the implementation of genetic counseling. J Gynecol Oncol 2020; 31:e24. [PMID: 31912679 PMCID: PMC7189074 DOI: 10.3802/jgo.2020.31.e24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/19/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The characteristics of patients with metachronous breast and ovarian malignancies and the pathogenic role of BRCA1/2 mutations remain poorly understood. We investigated these issues through a review of hospital records and nationwide Taiwanese registry data, followed by BRCA1/2 mutation analysis in hospital-based cases. METHODS We retrospectively retrieved consecutive clinical records of Taiwanese patients who presented with these malignancies to our hospital between 2001 and 2017. We also collected information from the Data Science Center of the Taiwan Cancer Registry (TCR) between 2007 and 2015. Next-generation sequencing and multiplex ligation-dependent probe amplification were used to identify BRCA1/2 mutations and large genomic rearrangements, respectively. When BRCA1/2 mutations were identified in index cases, pedigrees were reconstructed and genetic testing was offered to family members. RESULTS A total of 12,769 patients with breast cancer and 1,537 with ovarian cancer were retrieved from our hospital records. Of them, 28 had metachronous breast and ovarian malignancies. We also identified 113 cases from the TCR dataset. Eighteen hospital-based cases underwent BRCA1/2 sequencing and germline pathogenic mutations were detected in 7 patients (38.9%, 5 in BRCA1 and 2 in BRCA2). All BRCA1/2 mutation carriers had ovarian high-grade serous carcinomas. Of the 12 patients who were alive at the time of analysis, 5 were BRCA1/2 mutation carriers. All of them had family members with BRCA1/2-associated malignancies. CONCLUSIONS Our results provide pilot evidence that BRCA1/2 mutations are common in Taiwanese patients with metachronous breast and ovarian malignancies, supporting the clinical utility of genetic counseling.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Yi Hao Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Lan Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Ren Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- Department of Pathology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei Yang Chang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Pi Yueh Chang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih Cheng Chang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Huei Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Cheng Tao Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Hung Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Kuan Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Wen Ling Kuo
- Department of General Surgery, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Ting Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Chyong Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.
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Le Page C, Rahimi K, Rodrigues M, Heinzelmann-Schwarz V, Recio N, Tommasi S, Bataillon G, Portelance L, Golmard L, Meunier L, Tonin PN, Gotlieb W, Yasmeen A, Ray-Coquard I, Labidi-Galy SI, Provencher D, Mes-Masson AM. Clinicopathological features of women with epithelial ovarian cancer and double heterozygosity for BRCA1 and BRCA2: A systematic review and case report analysis. Gynecol Oncol 2019; 156:377-386. [PMID: 31753525 DOI: 10.1016/j.ygyno.2019.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Carriers of pathogenic variants in both BRCA1 and BRCA2 genes as a double mutation (BRCA1/2 DM) have been rarely reported in women with epithelial ovarian cancer (EOC). METHODS We reviewed the English literature and interrogated three repositories reporting EOC patients carrying BRCA1/2 DM. The clinicopathological parameters of 36 EOC patients carrying germline BRCA1/2 DM were compared to high-grade serous EOC women of the COEUR cohort with known germline BRCA1/BRCA2 mutation carrier status (n = 376 non-carriers, n = 65 BRCA1 and n = 38 BRCA2). Clinicopathological parameters evaluated were age at diagnosis, stage of disease, loss of heterozygosity, type of mutation, immunohistochemistry profile, progression occurrence and survival. RESULTS Median age at diagnosis of BRCA1/2 DM patients was 51.9 years, similar to BRCA1 mutation carriers (49.7 years, p = .58) and younger than BRCA2 mutation carriers (58.1 years, p = .02). Most patients were diagnosed at advanced stage (III-IV; 82%) and were carriers of founder/frequent mutations (69%). Tissue immunostainings revealed no progesterone receptor expression and low intraepithelial inflammation. The 5-year survival rate (60%) was significantly lower than that of BRCA2 mutation carriers (76%, p = .03) but not of BRCA1 mutation carriers (51%, p = .37). CONCLUSIONS Our data suggests some co-dominant effect of both mutations but the outcome of these patients more closely resembled that of BRCA1 mutation carriers with poor prognosis factors.
