Abstract P5-09-08: Germline variants in non-BRCA homologous recombination genes detected in HER2-negative breast cancer patients

Background: PARP inhibitors (PARPi) are FDA approved for a subset of metastatic human epidermal growth factor receptor 2-negative (H2N) breast cancer patients who harbor a germline pathogenic or likely pathogenic variant (PV) in BRCA1/2, two of the most well-described breast cancer susceptibility genes in the homologous recombination (HR) pathway. While the NCCN guidelines recommend consideration of BRCA1/2 testing for patients with H2N disease that are eligible for single-agent therapy, there are currently clinical trials available for women with advanced H2N breast cancer who have PVs in HR genes beyond BRCA1/2 to investigate outcomes of receiving PARPi. The yield of germline PVs in other HR genes in the H2N population is not well-described.

Methods: Clinical histories and test results were reviewed for women with a diagnosis of H2N breast cancer who underwent multi-gene hereditary cancer panel testing that included a minimum of 10 homologous recombination (HR) genes in addition to BRCA1/2 (ATM, BARD1, BRIP1, CHEK2, FANCC, NBN, PALB2, PTEN, RAD51C, RAD51D). Those with prior BRCA1/2 testing were excluded. We assessed the yield of PVs in non-BRCA1/2 HR genes in the H2N breast cancer population. In addition, we compared the yield of PVs in non-BRCA1/2 HR genes in a “low risk” population (probands with H2N breast cancer with no reported personal history of ovarian or pancreatic cancer and no reported family history of breast, ovarian, pancreatic, or prostate cancer) to a “high risk” population (probands with H2N breast cancer who also have a personal history of ovarian or pancreatic cancer and/or a reported family history of breast, ovarian, pancreatic, or prostate cancer) via a two-tailed Fisher's exact test.

Results: A total of 6179 women with H2N breast cancer were identified. Of these, BRCA1/2 PVs were identified in 4.8% (299/6179), while 5.7% (351/6179) carried PVs in HR genes other than BRCA1/2. These included CHEK2 (145), ATM (62), PALB2 (59), BRIP1 (26), FANCC (18), BARD1 (17), RAD51C (12), NBN (11), RAD51D (6), and PTEN (2). No statistically significant difference in the likelihood to harbor a PV in one of the 10 non-BRCA1/2 HR genes was observed between those with a “low risk” presentation (4.8% (53/1096) as compared to those with a “high risk” presentation (5.9% (298/5083)) (p=0.1956).

Conclusions: Our findings show that the yield of PVs in HR genes other than BRCA1/2 is appreciable in the H2N breast cancer population. As such, it may be beneficial to include all HR genes when testing H2N breast cancer patients, regardless of other personal or family history, if and/or when a patient develops metastatic disease.

Citation Format: Vogel Postula KJ, McGill AK, Sutcliffe E, Murphy PD, Klein RT, Hruska KS. Germline variants in non-BRCA homologous recombination genes detected in HER2-negative breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-08.

Abstract PD7-11: The role of multi-gene hereditary cancer panels in male patients with breast cancer

Background/Statement of Purpose: The role of cancer susceptibility genes in the male breast cancer population beyond BRCA1 and BRCA2 (BRCA) is not well defined. While breast cancer has been documented in men with pathogenic variants in a number of other breast cancer susceptibility genes (e.g. CHEK2, PALB2, PTEN), the yield of testing is not well documented nor are predictive clinical features of those likely to harbor causative variants. This study assesses the yield of pathogenic/likely pathogenic variants (collectively, PV) in male breast cancer patients who underwent multi-gene hereditary cancer panel testing. In addition, we aim to examine predictors of identifying a PV in this population.

Methods: Clinical histories and test results were reviewed for men with a diagnosis of breast cancer who underwent panel testing that included a minimum of eight well-described breast cancer susceptibility genes (ATM, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, TP53) and up to 24 additional genes. Using t-test and two-tailed Fisher's exact test, we assessed whether age at diagnosis, family history of breast cancer, or the presence of selected second primary cancers (second breast, prostate, pancreatic, colon, or melanoma cancers) were associated with a greater likelihood of identifying a PV.

Results: The clinical histories and test results of 381 men with breast cancer were reviewed, of whom 12.1% had at least one PV (46/381). When we limited our assessment to men who had not had prior negative BRCA testing, 13.3% had at least one PV (42/315). Variants were most commonly detected in BRCA2 (21) and CHEK2 (17), followed by PALB2 (4), BRCA1 (4), and ATM (2). A two sample t-test showed no significant difference (p=0.39) in the average age of diagnosis for those with a PV (62.5y, n=47) compared to those without a PV (60.9y, n=334). Two-tailed Fisher's exact test showed no association between having a PV and a history of a selected second primary (SP) cancer [10.8% (7/65) w/SP vs 12.3% (39/316) w/out SP; p=0.84]. Lastly, two-tailed Fisher's exact test showed those with a family history of breast cancer (fhx br) were more likely to have a PV [15.1% (32/212) fhx br vs. 8.3% (14/169) no fhx br], although this did not reach statistical significance (p=0.06).

