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Frey MK, Ahsan MD, Bergeron H, Lin J, Li X, Fowlkes RK, Narayan P, Nitecki R, Rauh-Hain JA, Moss HA, Baltich Nelson B, Thomas C, Christos PJ, Hamilton JG, Chapman-Davis E, Cantillo E, Holcomb K, Kurian AW, Lipkin S, Offit K, Sharaf RN. Cascade Testing for Hereditary Cancer Syndromes: Should We Move Toward Direct Relative Contact? A Systematic Review and Meta-Analysis. J Clin Oncol 2022; 40:4129-4143. [PMID: 35960887 PMCID: PMC9746789 DOI: 10.1200/jco.22.00303] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Evidence-based guidelines recommend cascade genetic counseling and testing for hereditary cancer syndromes, providing relatives the opportunity for early detection and prevention of cancer. The current standard is for patients to contact and encourage relatives (patient-mediated contact) to undergo counseling and testing. Direct relative contact by the medical team or testing laboratory has shown promise but is complicated by privacy laws and lack of infrastructure. We sought to compare outcomes associated with patient-mediated and direct relative contact for hereditary cancer cascade genetic counseling and testing in the first meta-analysis on this topic. MATERIALS AND METHODS We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO No.: CRD42020134276). We searched key electronic databases to identify studies evaluating hereditary cancer cascade testing. Eligible trials were subjected to meta-analysis. RESULTS Eighty-seven studies met inclusion criteria. Among relatives included in the meta-analysis, 48% (95% CI, 38 to 58) underwent cascade genetic counseling and 41% (95% CI, 34 to 48) cascade genetic testing. Compared with the patient-mediated approach, direct relative contact resulted in significantly higher uptake of genetic counseling for all relatives (63% [95% CI, 49 to 75] v 35% [95% CI, 24 to 48]) and genetic testing for first-degree relatives (62% [95% CI, 49 to 73] v 40% [95% CI, 32 to 48]). Methods of direct contact included telephone calls, letters, and e-mails; respective rates of genetic testing completion were 61% (95% CI, 51 to 70), 48% (95% CI, 37 to 59), and 48% (95% CI, 45 to 50). CONCLUSION Most relatives at risk for hereditary cancer do not undergo cascade genetic counseling and testing, forgoing potentially life-saving medical interventions. Compared with patient-mediated contact, direct relative contact increased rates of cascade genetic counseling and testing, arguing for a shift in the care delivery paradigm, to be confirmed by randomized controlled trials.
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Affiliation(s)
| | | | | | - Jenny Lin
- Weill Cornell Medicine, New York, NY
| | - Xuan Li
- Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY
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Boumehdi AL, Cherbal F, Khider F, Oukkal M, Mahfouf H, Zebboudj F, Maaoui M. Germline variants screening of MLH1, MSH2, MSH6 and PMS2 genes in 64 Algerian Lynch syndrome families: The first nationwide study. Ann Hum Genet 2022; 86:328-352. [PMID: 36073783 DOI: 10.1111/ahg.12482] [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: 11/16/2021] [Revised: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
Colorectal cancer is the second leading cause of cancer-related deaths in women and men in Algeria. Lynch syndrome (LS) is an autosomal dominant disease caused by heterozygous germline pathogenic variants in mismatch repair genes (MMR) and frequently predisposes to colorectal cancer. However, data about MMR germline pathogenic variants in Algerian patients are limited. This first nationwide study aims to describe clinicopathologic features and germline variants in MMR genes in Algerian families with suspected LS. Sixty-four (64) families with suspected LS were studied. Index cases with LS who fulfilled Amsterdam criteria were screened by PCR-direct sequencing for germline variants in MMR genes: MLH1 (exons 1, 9, 10, 13, 16), MSH2 (exons 5, 6, 7, 12), MSH6 (exons 4 and 8) and PMS2 (exons 6 and 10). We selected these specific risk exons genes since they have a higher probability of harboring pathogenic variants. In addition, two unrelated LS patients were screened by next-generation sequencing using a cancer panel of 30 hereditary cancer genes. Six germline pathogenic variants and one germline likely pathogenic variant were identified in 19 (29.68%) families (4 MLH1, 2 MSH2 and 1 MSH6). Of index cases and relatives who underwent genetic testing (n = 76), 30 (39.47%) had MMR pathogenic gene variants, one (0.13%) had MMR gene likely pathogenic variant and three had MMR variant of uncertain significance, respectively. Two novel germline pathogenic variants in MLH1 (2) and one germline likely pathogenic variant in MSH6 (1) never published in individuals with LS have been detected in the present study. The recurrent MLH1 germline pathogenic variant c.1546C>T has been found in nine LS families, six of them related with two large kindreds, from four North central provinces of Algeria. In addition, the common MSH2 germline pathogenic variant c.942+3A>T has been detected in five unrelated patients with a strong LS family history. The accumulative knowledge about clinicopathological and genetic characteristics of LS in Algerian patients will impact clinical management in the areas of both prevention and treatment.
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Affiliation(s)
- Asma-Lamia Boumehdi
- Molecular Genetics Team, LMCB, Faculty of Biological Sciences, University of Science and Technology Houari Boumediene, Algiers, Algeria
| | - Farid Cherbal
- Molecular Genetics Team, LMCB, Faculty of Biological Sciences, University of Science and Technology Houari Boumediene, Algiers, Algeria
| | - Feriel Khider
- Molecular Genetics Team, LMCB, Faculty of Biological Sciences, University of Science and Technology Houari Boumediene, Algiers, Algeria
| | - Mohammed Oukkal
- Clinic of Medical Oncology Amine Zirout, University Hospital of Beni-Messous, School of Medicine, University of Algiers-1, Algiers, Algeria
| | - Hassen Mahfouf
- Mohamed El Kolli Public Hospital, Academic Medical Oncology Services, School of Medicine, University of Algiers-1, Rouiba, Algeria
| | - Ferhat Zebboudj
- Mohamed El Kolli Public Hospital, Academic General Surgery Services, School of Medicine, University of Algiers-1, Rouiba, Algeria
| | - Mustapha Maaoui
- Bachir Mentouri Public Hospital, Academic General Surgery Services, School of Medicine, University of Algiers-1, Kouba, Algeria
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Kaissarian NM, Meyer D, Kimchi-Sarfaty C. Synonymous Variants: Necessary Nuance in our Understanding of Cancer Drivers and Treatment Outcomes. J Natl Cancer Inst 2022; 114:1072-1094. [PMID: 35477782 PMCID: PMC9360466 DOI: 10.1093/jnci/djac090] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Once called "silent mutations" and assumed to have no effect on protein structure and function, synonymous variants are now recognized to be drivers for some cancers. There have been significant advances in our understanding of the numerous mechanisms by which synonymous single nucleotide variants (sSNVs) can affect protein structure and function by affecting pre-mRNA splicing, mRNA expression, stability, folding, miRNA binding, translation kinetics, and co-translational folding. This review highlights the need for considering sSNVs in cancer biology to gain a better understanding of the genetic determinants of human cancers and to improve their diagnosis and treatment. We surveyed the literature for reports of sSNVs in cancer and found numerous studies on the consequences of sSNVs on gene function with supporting in vitro evidence. We also found reports of sSNVs that have statistically significant associations with specific cancer types but for which in vitro studies are lacking to support the reported associations. Additionally, we found reports of germline and somatic sSNVs that were observed in numerous clinical studies and for which in silico analysis predicts possible effects on gene function. We provide a review of these investigations and discuss necessary future studies to elucidate the mechanisms by which sSNVs disrupt protein function and are play a role in tumorigeneses, cancer progression, and treatment efficacy. As splicing dysregulation is one of the most well recognized mechanisms by which sSNVs impact protein function, we also include our own in silico analysis for predicting which sSNVs may disrupt pre-mRNA splicing.