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Affiliation(s)
- Cécile Le Page
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), and Institut du cancer de Montréal, Montreal, QC, Canada.
| | - Kurosh Rahimi
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), and Institut du cancer de Montréal, Montreal, QC, Canada; Department of Pathology, Centre hospitalier de l'Université de Montreal (CHUM), Montreal, QC, Canada
| | - Manuel Rodrigues
- Institut Curie, PSL Research University, Paris, France; Department of Medical Oncology, INSERM U830 "Cancer, heterogeneity, instability and plasticity", Paris, France
| | - Viola Heinzelmann-Schwarz
- Gynecological Cancer Centre and Ovarian Cancer Research Group, University Hospital Basel and Department of Biomedicine, Basel, Switzerland
| | - Neil Recio
- Departments of Human Genetics, McGill University; Cancer Research Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Guillaume Bataillon
- Institut Curie, PSL Research University, Paris, France; Department of Biopathology, Paris, France
| | - Lise Portelance
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), and Institut du cancer de Montréal, Montreal, QC, Canada
| | - Lisa Golmard
- Institut Curie, PSL Research University, Paris, France; Department of Genetics, Paris, France
| | - Liliane Meunier
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), and Institut du cancer de Montréal, Montreal, QC, Canada
| | - Patricia N Tonin
- Departments of Human Genetics, McGill University; Cancer Research Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada
| | - Walter Gotlieb
- Segal Cancer Center, Lady Davis Institute of Medical research, McGill University, Montreal, QC, Canada
| | - Amber Yasmeen
- Segal Cancer Center, Lady Davis Institute of Medical research, McGill University, Montreal, QC, Canada
| | | | - S Intidhar Labidi-Galy
- Department of Oncology, Hôpitaux Universitaires de Genève and Department of Medicine, Faculty of Medicine, Geneva, Switzerland
| | - Diane Provencher
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), and Institut du cancer de Montréal, Montreal, QC, Canada; Division of Gynecology-Oncology, CHUM, QC, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - Anne-Marie Mes-Masson
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), and Institut du cancer de Montréal, Montreal, QC, Canada; Department of Medicine, University of Montreal, Montreal, QC, Canada.
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Saito S, Nakazawa K, Nagahashi M, Ishikawa T, Akazawa K. Cost-effectiveness of BRCA1/2 mutation profiling to target olaparib use in patients with metastatic breast cancer. Per Med 2019; 16:439-448. [PMID: 31692405 DOI: 10.2217/pme-2018-0141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aim: Olaparib monotherapy improves progression-free survival in patients with metastatic breast cancer and BRCA1/2 mutations. We evaluated the cost-effectiveness of BRCA1/2 mutation profiling to target olaparib use. Methods: A Markov cohort model was generated to compare the 5-year cost-effectiveness of BRCA1/2 mutation profiling to target olaparib use. Results: The incremental cost-effectiveness ratio of BRCA1/2 mutation profiling plus olaparib monotherapy was JPY14,677,259/quality-adjusted life year (QALY) (US$131,047/QALY), compared with standard chemotherapy alone. Conclusion: BRCA1/2 mutation profiling to target olaparib use is not a cost-effective strategy for metastatic breast cancer. The strategy provides minimal incremental benefit at a high incremental cost per QALY. Hence, further cost reductions in the cost of both BRCA1/2 mutation profiling and olaparib are required.