Conclusions: While BRCA2 remains the most common gene in which PVs are identified in men with breast cancer, a significant proportion of patients will have a PV in another well-described breast cancer susceptibility gene, particularly CHEK2, PALB2, and ATM. Therefore, it is reasonable to utilize a panel that is inclusive of these genes when testing male breast cancer patients. As the likelihood to harbor a PV was not significantly associated with age of onset, family history of breast cancer, or presence of a second primary, all men with breast cancer could consider genetic testing. Further study is warranted as the current sample size may limit the power to detect associations.

Citation Format: Vogel Postula KJ, Andolina LM, Theobald K, McGill AK, Sutcliffe E, Arvai KJ, Murphy PD, Klein RT, Hruska KS. The role of multi-gene hereditary cancer panels in male patients with breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-11.

Heritability of udder morphology and colostrum quality traits in swine

The heritability of udder quality traits, defined as morphology and colostrum IgG concentration at farrowing, was estimated together with the genetic and phenotypic correlations of these traits with other production and reproduction criteria. Udder morphology traits were recorded in 988 Meidam sows and colostrum samples were collected from 528 sows. Teat length, teat diameter (DIA), interteat distance within the same row (SAMER), and teat distance from the abdominal midline (AML) were recorded to the nearest millimeter. For each sow, a record was also made of udder development score (DEV), the proportion of teats oriented perpendicular to the udder, and the proportion of nonfunctional teats. Colostrum IgG concentration was estimated with a Brix refractometer. Heritability of udder morphology traits varied from high ( = 0.46 for teat length and = 0.56 for DIA) to moderate ( = 0.37 for SAMER, = 0.22 for AML, = 0.25 for DEV, = 0.3 for the proportion of nonfunctional teats, = 0.1 for the proportion of teats oriented perpendicular to the udder, and = 0.35 for colostrum IgG concentration). The SAMER was negatively genetically correlated with the number of stillborns (genetic correlation [] = -0.48) and positively genetically correlated with the number of piglets born alive ( = 0.69), with the opposite for the trait AML ( = -0.40 for number of piglets born alive and = 0.40 for stillborns). The highest genetic correlation with productive traits was estimated between AML and ADG during rearing ( = 0.42), although this had a negative phenotypic correlation (; -0.11). Teat length was also moderately correlated with ADG ( = 0.27). Backfat thickness at 100 kg was positively correlated with DIA and the total number of teats present in both rows ( = 0.28 and = 0.36, respectively) and negatively correlated only with DEV ( = -0.22). The same results were found for the phenotypic correlation between backfat thickness at end of test and the total number of teats present in both rows ( = 0.03). Udder quality traits can be included in the breeding goal and appropriately weighted with other important traits in the breeding objectives to enhance maternal performance.

Identification of risk factors associated with poor lifetime growth performance in pigs

During the production period from birth to slaughter there are some pigs that grow markedly slower, despite conditions that seem to support the growth of their contemporaries. This reduction in growth inevitably leads to weight variation within a group, causes difficulties with management, and results in system inefficiencies. By understanding the factors that contribute to poor growth, the performance of these slow growing pigs might be improved, thereby decreasing the overall variability at slaughter. The aim of this paper was to analyze the factors associated with poor growth performance in pigs from birth to slaughter, determine the effect of piglet birth weight (BiW) and weaning weight (WW) on lifetime growth, and investigate the capacity of small piglets to compensate for any BW deficit. Two industry databases, with individual data for approximately 40,000 and 90,000 pigs, respectively, and containing BW profiles and relevant variables, were analyzed. Body weight at birth, weaning, intermediate, and finishing stages were available as well as sex, month of birth, litter size information (number born alive and total born including still born), sow parity number, and length of gestation. Absolute and relative growth rates, based on adjusted BW for age, were calculated for each time interval and 3 types of analysis were performed: a logistic regression, a continuous linear plateau model, and a weight category analysis. For both datasets poor absolute and relative growth from birth to final BW was associated with low BiW (P < 0.001), low WW (P < 0.001), sex (P < 0.001), breed code (P < 0.001), and month of birth (P < 0.001). The linear plateau model suggested that the relationship between BiW and lifetime growth was not linear beyond 1.91 (database 1) or 1.84 (database 2) kg; the same applied to the relationship between WW at 21 d and final BW (FW) growth, which was not linear beyond 7.53 kg. Finally, the weight category analysis revealed that piglets with the lightest BiW were able to exhibit compensatory growth from BiW to FW with 74 (database 1) and 82% (database 2) moving at least 1 BW category. It is concluded that growth performance to slaughter is not solely reliant on pig BiW, with WW also playing a critical role. Additionally, piglets with BiW below the average are capable of some degree of compensatory growth; this provides the opportunity for managing them so as to improve their lifetime growth.