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Affiliation(s)
- Nayiri M Kaissarian
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation & Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Douglas Meyer
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation & Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Chava Kimchi-Sarfaty
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation & Research, US Food and Drug Administration, Silver Spring, MD, USA
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4
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Tedjasaputra TR, Hatta M, Massi MN, Natzir R, Bukhari A, Masadah R, Parewangi ML, Prihantono P, Nariswati R, Tedjasaputra V. Prediction of hereditary nonpolyposis colorectal cancer using mRNA MSH2 quantitative and the correlation with nonmodifiable factor. World J Gastrointest Pathophysiol 2021; 12:130-142. [DOI: 10.4291/wjgp.v12.i6.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hereditary non-polyposis colon cancer is a dominantly inherited syndrome of colorectal cancer (CRC), with heightened risk for younger population. Previous studies link its susceptibility to the DNA sequence polymorphism along with Amsterdam and Bethesda criteria. However, those fail in term of applicability.
AIM To determine a clear cut-off of MSH2 gene expression for CRC heredity grouping factor. Further, the study also aims to examine the association of risk factors to the CRC heredity.
METHODS The cross-sectional study observed 71 respondents from May 2018 to December 2019 in determining the CRC hereditary status through MSH2 mRNA expression using reverse transcription-polymerase chain reaction and the disease’s risk factors. Data were analyzed through Chi-Square, Fischer exact, t-test, Mann-Whitney, and multiple logistics.
RESULTS There are significant differences of MSH2 within CRC group among tissue and blood; yet, negative for significance between groups. Through the blood gene expression fifth percentile, the hereditary CRC cut-off is 11059 fc, dividing the 40 CRC respondents to 32.5% with hereditary CRC. Significant risk factors include age, family history, and staging. Nonetheless, after multivariate control, age is just a confounder. Further, the study develops a probability equation with area under the curve 82.2%.
CONCLUSION Numerous factors have significant relations to heredity of CRC patients. However, true important factors are staging and family history, while age and others are confounders. The study also established a definite cut-off point for heredity CRC based on mRNA MSH2 expression, 11059 fc. These findings shall act as concrete foundations on further risk factors and/or genetical CRC future studies.
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Affiliation(s)
- Tjahjadi Robert Tedjasaputra
- Department of Internal Medicine, Tarakan General Hospital, Medical Faculty University of Hasanuddin, Jakarta 10720, DKI Jakarta, Indonesia
| | - Mochammad Hatta
- Department of Immunology and Biomolecular, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia
| | - Muh Nasrum Massi
- Department of Microbiology, Faculty of Medicine, University of Hasanuddin, Makassar 90245, South Sulawesi, Indonesia
| | - Rosdiana Natzir
- Department of Biochemistry Meidcal Faculty, University of Hasanuddin, Makassar 90245, South Sulawesi, Indonesia
| | - Agussalim Bukhari
- Department of Nutrition, Faculty of Medicine, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia
| | - Rina Masadah
- Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Makassar 20945, South Sulawesi, Indonesia
| | - Muh Lutfi Parewangi
- Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 20945, South Sulawesi, Indonesia
| | - Prihantono Prihantono
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia
| | - Rinda Nariswati
- Department of Statistic, School of Computer Science, Bina Nusantara University Jakarta, Jakarta 11530, Indonesia
| | - Vincent Tedjasaputra
- American Association for the Advancement of Science (AAAS), Science and Technology Policy Fellow, Alexandria, VA 22314, United States
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5
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Tedjasaputra TR, Hatta M, Massi MN, Natzir R, Bukhari A, Masadah R, Parewangi ML, Prihantono P, Nariswati R, Tedjasaputra V. Prediction of hereditary nonpolyposis colorectal cancer using mRNA MSH2 quantitative and the correlation with nonmodifiable factor. World J Gastrointest Pathophysiol 2021; 12:134-146. [PMID: 34877027 PMCID: PMC8611184 DOI: 10.4291/wjgp.v12.i6.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/13/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hereditary non-polyposis colon cancer is a dominantly inherited syndrome of colorectal cancer (CRC), with heightened risk for younger population. Previous studies link its susceptibility to the DNA sequence polymorphism along with Amsterdam and Bethesda criteria. However, those fail in term of applicability. AIM To determine a clear cut-off of MSH2 gene expression for CRC heredity grouping factor. Further, the study also aims to examine the association of risk factors to the CRC heredity. METHODS The cross-sectional study observed 71 respondents from May 2018 to December 2019 in determining the CRC hereditary status through MSH2 mRNA expression using reverse transcription-polymerase chain reaction and the disease's risk factors. Data were analyzed through Chi-Square, Fischer exact, t-test, Mann-Whitney, and multiple logistics. RESULTS There are significant differences of MSH2 within CRC group among tissue and blood; yet, negative for significance between groups. Through the blood gene expression fifth percentile, the hereditary CRC cut-off is 11059 fc, dividing the 40 CRC respondents to 32.5% with hereditary CRC. Significant risk factors include age, family history, and staging. Nonetheless, after multivariate control, age is just a confounder. Further, the study develops a probability equation with area under the curve 82.2%. CONCLUSION Numerous factors have significant relations to heredity of CRC patients. However, true important factors are staging and family history, while age and others are confounders. The study also established a definite cut-off point for heredity CRC based on mRNA MSH2 expression, 11059 fc. These findings shall act as concrete foundations on further risk factors and/or genetical CRC future studies.