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Affiliation(s)
- Shota Saito
- Department of Health Informatics, Niigata University of Health & Welfare, Niigata, Japan
| | - Kyoko Nakazawa
- Department of Medical Informatics & Statistics, Niigata University Graduate School of Medical & Dental Sciences, Niigata, Japan
| | - Masayuki Nagahashi
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, Niigata, Japan
| | - Takashi Ishikawa
- Division of Digestive & General Surgery, Niigata University Graduate School of Medical & Dental Sciences, Niigata, Japan.,Department of Medical Informatics, Niigata University Medical & Dental Hospital, Niigata, Japan
| | - Kouhei Akazawa
- Department of Medical Informatics, Niigata University Medical & Dental Hospital, Niigata, Japan
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Friebel TM, Andrulis IL, Balmaña J, Blanco AM, Couch FJ, Daly MB, Domchek SM, Easton DF, Foulkes WD, Ganz PA, Garber J, Glendon G, Greene MH, Hulick PJ, Isaacs C, Jankowitz RC, Karlan BY, Kirk J, Kwong A, Lee A, Lesueur F, Lu KH, Nathanson KL, Neuhausen SL, Offit K, Palmero EI, Sharma P, Tischkowitz M, Toland AE, Tung N, van Rensburg EJ, Vega A, Weitzel JN, Hoskins KF, Maga T, Parsons MT, McGuffog L, Antoniou AC, Chenevix-Trench G, Huo D, Olopade OI, Rebbeck TR. BRCA1 and BRCA2 pathogenic sequence variants in women of African origin or ancestry. Hum Mutat 2019; 40:1781-1796. [PMID: 31112363 PMCID: PMC6764847 DOI: 10.1002/humu.23804] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/22/2019] [Accepted: 05/07/2019] [Indexed: 01/03/2023]
Abstract
BRCA1 and BRCA2 (BRCA1/2) pathogenic sequence variants (PSVs) confer elevated risks of multiple cancers. However, most BRCA1/2 PSVs reports focus on European ancestry individuals. Knowledge of the PSV distribution in African descent individuals is poorly understood. We undertook a systematic review of the published literature and publicly available databases reporting BRCA1/2 PSVs also accessed the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA) database to identify African or African descent individuals. Using these data, we inferred which of the BRCA PSVs were likely to be of African continental origin. Of the 43,817 BRCA1/2 PSV carriers in the CIMBA database, 469 (1%) were of African descent. Additional African descent individuals were identified in public databases (n = 291) and the literature (n = 601). We identified 164 unique BRCA1 and 173 unique BRCA2 PSVs in individuals of African ancestry. Of these, 83 BRCA1 and 91 BRCA2 PSVs are of likely or possible African origin. We observed numerous differences in the distribution of PSV type and function in African origin versus non-African origin PSVs. Research in populations of African ancestry with BRCA1/2 PSVs is needed to provide the information needed for clinical management and decision-making in African descent individuals worldwide.
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Affiliation(s)
- Tara M. Friebel
- Harvard T.H. Chan School of Public Health. Boston, MA: USA; 02115
- Dana-Farber Cancer Institute. Boston, MA: USA; 02215
| | - Irene L. Andrulis
- Fred A. Litwin Center for Cancer Genetics. Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital. Toronto, ON: Canada; M5G 1X5
- Department of Molecular Genetics. University of Toronto. Toronto, ON: Canada; M5S 1A8
| | - Judith Balmaña
- High Risk and Cancer Prevention Group. Vall dHebron Institute of Oncology, University Hospital Vall dHebron. Barcelona: Spain; 08035
| | - Amie M. Blanco
- Cancer Genetics and Prevention Program. University of California San Francisco. San Francisco, CA: USA; 94143-1714
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology. Mayo Clinic. Rochester, MN: USA; 55905
| | - Mary B. Daly
- Department of Clinical Genetics. Fox Chase Cancer Center. Philadelphia, PA: USA; 19111
| | - Susan M. Domchek
- Department of Medicine, Abramson Cancer Center. Perelman School of Medicine at the University of Pennsylvania. Philadelphia, PA: USA; 19104
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology. University of Cambridge. Cambridge: UK; CB1 8RN
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care. University of Cambridge. Cambridge: UK; CB1 8RN
