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Kastrinos F, Uno H, Ukaegbu C, Alvero C, McFarland A, Yurgelun MB, Kulke MH, Schrag D, Meyerhardt JA, Fuchs CS, Mayer RJ, Ng K, Steyerberg EW, Syngal S. Development and Validation of the PREMM 5 Model for Comprehensive Risk Assessment of Lynch Syndrome. J Clin Oncol 2017; 35:2165-2172. [PMID: 28489507 DOI: 10.1200/jco.2016.69.6120] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Current Lynch syndrome (LS) prediction models quantify the risk to an individual of carrying a pathogenic germline mutation in three mismatch repair (MMR) genes: MLH1, MSH2, and MSH6. We developed a new prediction model, PREMM5, that incorporates the genes PMS2 and EPCAM to provide comprehensive LS risk assessment. Patients and Methods PREMM5 was developed to predict the likelihood of a mutation in any of the LS genes by using polytomous logistic regression analysis of clinical and germline data from 18,734 individuals who were tested for all five genes. Predictors of mutation status included sex, age at genetic testing, and proband and family cancer histories. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), and clinical impact was determined by decision curve analysis; comparisons were made to the existing PREMM1,2,6 model. External validation of PREMM5 was performed in a clinic-based cohort of 1,058 patients with colorectal cancer. Results Pathogenic mutations were detected in 1,000 (5%) of 18,734 patients in the development cohort; mutations included MLH1 (n = 306), MSH2 (n = 354), MSH6 (n = 177), PMS2 (n = 141), and EPCAM (n = 22). PREMM5 distinguished carriers from noncarriers with an AUC of 0.81 (95% CI, 0.79 to 0.82), and performance was similar in the validation cohort (AUC, 0.83; 95% CI, 0.75 to 0.92). Prediction was more difficult for PMS2 mutations (AUC, 0.64; 95% CI, 0.60 to 0.68) than for other genes. Performance characteristics of PREMM5 exceeded those of PREMM1,2,6. Decision curve analysis supported germline LS testing for PREMM5 scores ≥ 2.5%. Conclusion PREMM5 provides comprehensive risk estimation of all five LS genes and supports LS genetic testing for individuals with scores ≥ 2.5%. At this threshold, PREMM5 provides performance that is superior to the existing PREMM1,2,6 model in the identification of carriers of LS, including those with weaker phenotypes and individuals unaffected by cancer.
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Affiliation(s)
- Fay Kastrinos
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hajime Uno
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Chinedu Ukaegbu
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Carmelita Alvero
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ashley McFarland
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Matthew B Yurgelun
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Matthew H Kulke
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Deborah Schrag
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeffrey A Meyerhardt
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Charles S Fuchs
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert J Mayer
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kimmie Ng
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ewout W Steyerberg
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sapna Syngal
- Fay Kastrinos and Ashley McFarland, Columbia University Medical Center, New York, NY; Hajime Uno, Chinedu Ukaegbu, Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Dana-Farber Cancer Institute; Carmelita Alvero, Harvard T.H. Chan School of Public Health; Matthew B. Yurgelun, Matthew H. Kulke, Deborah Schrag, Jeffrey A. Meyerhardt, Charles S. Fuchs, Robert J. Mayer, Kimmie Ng, and Sapna Syngal, Harvard Medical School; Sapna Syngal, Brigham and Women's Hospital, Boston, MA; and Ewout W. Steyerberg, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Kastrinos F, Ojha RP, Leenen C, Alvero C, Mercado RC, Balmaña J, Valenzuela I, Balaguer F, Green R, Lindor NM, Thibodeau SN, Newcomb P, Win AK, Jenkins M, Buchanan DD, Bertario L, Sala P, Hampel H, Syngal S, Steyerberg EW. Comparison of Prediction Models for Lynch Syndrome Among Individuals With Colorectal Cancer. J Natl Cancer Inst 2015; 108:djv308. [PMID: 26582061 DOI: 10.1093/jnci/djv308] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 09/25/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent guidelines recommend the Lynch Syndrome prediction models MMRPredict, MMRPro, and PREMM1,2,6 for the identification of MMR gene mutation carriers. We compared the predictive performance and clinical usefulness of these prediction models to identify mutation carriers. METHODS Pedigree data from CRC patients in 11 North American, European, and Australian cohorts (6 clinic- and 5 population-based sites) were used to calculate predicted probabilities of pathogenic MLH1, MSH2, or MSH6 gene mutations by each model and gene-specific predictions by MMRPro and PREMM1,2,6. We examined discrimination with area under the receiver operating characteristic curve (AUC), calibration with observed to expected (O/E) ratio, and clinical usefulness using decision curve analysis to select patients for further evaluation. All statistical tests were two-sided. RESULTS Mutations were detected in 539 of 2304 (23%) individuals from the clinic-based cohorts (237 MLH1, 251 MSH2, 51 MSH6) and 150 of 3451 (4.4%) individuals from the population-based cohorts (47 MLH1, 71 MSH2, 32 MSH6). Discrimination was similar for clinic- and population-based cohorts: AUCs of 0.76 vs 0.77 for MMRPredict, 0.82 vs 0.85 for MMRPro, and 0.85 vs 0.88 for PREMM1,2,6. For clinic- and population-based cohorts, O/E deviated from 1 for MMRPredict (0.38 and 0.31, respectively) and MMRPro (0.62 and 0.36) but were more satisfactory for PREMM1,2,6 (1.0 and 0.70). MMRPro or PREMM1,2,6 predictions were clinically useful at thresholds of 5% or greater and in particular at greater than 15%. CONCLUSIONS MMRPro and PREMM1,2,6 can well be used to select CRC patients from genetics clinics or population-based settings for tumor and/or germline testing at a 5% or higher risk. If no MMR deficiency is detected and risk exceeds 15%, we suggest considering additional genetic etiologies for the cause of cancer in the family.
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Affiliation(s)
- Fay Kastrinos
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB).
| | - Rohit P Ojha
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Celine Leenen
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Carmelita Alvero
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Rowena C Mercado
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Judith Balmaña
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Irene Valenzuela
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Francesc Balaguer
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Roger Green
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Noralane M Lindor
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Stephen N Thibodeau
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Polly Newcomb
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Aung Ko Win
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Mark Jenkins
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Daniel D Buchanan
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Lucio Bertario
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Paola Sala
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Heather Hampel
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Sapna Syngal
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
| | - Ewout W Steyerberg
- Herbert Irving C omprehensive Cancer Center and Division of Digestive and Liver Diseases, Columbia University, Medical Center, New York, NY (FK); Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN (RPO); Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands (CL); Statistical and Data Analysis Center, Harvard School Public Health, Boston, MA (CA); Population Sciences Division, Dana-Farber Cancer Institute, Boston, MA (RCM); Department of Oncology (JB) and Genetics Department (IV), University Hospital Vall d'Hebrón, Barcelona, Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain (FB); Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada (RG); Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (NML); Division of Molecular Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (SNT); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (PN); Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia (AKW, MJ, DDB); Unit of Hereditary Digestive Tract Tumors, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (LB, PS); Clinical Cancer Genetics Program, Ohio State University Comprehensive Cancer Center, Columbus, OH (HH); Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA (SS); Harvard Medical School, Boston, MA (SS); Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (EWS); Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville, Victoria, Australia (DDB)
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