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Affiliation(s)
- Tjahjadi Robert Tedjasaputra
- Department of Internal Medicine, Tarakan General Hospital, Medical Faculty University of Hasanuddin, Jakarta 10720, DKI Jakarta, Indonesia
| | - Mochammad Hatta
- Department of Immunology and Biomolecular, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia
| | - Muh Nasrum Massi
- Department of Microbiology, Faculty of Medicine, University of Hasanuddin, Makassar 90245, South Sulawesi, Indonesia
| | - Rosdiana Natzir
- Department of Biochemistry Meidcal Faculty, University of Hasanuddin, Makassar 90245, South Sulawesi, Indonesia
| | - Agussalim Bukhari
- Department of Nutrition, Faculty of Medicine, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia
| | - Rina Masadah
- Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Makassar 20945, South Sulawesi, Indonesia
| | - Muh Lutfi Parewangi
- Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 20945, South Sulawesi, Indonesia
| | - Prihantono Prihantono
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia
| | - Rinda Nariswati
- Department of Statistic, School of Computer Science, Bina Nusantara University Jakarta, Jakarta 11530, Indonesia
| | - Vincent Tedjasaputra
- American Association for the Advancement of Science (AAAS), Science and Technology Policy Fellow, Alexandria, VA 22314, United States
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6
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Beard VK, Bedard AC, Nuk J, Lee PWC, Hong Q, Bedard JEJ, Sun S, Schrader KA. Genetic testing in families with hereditary colorectal cancer in British Columbia and Yukon: a retrospective cross-sectional analysis. CMAJ Open 2020; 8:E637-E642. [PMID: 33077534 PMCID: PMC7588261 DOI: 10.9778/cmajo.20190167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Genetic testing in families with hereditary cancer enables identification of people most likely to benefit from intensive screening and preventive measures; however, the uptake of testing in relatives (known as cascade carrier testing) for hereditary colorectal cancer syndromes has been shown to be low. Our objective was to report rates of familial testing for hereditary colorectal cancer syndromes in a publicly funded hereditary cancer clinic in Canada. METHODS A cross-sectional retrospective database review was used to determine testing uptake between 1997 and 2016 for families served by the provincial Hereditary Cancer Program for British Columbia and Yukon. Analyses were conducted for genes associated with syndromes with an increased risk for colorectal cancer, including Lynch syndrome (MLH1, MSH2, MSH6, PMS2 and EPCAM) and familial adenomatous polyposis (APC), and for additional moderate- to high-penetrance genes (STK11, TP53, SMAD4, MUTYH, PTEN and CHEK2). Descriptive statistics were used and all analyses were 2-tailed. RESULTS The study cohort included 245 index patients, with carrier testing performed in 382 relatives. The mean age at family member testing was 41.2 years, and most (61.0%) of the family members who underwent testing were women. The median time between disclosure of index cases and their family member's results was 8.3 months. Among eligible first-degree relatives, 32.6% (268/821) underwent testing in BC. Of 67 cancer diagnoses in family members, most (62.7%) occurred before genetic testing. INTERPRETATION A substantial proportion of people at risk for hereditary colorectal cancer do not undergo genetic testing. This gap highlights the need to explore barriers to testing and to consider interventions to promote uptake; more aggressive efforts by hereditary cancer programs are needed to reach this highest risk population.
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Affiliation(s)
- Vivienne K Beard
- Department of Biology (Beard, Lee, J.E.J. Bedard), University of the Fraser Valley, Abbotsford, BC; Hereditary Cancer Program (A.C. Bedard, Nuk, Hong, Sun, Schrader), BC Cancer; Division of Medical Oncology (Sun), University of British Columbia; Department of Molecular Oncology (Schrader), BC Cancer; Department of Medical Genetics (Schrader), University of British Columbia, Vancouver, BC
| | - Angela C Bedard
- Department of Biology (Beard, Lee, J.E.J. Bedard), University of the Fraser Valley, Abbotsford, BC; Hereditary Cancer Program (A.C. Bedard, Nuk, Hong, Sun, Schrader), BC Cancer; Division of Medical Oncology (Sun), University of British Columbia; Department of Molecular Oncology (Schrader), BC Cancer; Department of Medical Genetics (Schrader), University of British Columbia, Vancouver, BC
| | - Jennifer Nuk
- Department of Biology (Beard, Lee, J.E.J. Bedard), University of the Fraser Valley, Abbotsford, BC; Hereditary Cancer Program (A.C. Bedard, Nuk, Hong, Sun, Schrader), BC Cancer; Division of Medical Oncology (Sun), University of British Columbia; Department of Molecular Oncology (Schrader), BC Cancer; Department of Medical Genetics (Schrader), University of British Columbia, Vancouver, BC
| | - Petra W C Lee
- Department of Biology (Beard, Lee, J.E.J. Bedard), University of the Fraser Valley, Abbotsford, BC; Hereditary Cancer Program (A.C. Bedard, Nuk, Hong, Sun, Schrader), BC Cancer; Division of Medical Oncology (Sun), University of British Columbia; Department of Molecular Oncology (Schrader), BC Cancer; Department of Medical Genetics (Schrader), University of British Columbia, Vancouver, BC
| | - Quan Hong
- Department of Biology (Beard, Lee, J.E.J. Bedard), University of the Fraser Valley, Abbotsford, BC; Hereditary Cancer Program (A.C. Bedard, Nuk, Hong, Sun, Schrader), BC Cancer; Division of Medical Oncology (Sun), University of British Columbia; Department of Molecular Oncology (Schrader), BC Cancer; Department of Medical Genetics (Schrader), University of British Columbia, Vancouver, BC
| | - James E J Bedard
- Department of Biology (Beard, Lee, J.E.J. Bedard), University of the Fraser Valley, Abbotsford, BC; Hereditary Cancer Program (A.C. Bedard, Nuk, Hong, Sun, Schrader), BC Cancer; Division of Medical Oncology (Sun), University of British Columbia; Department of Molecular Oncology (Schrader), BC Cancer; Department of Medical Genetics (Schrader), University of British Columbia, Vancouver, BC
| | - Sophie Sun
- Department of Biology (Beard, Lee, J.E.J. Bedard), University of the Fraser Valley, Abbotsford, BC; Hereditary Cancer Program (A.C. Bedard, Nuk, Hong, Sun, Schrader), BC Cancer; Division of Medical Oncology (Sun), University of British Columbia; Department of Molecular Oncology (Schrader), BC Cancer; Department of Medical Genetics (Schrader), University of British Columbia, Vancouver, BC
| | - Kasmintan A Schrader
- Department of Biology (Beard, Lee, J.E.J. Bedard), University of the Fraser Valley, Abbotsford, BC; Hereditary Cancer Program (A.C. Bedard, Nuk, Hong, Sun, Schrader), BC Cancer; Division of Medical Oncology (Sun), University of British Columbia; Department of Molecular Oncology (Schrader), BC Cancer; Department of Medical Genetics (Schrader), University of British Columbia, Vancouver, BC
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7
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Serra S, Capo-Chichi JM, McCarthy AJ, Sabatini P, Chetty R. Unique MLH1 mutations in colonic adenomas in an obligate germline Lynch syndrome carrier. J Clin Pathol 2019; 73:291-295. [PMID: 31649038 DOI: 10.1136/jclinpath-2019-206234] [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: 09/24/2019] [Accepted: 10/05/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND An obligate germline Lynch syndrome carrier had four colonic adenomas removed. MATERIALS AND METHODS The adenomas were evaluated for grade of dysplasia, MLH1, PMS2, MSH2 and MSH6 protein expression, microsatellite instability (MSI), BRAF, methylation status and a next-generation sequencing (NGS) panel of 52 cancer genes. RESULTS There were four tubular or tubulovillous adenomas from the hepatic flexure, rectosigmoid and rectum; one with low-grade and high-grade dysplasia, one with high-grade dysplasia only and two with low-grade dysplasia. All four adenomas showed retention of MLH1, MHS2 and MSH6 but complete loss of PMS2 in both low-grade and high-grade dysplasia areas.Two of the four adenomas were MSI-high, BRAF V600E wild type and were not MLH1 methylated. NGS identified an MLH1 germline variant: NM_000249.3: c.1558+1 G>A, p.(?) in all tissue (adenomas and normal), which likely explains the pathophysiology of Lynch syndrome in this patient. Other variants were also detected in MLH1 and MSH6 in all four adenomas tested; these being reported previously in somatic colorectal cancers. CONCLUSION We highlight an MLH1 variant in the colonic adenomas in an obligate Lynch syndrome carrier that resulted in PMS2 protein loss in the absence of mutations of the PMS2 gene.