| | - William D. Foulkes
- Program in Cancer Genetics, Departments of Human Genetics and Oncology. McGill University. Montréal, QC: Canada; H4A 3J1
| | - Patricia A. Ganz
- Schools of Medicine and Public Health, Division of Cancer Prevention & Control Research. Jonsson Comprehensive Cancer Centre, UCLA. Los Angeles, CA: USA; 90096-6900
| | - Judy Garber
- Cancer Risk and Prevention Clinic. Dana-Farber Cancer Institute. Boston, MA: USA; 02215
| | - Gord Glendon
- Fred A. Litwin Center for Cancer Genetics. Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital. Toronto, ON: Canada; M5G 1X5
| | - Mark H. Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics. National Cancer Institute. Bethesda, MD: USA; 20850-9772
| | - Peter J. Hulick
- Center for Medical Genetics. NorthShore University HealthSystem. Evanston, IL: USA; 60201
- The University of Chicago Pritzker School of Medicine. Chicago, IL: USA; 60637
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University. Washington, DC: USA; 20007
| | - Rachel C. Jankowitz
- Department of Medicine, Division of Hematology/Oncology. UPMC Hillman Cancer Center; University of Pittsburgh School of Medicine. Pittsburgh: USA; PA 15232
| | - Beth Y. Karlan
- Womens Cancer Program at the Samuel Oschin Comprehensive Cancer Institute. Cedars-Sinai Medical Center. Los Angeles, CA: USA; 90048
| | - Judy Kirk
- Familial Cancer Service. Weatmead Hospital. Vol P.O. Box 533. Wentworthville, New South Wales: Australia; 2145
| | - Ava Kwong
- Hong Kong Hereditary Breast Cancer Family Registry. Cancer Genetics Centre. Happy Valley: Hong Kong
- Department of Surgery. The University of Hong Kong. Pok Fu Lam: Hong Kong
- Department of Surgery. Hong Kong Sanatorium and Hospital. Happy Valley: Hong Kong
| | - Annette Lee
- The Feinstein Institute for Medical Research. Manhasset, NY: USA; 11030
| | - Fabienne Lesueur
- Genetic Epidemiology of Cancer team. Inserm U900. Paris: France; 75005
- Service de Génétique. Institut Curie. Paris: France; 75005
- Institut Curie. Paris: France; 75005
- Mines ParisTech. Fontainebleau: France; 77305
| | - Karen H. Lu
- Department of Gynecologic Oncology and Clinical Cancer Genetics Program. University of Texas MD Anderson Cancer Center. Houston, TX: USA; 77030
| | - Katherine L. Nathanson
- Department of Medicine, Abramson Cancer Center. Perelman School of Medicine at the University of Pennsylvania. Philadelphia, PA: USA; 19104
| | - Susan L. Neuhausen
- Department of Population Sciences. Beckman Research Institute of City of Hope. Duarte, CA: USA; 91010
| | - Kenneth Offit
- Clinical Genetics Research Lab, Department of Cancer Biology and Genetics. Memorial Sloan-Kettering Cancer Center. New York, NY: USA; 10065
- Clinical Genetics Service, Department of Medicine. Memorial Sloan-Kettering Cancer Center. New York, NY: USA; 10065
| | - Edenir I. Palmero
- Molecular Oncology Research Center. Barretos Cancer Hospital. São Paulo: Brazil; 784-400
- Barretos School of Health Sciences, Dr. Paulo Prata - FACISB. São Paulo: Brazil; 785-002
| | - Priyanka Sharma
- Department of Internal Medicine, Division of Oncology. University of Kansas Medical Center. Westwood, KS: USA; 66205
| | - Marc Tischkowitz
- Program in Cancer Genetics, Departments of Human Genetics and Oncology. McGill University. Montréal, QC: Canada; H4A 3J1
- Department of Medical Genetics. University of Cambridge. Vol Box 134, Level 6 Addenbrookes Treatment Centre, Addenbrookes Hosptital. Cambridge: UK; CB2 0QQ
| | - Amanda E. Toland
- Department of Cancer Biology and Genetics. The Ohio State University. Columbus, OH: USA; 43210
| | - Nadine Tung
- Department of Medical Oncology. Beth Israel Deaconess Medical Center. Boston, MA: USA; 02215
| | | | - Ana Vega
- Fundación Pública Galega Medicina Xenómica. Santiago De Compostela: Spain; 15706
- Instituto de Investigación Sanitaria de Santiago de Compostela. Santiago De Compostela: Spain; 15706
- Biomedical Network on Rare Diseases (CIBERER). Madrid: Spain; 28029
| | | | | | - Kent F. Hoskins
- Department of Medicine. University of Illinois. Chicago, IL: USA
| | - Tara Maga
- Department of Medicine. University of Illinois. Chicago, IL: USA
| | - Michael T. Parsons
