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Kowalik A, Siołek M, Kopczyński J, Krawiec K, Kalisz J, Zięba S, Kozak-Klonowska B, Wypiórkiewicz E, Furmańczyk J, Nowak-Ozimek E, Chłopek M, Macek P, Smok-Kalwat J, Góźdź S. BRCA1 founder mutations and beyond in the Polish population: A single-institution BRCA1/2 next-generation sequencing study. PLoS One 2018; 13:e0201086. [PMID: 30040829 PMCID: PMC6057642 DOI: 10.1371/journal.pone.0201086] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/10/2018] [Indexed: 12/22/2022] Open
Abstract
Hereditary mutations in BRCA1/2 genes increase the risk of breast cancer by 60–80% and ovarian cancer by about 20–40% in female carriers. Detection of inherited mutations in asymptomatic carriers allows for the implementation of appropriate preventive measures. BRCA1/2 genotyping is also important for poly(adenosine diphosphate)-ribose polymerase (PARP) inhibitor administration. This work addresses the need for next-generation sequencing (NGS) technology for the detection of BRCA1/2 mutations in Poland where until recently mostly founder mutations have been tested, and whether BRCA diagnostics should be extended beyond the panel of founder mutations in this population. The study comprises 2931 patients who were referred for genetic counseling and tested for founder and recurrent mutations in BRCA1 (5382insC (c.5266dupC; p.Gln1756Profs), c.5370C>T (c.5251C>T; p.R1751*), 300T>G (c.181T>G; p.Cys61Gly), 185delAG (c.68_69delAG; p.Glu23Valfs), and 4153delA (c.4035delA; p.Glu1346Lysfs)) by high-resolution melting/Sanger sequencing. A total of 103 (3.5%) mutations were detected, including 53 (51%) in healthy subjects and 50 (49%) in cancer patients. Then, based on more stringent clinical and pedigree criteria, sequencing of all BRCA1/2 exons was performed in 454 (16%) patients without founder mutations by NGS, which detected 58 mutations (12.8%), 40 (8.8%) of which were pathogenic. In 14 (3.1%) subjects, variants of uncertain significance (VUS) were detected, and in four (0.9%) subjects, the detected mutations were benign. In total, 161 mutations were detected using our two-step algorithm (founder test and NGS), of which 64% were founder mutations, 25% were NGS-detected pathogenic mutations, 9% were VUS, and 2% were benign. In addition, 38 mutations not yet reported in the Polish population were detected. In total, founder mutations accounted for only 64% of all detected mutations, and the remaining mutations (36%) were dispersed across the BRCA1/2 gene sequences. Thus, in Poland, testing for constitutional mutations in BRCA1/2 should be carried out in two stages, where NGS is performed in qualifying subjects if founder mutations are not identified.
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Affiliation(s)
- Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
- * E-mail:
| | - Monika Siołek
- Genetic Clinic, Holycross Cancer Centre, Kielce, Poland
| | - Janusz Kopczyński
- Department of Surgical Pathology, Holycross Cancer Centre, Kielce, Poland
| | - Kamila Krawiec
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Joanna Kalisz
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Sebastian Zięba
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | | | | | - Jowita Furmańczyk
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | | | - Małgorzata Chłopek
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Paweł Macek
- Department of Cancer Epidemiology and Cancer Control, Holycross Cancer Centre, Kielce, Poland
| | | | - Stanisław Góźdź
- Oncology Clinic, Holycross Cancer Centre, Kielce, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Poland
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Agency and choice in genetic counseling: Acknowledging patients' concerns. J Genet Couns 2009; 18:464-74. [PMID: 19714455 DOI: 10.1007/s10897-009-9237-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
Abstract
This paper investigates to what degree patients can be said to effectively manifest agency during the process of genetic counseling for cancer risk. Rather than talk about agency on an abstract level, the discussion is grounded in examples from actual genetic counseling sessions. Past research in this area recognises three dimensions along which clients' agency can be assessed: the availability of choice; potential prescriptiveness or framing biases in the presentation of options; and whether particular decisions are embedded within broader moral frameworks (in particular, perceived obligation to kin). In this paper it is argued that in addition to these three dimensions, an investigation of agency needs to explore the degree to which the concerns brought to counseling sessions by patients match up with the choices and management strategies offered by genetic counsellors. An analysis of four excerpts from actual counseling sessions is presented to illustrate the case.
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Kenen RH, Shapiro PJ, Hantsoo L, Friedman S, Coyne JC. Women with BRCA1 or BRCA2 mutations renegotiating a post-prophylactic mastectomy identity: self-image and self-disclosure. J Genet Couns 2007; 16:789-98. [PMID: 17917796 DOI: 10.1007/s10897-007-9112-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 06/20/2007] [Indexed: 12/21/2022]
Abstract
The Facing Our Risk of Cancer Empowered (FORCE) website is devoted to women at risk for hereditary breast and ovarian cancers. One of the most frequently discussed topics on the archived messaged board has been prophylactic mastectomy (PM) for women with a BRCA1/2 mutation. We reviewed the messages, over a 4 year period, of 21 high risk women and their "conversational" partners who originally posted on a thread about genetic testing, genetic counseling and family history. We used a qualitative research inductive process involving close reading, coding and identification of recurrent patterns, relationships and processes in the data. The women sought emotional support, specific experiential knowledge and information from each other. They frequently found revealing their post PM status problematic because of possible negative reactions and adopted self-protective strategies of evasion and concealment outside of their web-based community. The FORCE message board was considered to be a safe place in which the women could be truthful about their choices and feelings. Results are discussed in terms of Goffman's concepts "stigma" and "disclosure" and Charmaz's concepts "interruptions," "intrusions" and a "dreaded future."
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Affiliation(s)
- Regina H Kenen
- Department of Sociology and Anthropology, The College of New Jersey, PO Box 7718, Ewing, NJ 08628-0718, USA.
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