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Affiliation(s)
- Stefano Serra
- Laboratory Medicine Program, Divisions of Anatomical Pathology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | | | - Aoife J McCarthy
- Laboratory Medicine Program, Divisions of Anatomical Pathology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Peter Sabatini
- Clinical Laboratory Genetics, University Health Network, Toronto, Ontario, Canada
| | - Runjan Chetty
- Laboratory Medicine Program, Divisions of Anatomical Pathology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Sunga AY, Ricker C, Espenschied CR, Castillo D, Melas M, Herzog J, Bannon S, Cruz-Correa M, Lynch P, Solomon I, Gruber SB, Weitzel JN. Spectrum of mismatch repair gene mutations and clinical presentation of Hispanic individuals with Lynch syndrome. Cancer Genet 2017; 212-213:1-7. [PMID: 28449805 PMCID: PMC8800930 DOI: 10.1016/j.cancergen.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 01/13/2017] [Accepted: 01/15/2017] [Indexed: 12/21/2022]
Abstract
Lynch syndrome (LS), the most common hereditary colorectal cancer syndrome, is caused by mismatch repair (MMR) gene mutations. However, data about MMR mutations in Hispanics are limited. This study aims to describe the spectrum of MMR mutations in Hispanics with LS and explore ancestral origins. This case series involved an IRB-approved retrospective chart review of self-identified Hispanic patients (n = 397) seen for genetic cancer risk assessment at four collaborating academic institutions in California, Texas, and Puerto Rico who were evaluated by MMR genotyping and/or tumor analysis. A literature review was conducted for all mutations identified. Of those who underwent clinical genetic testing (n = 176), 71 had MMR gene mutations. Nine mutations were observed more than once. One third (3/9) of recurrent mutations and two additional mutations (seen only once) were previously reported in Spain, confirming the influence of Spanish ancestry on MMR mutations in Hispanic populations. The recurrent mutations identified (n = 9) included both previously reported mutations as well as unique mutations not in the literature. This is the largest report of Hispanic MMR mutations in North America; however, a larger sample and haplotype analyses are needed to better understand recurrent MMR mutations in Hispanic populations.
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Affiliation(s)
- Annette Y Sunga
- Clinical Cancer Genetics, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Charité Ricker
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Carin R Espenschied
- Clinical Cancer Genetics, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Danielle Castillo
- Clinical Cancer Genetics, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Marilena Melas
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Josef Herzog
- Clinical Cancer Genetics, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Sarah Bannon
- Clinical Cancer Genetics, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marcia Cruz-Correa
- Clinical Cancer Genetics, University of Puerto Rico Comprehensive Cancer Center, Rio Piedras 00935, Puerto Rico
| | - Patrick Lynch
- Clinical Cancer Genetics, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ilana Solomon
- Clinical Cancer Genetics, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Stephen B Gruber
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Jeffrey N Weitzel
- Clinical Cancer Genetics, City of Hope National Medical Center, Duarte, CA 91010, USA.
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9
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Huang XY, Huang ZL, Huang J, Wang ZG, Zheng Q. A case of multiple primary malignancies and investigation of family history. Oncol Lett 2012; 4:931-934. [PMID: 23162625 PMCID: PMC3499463 DOI: 10.3892/ol.2012.885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/06/2012] [Indexed: 11/06/2022] Open
Abstract
The occurrence of multiple primary malignancies (MPM) in one patient is a rare but increasingly frequent event, partly due to medical advances in diagnosis and therapy. A number of theories have been proposed to explain MPM, but none have been proven. A key risk factor appears to be family history. We present the case of a 43-year-old male with multiple cancers who was first admitted to the hospital for an undifferentiated pleomorphic sarcoma/pleomorphic malignant fibrous histiocytoma (pG2T2bN0Mx stage III) of the right scapula in May 2009. The patient underwent three tumor resections in situ due to tumor recurrence. During the period of chemotherapy and radiotherapy, computed tomography (CT) revealed a 10x10-cm enhancing soft mass of the ascending colon, which was diagnosed as mucinous adenocarcinoma in a pathological report. Laboratory data showed elevated serum levels of carcinoembryonic antigen (CEA, 20.0 μg/l; normal range, 0.0-10.0 μg/l). Certain family members of the patient had been diagnosed with endometrial, colon and pancreatic cancer. None of the family had a smoking history or presented with familial adenomatous polyposis (FAP). The patient with hereditary non-polyposis colorectal cancer (HNPCC), whose family fulfilled Amsterdam Criteria I (AC I), has remained free of disease for 15 months. Family history may be a key risk factor for MPM and HNPCC, the detailed molecular mechanisms of which remain to be elucidated. This case report with an investigation of family history may improve the clinical recognition of HNPCC and MPM.
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Affiliation(s)
- Xiu-Yan Huang
- Department of General Surgery, The 6th People's Hospital of Shanghai, School of Medicine, Shanghai Jiaotong University, Shanghai 200233
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Chen HJ, Lin Q, Zeng L, Yang BL. Recent advances in molecular diagnosis of hereditary nonpolyposis colorectal cancer. Shijie Huaren Xiaohua Zazhi 2012; 20:2806-2811. [DOI: 10.11569/wcjd.v20.i29.2806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hereditary nonpolyposis colorectal cancer (HNPCC) is a dominant autosomal genetic syndrome, accounting for 5%-10% of all colorectal cancers. It is caused by inactivating germ-line mutations of DNA mismatch repair (MMR) genes, including hMLH1, hMSH2, hMSH6, hPMS2, and hPMS1. HNPCC shows a tendency towards early age at onset, multiplicity of tumors, right-sided colon involvement, characteristic tumor pathology, and spectrum of extracolonic tumors. The diagnosis of HNPCC mainly relies on history and genetic linkage analysis. Patients meeting the Amsterdam criteria or Bethesda guidelines should undergo detection of microsatellite instability and immunohistochemistry analysis of hMSH2 and hMLH1 expression. If one of the two detections yields a positive result, molecular genetic testing for germline mutations of MMR genes should be taken into consideration.