- Department of Genetics and Computational Biology. QIMR Berghofer Medical Research Institute. Vol Locked Bag 2000, Herston, QLD 4029. Brisbane, Queensland: Australia; 4006
| | - Lesley McGuffog
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care. University of Cambridge. Cambridge: UK; CB1 8RN
| | - Antonis C. Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care. University of Cambridge. Cambridge: UK; CB1 8RN
| | - Georgia Chenevix-Trench
- Department of Genetics and Computational Biology. QIMR Berghofer Medical Research Institute. Vol Locked Bag 2000, Herston, QLD 4029. Brisbane, Queensland: Australia; 4006
| | - Dezheng Huo
- Center for Clinical Cancer Genetics. The University of Chicago. Chicago, IL: USA; 60637
| | | | - Timothy R. Rebbeck
- Harvard T.H. Chan School of Public Health. Boston, MA: USA; 02115
- Dana-Farber Cancer Institute. Boston, MA: USA; 02215
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Masuda T, Low SK, Akiyama M, Hirata M, Ueda Y, Matsuda K, Kimura T, Murakami Y, Kubo M, Kamatani Y, Okada Y. GWAS of five gynecologic diseases and cross-trait analysis in Japanese. Eur J Hum Genet 2019; 28:95-107. [PMID: 31488892 PMCID: PMC6906293 DOI: 10.1038/s41431-019-0495-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
We performed genome-wide association studies of five gynecologic diseases using data of 46,837 subjects (5236 uterine fibroid, 645 endometriosis, 647 ovarian cancer (OC), 909 uterine endometrial cancer (UEC), and 538 uterine cervical cancer (UCC) cases allowing overlaps, and 39,556 shared female controls) from Biobank Japan Project. We used the population-specific imputation reference panel (n = 3541), yielding 7,645,193 imputed variants. Analyses performed under logistic model, linear mixed model, and model incorporating correlations identified nine significant associations with three gynecologic diseases including four novel findings (rs79219469:C > T, LINC02183, P = 3.3 × 10−8 and rs567534295:C > T, BRCA1, P = 3.1 × 10−8 with OC, rs150806792:C > T, INS-IGF2, P = 4.9 × 10−8 and rs140991990:A > G, SOX9, P = 3.3 × 10−8 with UCC). Random-effect meta-analysis of the five GWASs correcting for the overlapping subjects suggested one novel shared risk locus (rs937380553:A > G, LOC730100, P = 2.0 × 10−8). Reverse regression analysis identified three additional novel associations (rs73494486:C > T, GABBR2, P = 4.8 × 10−8, rs145152209:A > G, SH3GL3/BNC1, P = 3.3 × 10−8, and rs147427629:G > A, LOC107985484, P = 3.8 × 10−8). Estimated heritability ranged from 0.026 for OC to 0.220 for endometriosis. Genetic correlations were relatively strong between OC and UEC, endometriosis and OC, and uterine fibroid and OC (rg > 0.79) compared with relatively weak correlations between UCC and the other four (rg = −0.08 ~ 0.25). We successfully identified genetic associations with gynecologic diseases in the Japanese population. Shared genetic effects among multiple related diseases may help understanding the pathophysiology.
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Affiliation(s)
- Tatsuo Masuda
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan.,Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Siew-Kee Low
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan.,Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, 135-8550, Japan
| | - Masato Akiyama
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan.,Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, 812-8582, Japan
| | - Makoto Hirata
- Laboratory of Genome Technology, Institute of Medical Science, the University of Tokyo, Tokyo, 108-8639, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Koichi Matsuda
- Department of Computational Biology and Medical Sciences, Graduate school of Frontier Sciences, The University of Tokyo, Tokyo, 108-8639, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Yoshinori Murakami
- Division of Molecular Pathology, the Institute of Medical Sciences, the University of Tokyo, Tokyo, 108-8639, Japan
| | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, 230-0045, Japan.,Kyoto-McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan. .,Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, 565-0871, Japan.