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Identification and surveillance of 19 Lynch syndrome families in southern Italy: report of six novel germline mutations and a common founder mutation. Fam Cancer 2011; 10:285-95. [PMID: 21286823 DOI: 10.1007/s10689-011-9419-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Lynch syndrome (LS), or hereditary non-polyposis colorectal cancer (HNPCC), is an autosomal dominant condition responsible for early onset cancer mostly in the colonrectum and endometrium as well as in other organ sites. Lynch syndrome is caused by germline mutations in mismatch repair genes, prevalently in hMSH2, hMLH1, and less frequently in hMSH6 and hPMS2. Twenty-nine non-related index cases with colorectal cancer (CRC) were collected from a region in southeast Italy (Apulia). Among this set of patients, fifteen fulfilled the Amsterdam criteria II. The presence of tumor microsatellite instability (MSI) was assessed in all index cases and 19 (15 AC+/4 AC-) were classified as MSI-H. Mutation analysis performed on all patients, identified 15 pathogenic mutations in hMLH1 and 4 in hMSH2. 4/15 mutations in hMLH1 and 2/4 hMSH2 mutations have not been previously reported. Three previously reported mutations were further investigated for the possibility of a common founder effect. Genetic counseling was offered to all probands and extended to 183 relatives after molecular testing and 85 (46%) mutation carriers were identified. Eighty mutation carriers underwent an accurate clinical and instrumental surveillance protocol. Our results confirm that the identification of LS patients based exclusively on family history may miss patients carrying germline mutations in the MMR genes. Moreover, our results demonstrated that molecular screening and subsequent instrumental surveillance are very effective in identifying CRCs at earlier stages and reducing the number of deaths from secondary cancers in HNPCC patients.
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Landsbergen KM, Prins JB, Brunner HG, Hoogerbrugge N. Shortened time interval between colorectal cancer diagnosis and risk testing for hereditary colorectal cancer is not related to higher psychological distress. Fam Cancer 2011; 10:51-7. [PMID: 20853153 PMCID: PMC3036824 DOI: 10.1007/s10689-010-9387-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Current diagnostic practices have shortened the interval between colorectal cancer (CRC) diagnosis and genetic analysis for Lynch syndrome by MSI-testing. We studied the relation of time between MSI-testing since CRC diagnosis (MSI-CRC interval) and psychological distress. We performed a cross-sectional study in 89 patients who had previously been treated for CRC. Data were collected during MSI-testing after genetic counseling. Psychological distress was measured with the IES, the SCL-90 and the POMS; social issues with the ISS, ISB and the ODHCF. The median time of MSI-CRC interval was 24 months (range 0-332), with 23% of the patients diagnosed less than 12 months and 42% more than 36 months prior to MSI-testing. In 34% of the patients cancer specific distress was high (IES scores >26). Mean psychopathology (SCL-90) scores were low, mean mood states (POMS) scores were moderate. Interval MSI-CRC was not related to psychological distress. High cancer specific distress was reported by 24% of patients diagnosed with CRC less than 12 months ago versus 39 and 35% by those diagnosed between 12 and 36 months and more than 36 months ago respectively. Distress was positively related to female gender (P = 0.04), religiousness (P = 0.01), low social support (P = 0.02) and difficulties with family communication (P < 0.001). Shortened time interval between CRC diagnosis and MSI-testing is not associated with higher psychological distress. Females, religious persons, those having low social support and those reporting difficulties communicating hereditary colorectal cancer with relatives are at higher risk for psychological distress.
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Affiliation(s)
- K M Landsbergen
- Department of Human Genetics, Raboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Kim YM, Choe CG, Cho SK, Jung IH, Chang WY, Cho M. Three novel germline mutations in MLH1 and MSH2 in families with Lynch syndrome living on Jeju island, Korea. BMB Rep 2011; 43:693-7. [PMID: 21034533 DOI: 10.5483/bmbrep.2010.43.10.693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomal dominant syndrome characterized by predisposition to early-onset cancers. HNPCC is caused by heterozygous loss-of-function mutations within the mismatch repair genes MLH1, MSH2, MSH6, PMS1, and PMS2. We genotyped the MLH1 and MSH2 genes in patients suffering from Lynch syndrome and in 11 unrelated patients who were diagnosed with colorectal cancer and had subsequently undergone surgery. Five Lynch syndrome patients carried germline mutations in MLH1 or MSH2. Two of these were identified as known mutations in MLH1: deletion of exon 10 and a point mutation (V384D). The remaining three patients exhibited novel mutations: a duplication (937_942dupGAAGTT) in MLH1; deletion of exons 8, 9, and 10; and a point mutation in MLH1 (F396I) combined with multiple missense mutations in MSH2 (D295G, K808E, Q855P, and I884T). The findings underline the importance of efficient pre-screening of conspicuous cases.
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Affiliation(s)
- Young Mee Kim
- Department of Biochemistry, Institute of Medical Science, Jeju National University, Jeju 690-756, Korea
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Helderman-van den Enden ATJM, van den Bergen JC, Breuning MH, Verschuuren JJGM, Tibben A, Bakker E, Ginjaar HB. Duchenne/Becker muscular dystrophy in the family: have potential carriers been tested at a molecular level? Clin Genet 2010; 79:236-42. [DOI: 10.1111/j.1399-0004.2010.01579.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sheng X, Zhou HH, Zhou XY, Du X, Zhang TM, Cai SJ, Sheng WQ, Shi DR. Germline mutation analysis of hPMS2 gene in Chinese families with hereditary nonpolyposis colorectal cancer. World J Gastroenterol 2010; 16:3847-52. [PMID: 20698049 PMCID: PMC2921098 DOI: 10.3748/wjg.v16.i30.3847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the germline mutation of hPMS2 gene in 26 unrelated Chinese hereditary nonpolyposis colorectal cancer (HNPCC) probands and to fulfill the screening strategy for HNPCC in Chinese.
METHODS: Genomic DNA was extracted from the peripheral blood. To avoid the interference of pseudogene in detection of the remaining 11 exons (exon 1-5, 9, 11-15), long-range polymerase chain reaction (PCR) was conducted to amplify the complete coding region of hPMS2 gene firstly. Then 1/8 of the PCR products were used as template to amplify the individual exon respectively and DNA sequencing was done. Direct DNA sequencing of the conventional PCR products of exon 6, 7, 8 and 10 of hPMS2 gene was performed. The same analysis was made in 130 healthy persons without family histories of HNPCC to further investigate the pathological effects of the detected missense mutation.
RESULTS: One HNPCC proband fulfilled Bethesda guidelines and was found to carry the germline mutation of hPMS2 gene, which has not been reported in Chinese HNPCC families. It was a missense mutation at c.1532C>T of exon 11. It was detected in three controls as well with an occurrence rate of 2.3% (3/130). Since it could not be found in the PMS2-single nucleotide polymorphism (SNP) database, this missense mutation is a new SNP unreported up to date. Meanwhile, 260 reported SNPs of hPMS2 gene were detected in the 26 HNPCC probands. The 2nd and 5th exons were probably the hot SNP regions of hPMS2 gene in Chinese HNPCC families involving 53.1% of all reported SNP.
CONCLUSION: The germline mutation of hPMS2 gene may be rare in Chinese HNPCC families. The 2nd and 5th exons are hot SNP regions of hPMS2 gene.
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Lammens CR, Aaronson NK, Wagner A, Sijmons RH, Ausems MG, Vriends AHJ, Ruijs MW, van Os TA, Spruijt L, Gómez García EB, Kluijt I, Nagtegaal T, Verhoef S, Bleiker EM. Genetic Testing in Li-Fraumeni Syndrome: Uptake and Psychosocial Consequences. J Clin Oncol 2010; 28:3008-14. [DOI: 10.1200/jco.2009.27.2112] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Li-Fraumeni syndrome (LFS) is a hereditary cancer syndrome, characterized by a high risk of developing cancer at various sites and ages. To date, limited clinical benefits of genetic testing for LFS have been demonstrated, and there are concerns about the potential adverse psychosocial impact of genetic testing for LFS. In this study, we evaluated the uptake of genetic testing and the psychosocial impact of undergoing or not undergoing a genetic test for LFS. Patients and Methods In total, 18 families with a p53 germline mutation in the Netherlands were identified. Eligible family members were invited to complete a self-report questionnaire assessing motives for undergoing or not undergoing genetic testing, LFS-related distress and worries, and health-related quality of life. Results Uptake of presymptomatic testing was 55% (65 of 119). Of the total group, 23% reported clinically relevant levels of LFS-related distress. Carriers were not significantly more distressed than noncarriers or than those with a 50% risk who did not undergo genetic testing. Those with a lack of social support were more prone to report clinically relevant levels of distress (odds ratio, 1.3; 95% CI, 1.0 to 1.5). Conclusion Although preventive and treatment options for LFS are limited, more than half of the family members from known LFS families choose to undergo presymptomatic testing. An unfavorable genetic test result, in general, does not cause adverse psychological effects. Nonetheless, it is important to note that a substantial proportion of individuals, irrespective of their carrier status, exhibit clinically relevant levels of distress which warrant psychological support.
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Affiliation(s)
- Chantal R.M. Lammens
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Neil K. Aaronson
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Anja Wagner
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Rolf H. Sijmons
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Margreet G.E.M. Ausems
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Annette H. J.T. Vriends
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Mariëlle W.G. Ruijs
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Theo A.M. van Os
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Liesbeth Spruijt
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Encarna B. Gómez García
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Irma Kluijt
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Tanja Nagtegaal
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Senno Verhoef
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
| | - Eveline M.A. Bleiker
- From the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, and Family Cancer Clinic; VU University Medical Centre; Amsterdam Medical Centre, Amsterdam; Erasmus Medical Centre, Rotterdam; University Medical Center Groningen, University of Groningen, Groningen; University Medical Centre Utrecht, Utrecht; Leiden University Medical Centre, Leiden; University Medical Centre Nijmegen, Nijmegen; and the Academic Hospital Maastricht, Maastricht, the
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Interest in genetic testing among affected men from hereditary prostate cancer families and their unaffected male relatives. Genet Med 2009; 11:344-55. [PMID: 19346959 DOI: 10.1097/gim.0b013e31819b2425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate potential sociodemographic, medical, psychosocial, and behavioral correlates of interest in genetic testing in men from hereditary prostate cancer families. METHODS Family members affected with prostate cancer (n = 559) and their unaffected male relatives (n = 370) completed a mailed survey. Multivariable logistic regression models were used to examine the association between potential correlates and interest in genetic testing for prostate cancer. RESULTS Forty-five percent of affected and 56% of unaffected men reported that they definitely would take a genetic test for prostate cancer. More affected men reported high levels of familiarity with genetic testing than unaffected men (46 vs. 25%). There were several variables that were significantly correlated with interest in either affected or unaffected men, but only age and familiarity with genetics were significant in both groups. After controlling for confounding variables, only familiarity remained a significant correlate in both groups. CONCLUSIONS The contrast between low levels of familiarity with genetics and high test interest among unaffected men highlights the need for increased educational efforts targeting hereditary prostate cancer families. Overall, results illuminated several novel characteristics of men from hereditary prostate cancer families that should be considered when developing future informed consent procedures or educational materials for prostate cancer genetic testing.
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Four novel germline mutations in the MLH1 and PMS2 mismatch repair genes in patients with hereditary nonpolyposis colorectal cancer. Int J Colorectal Dis 2009; 24:885-93. [PMID: 19479271 DOI: 10.1007/s00384-009-0731-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common cause of early onset hereditary colorectal cancer. In the majority of HNPCC families, microsatellite instability (MSI) and germline mutation in one of the DNA mismatch repair (MMR) genes are found. MATERIALS AND METHODS The entire coding sequence of MMR genes (MLH1, MLH2, MLH6, and PMS2) was analyzed using direct sequencing. Also, tumor tests were done as MSI and immunohistochemistry testing. RESULTS We were able to find three novel MLH1 and one novel PMS2 germline mutations in three Iranian HNPCC patients. The first was a transversion mutation c.346A>C (T116P) and happened in the highly conserved HATPase-c region of MLH1 protein. The second was a transversion mutation c.736A>T (I246L), which caused an amino acid change of isoleucine to leucine. The third mutation (c.2145,6 delTG) was frameshift and resulted in an immature stop codon in five codons downstream. All of these three mutations were detected in the MLH1 gene. The other mutation was a transition mutation, c.676G>A (G207E), which has been found in exon six of the PMS2 gene and caused an amino acid change of glycine to glutamic acid. MSI assay revealed high instability in microsatellite for two patients and microsatellite stable for one patient. CONCLUSION In all patients, an abnormal expression of the MMR proteins in HNPCC was related to the above novel mutations.