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Yoshida R, Watanabe C, Yokoyama S, Inuzuka M, Yotsumoto J, Arai M, Nakamura S. Analysis of clinical characteristics of breast cancer patients with the Japanese founder mutation BRCA1 L63X. Oncotarget 2019; 10:3276-3284. [PMID: 31143373 PMCID: PMC6524931 DOI: 10.18632/oncotarget.26852] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/23/2019] [Indexed: 12/26/2022] Open
Abstract
Background: BRCA1 and BRCA2 are high-penetrance inherited genes; different founder mutations have been reported in various areas and races. By using trial registration data from the Japanese hereditary breast and ovarian cancer syndrome (HBOC) consortium, we aimed to explore the clinicopathological characteristics of breast cancer patients with the Japanese founder mutation BRCA1 L63X. Results: We found 88 BRCA1 carriers, 76 BRCA2 carriers, and one carrier of both BRCA1 and BRCA2. Of 46 independent BRCA1 mutations, the BRCA1 L63X mutation was detected in 26 patients. We observed a significant difference in the proportion of triple-negative breast cancer phenotype among 88.9%, 72.5%, and 26.8% of BRCA1 L63X mutation, BRCA1 mutation, and BRCA2 mutation carriers, respectively (p < .001). Additionally, significant differences were also observed in nuclear grade in the resultant breast cancer between the groups (p < .001). Conclusions: A high proportion of Japanese HBOC patients showed the BRCA1 L63X mutation, and the clinical characteristics of breast cancer in patients with this mutation might differ from those in patients with other BRCA1 or BRCA2 mutations, in terms of the subtype and nuclear grade of the resultant cancer. Methods: From 827 patients in the Japanese HBOC consortium through August 2015, patients with BRCA1/2 mutations were included in this study. We compared the clinicopathological features among patients with BRCA1 L63X mutation, other BRCA1 mutations, and BRCA2 mutations using Chi-square test.
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Affiliation(s)
- Reiko Yoshida
- Division of Clinical Genetic Oncology, Cancer Institute Hospital, Tokyo, Japan.,Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Chie Watanabe
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan.,Department of Nursing, Faculty of Human Sciences, Sophia University, Tokyo, Japan
| | - Shiro Yokoyama
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Mayuko Inuzuka
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Junko Yotsumoto
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Masami Arai
- Division of Clinical Genetic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan.,The 3rd Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
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Clinical background and outcomes of risk-reducing salpingo-oophorectomy for hereditary breast and ovarian cancers in Japan. Int J Clin Oncol 2019; 24:1105-1110. [DOI: 10.1007/s10147-019-01456-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/23/2019] [Indexed: 01/13/2023]
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40
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Yodsurang V, Tang Y, Takahashi Y, Tanikawa C, Kamatani Y, Takahashi A, Momozawa Y, Fuse N, Sugawara J, Shimizu A, Fukushima A, Hishida A, Furusyo N, Naito M, Wakai K, Yamaji T, Sawada N, Iwasaki M, Tsugane S, Hirata M, Murakami Y, Kubo M, Matsuda K. Genome-wide association study (GWAS) of ovarian cancer in Japanese predicted regulatory variants in 22q13.1. PLoS One 2018; 13:e0209096. [PMID: 30557369 PMCID: PMC6296504 DOI: 10.1371/journal.pone.0209096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/29/2018] [Indexed: 12/22/2022] Open
Abstract
Genome-wide association studies (GWAS) have identified greater than 30 variants associated with ovarian cancer, but most of these variants were investigated in European populations. Here, we integrated GWAS and subsequent functional analyses to identify the genetic variants with potential regulatory effects. We conducted GWAS for ovarian cancer using 681 Japanese cases and 17,492 controls and found that rs137672 on 22q13.1 exhibited a strong association with a P-value of 1.05 × 10−7 and an odds ratio of 0.573 with a 95% confidence interval of 0.466–0.703. In addition, three previously reported SNPs, i.e., rs10088218, rs9870207 and rs1400482, were validated in the Japanese population (P < 0.05) with the same risk allele as noted in previous studies. Functional studies including regulatory feature analysis and electrophoretic mobility shift assay (EMSA) revealed two regulatory SNPs in 22q13.1, rs2072872 and rs6509, that affect the binding affinity to some nuclear proteins in ovarian cancer cells. The plausible regulatory proteins whose motifs could be affected by the allele changes of these two SNPs were also proposed. Moreover, the protective G allele of rs6509 was associated with a decreased SYNGR1 expression level in normal ovarian tissues. Our findings elucidated the regulatory variants in 22q13.1 that are associated with ovarian cancer risk.
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Affiliation(s)
- Varalee Yodsurang
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Yaqi Tang
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
- Institute of Pharmaceutical and Biological Sciences, University Claude Bernard Lyon 1, Lyon, France
| | - Yukie Takahashi
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
- Department of Hematology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Chizu Tanikawa
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | | | | | | | - Nobuo Fuse
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Junichi Sugawara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Atsushi Shimizu
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Iwate, Japan
| | - Akimune Fukushima
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Iwate, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norihiro Furusyo
- Department of Environmental Medicine and Infectious Disease, Kyushu University, Fukuoka, Japan
| | - Mariko Naito
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Oral Epidemiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taiki Yamaji
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Makoto Hirata
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoshinori Murakami
- Division of Molecular Pathology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Koichi Matsuda
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- * E-mail:
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High rate of occult cancer found in prophylactic mastectomy specimens despite thorough presurgical assessment with MRI and ultrasound: findings from the Hereditary Breast and Ovarian Cancer Registration 2016 in Japan. Breast Cancer Res Treat 2018; 172:679-687. [PMID: 30203341 PMCID: PMC6245054 DOI: 10.1007/s10549-018-4953-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/01/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Prophylactic surgery is a preemptive strategy for hereditary breast and ovarian cancer (HBOC). Prophylactic mastectomy (PM) reduces breast cancer risk by > 90%. The aim of our study is to analyze the information of the Japanese pedigrees and to utilize the results for clinical practice. METHODS We statistically analyzed records of HBOC registrees who had undergone BRCA1/2 genetic testing at seven medical institutions up until 2016. In the cases of PM, we examined breasts with the use of mammography (MMG), ultrasound (US), and magnetic resonance imaging (MRI) before surgery. After PM, the specimens were divided about 1 cm serially and examined in their entirety. RESULTS Of 1527 registrees who underwent BRCA testing, 1125 (73.7%) were negative for BRCA1/2 mutation, 297 (19.5%) were positive for BRCA1/2 mutation (BRCA1/2MUT+), and 105 (6.9%) had uncertain results. To decide whether to undergo total mastectomy vs. breast-conserving surgery (BCS), 370 registrees underwent presurgical genetic testing. During the follow-up period, four new-onset breast cancers were found among the 55 non-affected BRCA carriers. Among the 73 BRCA1/2MUT+ carriers who underwent BCS, 3 were found to have ipsilateral breast cancer. Of 189 BRCA1/2MUT+ carriers with unilateral breast cancer, 8 were found to have contralateral breast cancer. Of 53 PM specimens, 6 (11.3%) were found to have occult breast cancer despite using MMG, US, and MRI. CONCLUSIONS Our report showed a relatively higher incidence rate of occult cancer at 11.3% in PM specimens despite thorough pre-operative radiological evaluations, which included a breast MRI. Considering the occult cancer rates and the various pathological methods of our study and published studies, we propose the necessity of a histopathological protocol.
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42
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Cost-effectiveness of surveillance and prevention strategies in BRCA1/2 mutation carriers. Breast Cancer 2017; 25:141-150. [PMID: 29019095 DOI: 10.1007/s12282-017-0803-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/18/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cost-effectiveness analysis is an important aspect of healthcare, including in Japan, where preventive measures for BRCA1/2 mutation carriers are not covered by health insurance. METHODS We developed Markov models in a simulated cohort of women aged 35-70 years, and compared outcomes of surveillance with risk-reducing mastectomy (RRM) at age 35, risk-reducing salpingo-oophorectomy (RRSO) at age 45, and both (RRM&RRSO). We used breast and ovarian cancer incidences and adverse event rates from the previous studies, adjuvant chemotherapy, and hormonal therapy rates from the Hereditary Breast and Ovarian Cancer Registration 2015 in Japan, mortality rates from the National Cancer Center Hospital, Japan Society of Clinical Oncology, and Ministry of Health, Labour and Welfare, and direct costs from St. Luke's International Hospital and Keio University Hospital. We used previously published preference ratings of women without known high risk to adjust survival for quality of life. The discount rate was 2%. RESULTS Compared with surveillance, RRSO and RRM&RRSO were dominant (both cost-saving and more effective), and RRM was cost-effective in BRCA1 mutation carriers, while RRM and RRM&RRSO were dominant and RRSO was cost-effective in BRCA2. Among the four strategies including surveillance, RRM&RRSO and RRM were the most cost-effective in BRCA1 and BRCA2 mutation carriers, respectively. CONCLUSIONS With quality adjustment, RRM, RRSO, and RRM&RRSO were all cost-effective preventive strategies in BRCA1/2 mutation carriers, with RRM&RRSO being the most cost-effective in BRCA1 and RRM in BRCA2. This result supports the inclusion of insurance coverage for BRCA mutation carriers in Japan.
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