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Domanska K, Carlsson C, Bendahl PO, Nilbert M. Knowledge about hereditary nonpolyposis colorectal cancer; mutation carriers and physicians at equal levels. BMC MEDICAL GENETICS 2009; 10:30. [PMID: 19323816 PMCID: PMC2671498 DOI: 10.1186/1471-2350-10-30] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 03/26/2009] [Indexed: 11/13/2022]
Abstract
Background Identification and adequate management of individuals at risk for hereditary nonpolyposis colorectal cancer (HNPCC) is crucial since surveillance programmes reduce morbidity and mortality. We investigated knowledge about key features of HNPCC in at risk individuals and physicians in surgery, gynecology and oncology. Methods Data were collected using a questionnaire which was answered by 67 mutation carriers and 102 physicians from the southern Swedish health care region. The statements were related to colorectal cancer, heredity and surveillance and the physicians were also asked questions about cancer risks and surveillance strategies. Results Both groups answered questions on colorectal cancer risk, surveillance and genetic testing well, whereas answers about inheritance and risks for HNPCC associated cancer were less accurate. Only half of the family members and one third of the physicians correctly estimated the risk to inherit an HNPCC predisposing mutation. Among family members, young age (<57 years), female sex and recent genetic counseling significantly correlated with better results. Physicians generally underestimated the risk of HNPCC associated cancers and three out of four suggested a later starting age for surveillance than recommended. Conclusion The finding of similar levels of knowledge about key features of HNPCC in at risk individuals and physicians reflect the challenge physicians face in keeping up to date on hereditary cancer and may have implications for the clinical management and professional relations with HNPCC family members.
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Affiliation(s)
- Katarina Domanska
- Department of Oncology, Institute of Clinical Sciences, Lund University, Sweden.
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Sheng JQ, Zhang H, Ji M, Fu L, Mu H, Zhang MZ, Huang JS, Han M, Li AQ, Wei Z, Sun ZQ, Wu ZT, Xia CH, Li SR. Genetic diagnosis strategy of hereditary non-polyposis colorectal cancer. World J Gastroenterol 2009; 15:983-9. [PMID: 19248199 PMCID: PMC2653409 DOI: 10.3748/wjg.15.983] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the characteristics of mismatch repair gene mutation of Chinese hereditary non-polyposis colorectal cancer (HNPCC) and hMLH1 gene promoter methylation, and to improve the screening strategy and explore the pertinent test methods.
METHODS: A systematic analysis of 30 probands from HNPCC families in the north of China was performed by immunohistochemistry, microsatellite instability (MSI), gene mutation and methylation detection.
RESULTS: High frequency microsatellite instability occurred in 25 probands (83.3%) of HNPCC family. Loss of hMLH1 and hMSH2 protein expression accounted for 88% of all microsatellite instability. Pathogenic mutation occurred in 14 samples and 3 novel mutational sites were discovered. Deletion of exons 1-6, 1-7 and 8 of hMSH2 was detected in 3 samples and no large fragment deletion was found in hMLH1. Of the 30 probands, hMLH1 gene promoter methylation occurred in 3 probands. The rate of gene micromutation detection combined with large fragment deletion detection was 46.7%-56.7%. The rate of the two methods in combination with methylation detection was 63.3%.
CONCLUSION: Scientific and rational detection strategy can improve the detection rate of HNPCC. Based on traditional molecular genetics and combined with epigenetics, multiple detection methods can accurately diagnose HNPCC.
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Ramsoekh D, Van Leerdam ME, Wagner A, Kuipers EJ. Review article: Detection and management of hereditary non-polyposis colorectal cancer (Lynch syndrome). Aliment Pharmacol Ther 2007; 26 Suppl 2:101-11. [PMID: 18081654 DOI: 10.1111/j.1365-2036.2007.03492.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The most common hereditary colorectal cancer syndrome is hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome. Diagnosis of this syndrome is difficult, because of lack of specific diagnostic features. AIM To discuss the diagnostic criteria and laboratory work up for HNPCC. Furthermore, surveillance programs for HNPCC and treatment of HNPCC associated colorectal cancer are discussed. RESULTS Current diagnostic criteria, including the Amsterdam II and Bethesda criteria, are suboptimal for the detection of HNPCC. Molecular screening by microsatellite instability (MSI) and immunohistochemistry (IHC) is useful in the diagnosis of HNPCC. Both techniques have a higher sensitivity compared to the Amsterdam II and Bethesda criteria. A combination of both MSI and IHC provides the most optimal selection for mutation analysis. After identification of a mutation in an affected individual, genetic counselling and presymptomatic mutation analysis should be offered to relatives. Furthermore, colonoscopic surveillance should be performed in proven mutation carriers. CONCLUSIONS Identification of HNPCC is a clinical challenge involving many clinicians. Identification of persons at risk can be achieved by a combination of a detailed family history, testing with molecular and mutation analysis.
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Affiliation(s)
- D Ramsoekh
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Abstract
BACKGROUND The most common inherited colorectal cancer syndrome is the Lynch syndrome (HNPCC) which is characterized by the development of colorectal, endometrial, and other cancers and the presence of microsatellite instability (MSI) in tumours. The syndrome is due to a mutation in one of the mismatch repair (MMR) genes: MSH2, MLH1, MSH6 and PMS2. AIMS To evaluate the clinical features of the Lynch syndrome and to assess the tools that are available for the identification of families with this syndrome. METHODS A systematic literature search using PubMed and reference lists of retrieved articles was performed. RESULTS The review provides an update of the clinical phenotype of the Lynch syndrome. Until recently, the Amsterdam criteria were the most important tool for the identification of Lynch syndrome. Nowadays, the Bethesda guidelines are more widely used. These guidelines describe all clinical conditions in which a search for MSI indicated. Both MSI-analysis as well as immunohistochemical analysis of the MMR-proteins are appropriate to identify patients with a high probability of carrying a MMR-gene mutation. CONCLUSION All specialists that are involved in the treatment of cancer patients should know the Bethesda criteria in order to identify all families suspected of the Lynch syndrome.
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Affiliation(s)
- H F A Vasen
- Department of Gastroenterology & Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
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Ramsoekh D, van Leerdam ME, Tops CMJ, Dooijes D, Steyerberg EW, Kuipers EJ, Wagner A. The use of genetic testing in hereditary colorectal cancer syndromes: genetic testing in HNPCC, (A)FAP and MAP. Clin Genet 2007; 72:562-7. [DOI: 10.1111/j.1399-0004.2007.00912.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Walsh CS, Miller CW, Karlan BY, Koeffler HP. Association between a functional single nucleotide polymorphism in the MDM2 gene and sporadic endometrial cancer risk. Gynecol Oncol 2007; 104:660-4. [PMID: 17123590 DOI: 10.1016/j.ygyno.2006.10.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 09/23/2006] [Accepted: 10/03/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES MDM2 is an important negative regulator of the p53 tumor suppressor protein. A naturally occurring T/G single nucleotide polymorphism (SNP) in the MDM2 gene promoter, SNP309, causes an increase in MDM2 protein levels and impairment of p53 tumor suppressor activity. SNP309 occurs at a relatively high frequency in the general population and has been associated with accelerated tumorigenesis in hereditary Li-Fraumeni associated cancers as well as in sporadic soft tissue sarcomas. The objective of this study was to examine the association between SNP309 and sporadic endometrial cancer risk. METHODS Genomic DNA was isolated from 73 patients with endometrial cancer and 79 healthy, female controls. The MDM2 gene promoter region was amplified by PCR and the SNP309 genotype determined by restriction enzyme digestion of the amplified DNA fragment. Unconditional logistic regression analysis was used to determine the relationship between genotypes and endometrial cancer risk and histopathologic features. RESULTS The homozygous G/G genotype was found in 25% of endometrial cancer cases and 11% of controls. In an age-adjusted analysis of cases and controls, the G/G genotype increased the risk of endometrial cancer 2.76-fold (95% CI: 1.06, 7.20; p=0.03) compared to presence of a wild-type T allele (T/G and T/T genotypes). No association was found between the SNP309 G/G genotype and either endometrial cancer histology, grade, stage, or age at diagnosis. CONCLUSIONS The MDM2 SNP309 homozygous G/G genotype may be a genetic variant that influences sporadic endometrial cancer susceptibility.
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Affiliation(s)
- Christine S Walsh
- Department of Obstetrics and Gynecology, Cedars-Sinai Women's Cancer Research Institute, David Geffen School of Medicine at UCLA, 8700 Beverly Boulevard, Suite 290W, Los Angeles, CA 90048, USA.
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van Oostrom I, Meijers-Heijboer H, Duivenvoorden HJ, Bröcker-Vriends AHJT, van Asperen CJ, Sijmons RH, Seynaeve C, Van Gool AR, Klijn JGM, Tibben A. Comparison of individuals opting for BRCA1/2 or HNPCC genetic susceptibility testing with regard to coping, illness perceptions, illness experiences, family system characteristics and hereditary cancer distress. PATIENT EDUCATION AND COUNSELING 2007; 65:58-68. [PMID: 16872788 DOI: 10.1016/j.pec.2006.05.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Revised: 04/26/2006] [Accepted: 05/01/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To study differences between individuals opting for genetic cancer susceptibility testing of a known familial BRCA1/2 and HNPCC related germline mutation. METHODS Coping, illness perceptions, experiences with cancer in relatives and family system characteristics were assessed in 271 applicants for genetic testing before test result disclosure. Hereditary cancer distress, worry and cancer risk perception were assessed before, 1 week after, and 6 months after disclosure. RESULTS Individuals from BRCA1/2 and HNPCC mutation families did not differ with regard to the number of experiences with cancer in relatives, grief symptoms, the course of cancer distress, worry and risk perception through time and most illness perceptions, coping responses and family characteristics. Individuals from BRCA1/2 families perceived hereditary cancer as more serious. They reported more frequently a passive coping style, cancer worry and a less open communication with their partner and children. CONCLUSION Besides subtle differences, psychological mechanisms may be mainly identical in individuals opting for BRCA1/2 and HNPCC susceptibility testing. PRACTICE IMPLICATIONS Based on our findings, using a similar counseling approach for individuals opting for BRCA1/2 or HNPCC genetic susceptibility testing is justified. In this approach, attention should be directed more to individual aspects than to the type of disorder.
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Affiliation(s)
- Iris van Oostrom
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, The
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d'Agincourt-Canning L, Baird P. Genetic testing for hereditary cancers: the impact of gender on interest, uptake and ethical considerations. Crit Rev Oncol Hematol 2006; 58:114-23. [PMID: 16600617 DOI: 10.1016/j.critrevonc.2006.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Revised: 11/30/2005] [Accepted: 03/02/2006] [Indexed: 01/08/2023] Open
Abstract
Genetic testing promises earlier intervention and more successful outcomes for individuals at risk for hereditary breast/ovarian and colorectal cancer. Research shows that gender influences health and access to health care services. In this paper, we review theoretical issues of gender, and research outcomes, in relation to genetic testing for hereditary cancers. We argue that integrating a gender analysis into assessment of new technologies and health programs is necessary to improve appropriateness, accessibility and effectiveness. Attention to gender is also critical to developing a deeper understanding of the ethical issues (both benefits and harms) raised by new genetic technologies.
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Liu SR, Zhao B, Wang ZJ, Wan YL, Huang YT. Clinical features and mismatch repair gene mutation screening in Chinese patients with hereditary nonpolyposis colorectal carcinoma. World J Gastroenterol 2004; 10:2647-51. [PMID: 15309712 PMCID: PMC4572186 DOI: 10.3748/wjg.v10.i18.2647] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominantly-inherited cancer-susceptibility syndrome that confers an increased risk for colorectal cancer and a variety of other tumors at a young age. It has been associated with germline mutations in five mismatch repair (MMR) genes (hMSH2, hMLH1, hPMS1, hPMS2, and hMSH6/GTBP). The great majority of germline mutations were found in hMSH2 and hMLH1. The purpose of this study was to analyze the clinical features of Chinese HNPCC patients and to screen hMSH2 and hMLH1 gene mutations.
METHODS: Twenty-eight independent Chinese families were collected, of which 15 met Amsterdam criteria I and 13 met the Japanese clinical diagnosis criteria. The data were recorded including sex, site of colorectal cancer (CRC), age of diagnosis, history of synchronous and/or metachronous CRC, instance of extracolonic cancers, and histopathology of tumors. Peripheral blood samples were collected from all pedigrees after formal written consents were signed. PCR and denaturing high-performance liquid chromatography (DHPLC) were used to screen the coding regions of hMSH2 and hMLH1 genes. The samples showing abnormal DHPLC profiles were sequenced by a 377 DNA sequencer.
RESULTS: One hundred and seventy malignant neoplasms were found in one hundred and twenty-six patients (multiple cancer in twenty-three), including one hundred and twenty-seven CRCs, fifteen gastric, seven endometrial, and five esophageal cancers. Seventy-seven point eight percent of the patients had CRCs, sharing the features of early occurrence (average age of onset, 45.9 years) and of the right-sided predominance reported in the literature. In Chinese HNPCC patients, gastric cancer occurred more frequently, accounting for 11.9% of all cancers patients and ranking second in the spectrum of HNPCC predisposing cancers. Synchronous CRCs occurred less frequently, only accounting for 3.1% of the total CRCs. Twenty percent of the colorectal patients had metachronous CRCs within 10 years after operation. Eight hMSH2 or hMLH1 gene sequence variations were found in twelve families, including the first Mongolian kindred with a hMSH2 gene mutation.
CONCLUSION: HNPCC is characterized by an early-age onset, proximal predominance of CRC, multiple metachronous CRCs, and an excess of extra-colonic cancers. Frequent gastric cancer occurrence and less synchronous CRCs are the remarkable features in Chinese HNPCC patients. DHPLC is a powerful tool in hMSH2 and hMLH1 gene mutation screening. hMLH1 gene mutations, especially of the first nine exons, have been found more common than hMSH2 gene mutations in Chinese patients. Three of seven mutations have been found to be novel, and the germline G204X nonsense mutation in the third exon of hMSH2 has become the first MMR gene mutation found in Chinese Mongolian people.
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Affiliation(s)
- Shan-Run Liu
- Department of Surgery, Peking University First Hospital, Beijing 100034, China
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