The cholecystokinin type A receptor g.179A>G polymorphism affects feeding rate

A polymorphism within the 5' untranslated region of the cholecystokinin type A receptor (CCKAR) gene has been shown to affect feed intake and growth in commercial pig lines. To further investigate the phenotype of animals carrying alternative alleles at this polymorphism, we genotyped animals from a distinct segregating commercial line and an experimental cross F(2) population, both with electronically recorded feeding pattern data. The data indicate that the daily feed intake increasing effect of the DQ496228:g.179G allele is mediated through a faster rate of feed intake, without evidence for an effect on other feeding behaviour traits.

Increasing breastfeeding rates to reduce infant illness at the community level

OBJECTIVE

Although breastfeeding is associated with lower rates of a variety of infant illnesses, skeptics have suggested that much of the association is attributable to confounding, even after appropriate statistical adjustment. This article utilizes a novel design to investigate changes in infant illness at the community level after a successful breastfeeding promotion program.

METHODS

In this population-based cohort study, the medical records of all infants born in one Navajo community the year before a breastfeeding promotion program (n = 977) and the year during the intervention (n = 858) were reviewed. Outcomes assessed include changes after the intervention in: proportion breastfeeding and/or breastfeeding exclusively; incidence of common infant illnesses in the first year of life; and feeding-group specific incidence of illness.

RESULTS

The proportion of women breastfeeding exclusively for any period of time increased from 16.4% to 54.6% after the intervention. The percent of children having pneumonia and gastroenteritis declined 32. 2% and 14.6%, respectively, after the intervention. Feeding-group specific rates of these illnesses were unchanged, indicating that the decline observed was attributable to the increased proportion of infants breastfeeding. In contrast, rates of croup and bronchiolitis increased after the intervention among those fed formula from birth, suggesting a viral epidemic which was limited to those never exclusively breastfed. Finally, sepsis declined in both formula-fed and breastfed infants after the intervention, suggesting that other factors affected this illness outcome after the intervention.

CONCLUSIONS

Increasing the proportion of exclusively breastfed infants seems to be an effective means of reducing infant illness at the community level. The experimental design suggests that the increased incidence of illness among minimally breastfed infants is causally related to lack of breast milk, rather than being attributable to confounding.

Using cultural knowledge in health promotion: breastfeeding among the Navajo

Although many attempts have been made to promote breastfeeding in a variety of contexts, few programs have explicitly incorporated cultural beliefs in these efforts. This article describes a breastfeeding promotion program conducted on the Navajo reservation. This program was designed to be culturally appropriate. Background information regarding beliefs and factors affecting infant feeding practices in this setting is provided, followed by a description of the intervention. The intervention, which incorporated both social marketing and community participation techniques, consisted of three components: an intervention in the health care system, a community intervention, and an individual intervention. Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful. This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change.

Campylobacter bacteraemia in England and Wales, 1981-91

Routine surveillance of infection in England and Wales detected 394 cases of campylobacter bacteraemia in 11 years. This represented an average incidence of 1.5 per 1000 intestinal campylobacter infections, with a range of 0.3/1000 in children aged 1-4 years to 5.9/1000 in patients aged 65 years or more. Definitive identification of 257 isolates showed that 89% were Campylobacter jejuni or C. coli; other species were C. fetus (8.6%), C. lari (0.8%), C. upsaliensis (0.8%), Helicobacter (Campylobacter) fennelliae (0.8%), and Helicobacter (Campylobacter) cinaedi (0.4%). Most (71%) of the C. jejuni/C. coli bacteraemias were in patients with acute enteritis. Of the patients with C. fetus bacteraemia only 27% had diarrhoea; they were older than patients with C. jejuni or C. coli bacteraemia (54.1 v. 45.9 years) and proportionally more of them were male (M:F ratio 2.7:1 v. 1.9:1); 41% had endovascular pathology or cellulitis. There was a higher proportion of C. jejuni serogroup O 4 (Penner) and O 18 strains among blood than faecal isolates, which suggests that they were unusually serum resistant and/or invasive.

Diagnosing functional visual deficits with the P300 component of the visual evoked potential

The visual evoked potential (VEP) is routinely used to assess visual function, though it occasionally does not reflect a patient's conscious experience. Reports of normal flash or pattern VEPs obtained from blind persons are extreme examples of this problem. The difficulty in interpreting VEPs in light of such findings can be partly overcome by obtaining a cognitive component of the evoked potential, P300. We obtained traditional visual acuity measurements, pattern-reversal VEPs, and VEPs containing P300s from three patients with clinically diagnosed functional visual deficits. The P300s were obtained in response to stimuli that the patients claimed they could not see, supporting the clinical conclusions that malingering or hysteria was involved. The P300 component can be helpful in assessing the subjective visual experience of patients suspected of having functional visual loss.

Acute Idiopathic Corneal Endotheliitis

Seven patients presenting with acute corneal stromal edema without prior surgery, trauma, ocular disease or known exposure to noxious agents are reported. One patient had a severe iridocyclitis; two others subsequently developed herpetic keratouveitis. Four cases, however, were unassociated with other known ocular disease. All four of these patients exhibited keratic precipitates and displayed minimal or no flare and cells in the anterior chamber, although the latter was largely obscured by the corneal edema. In each of these four instances, the inflammation and corneal edema resolved following topical corticosteroid therapy. In two of the four cases, both children, antibody to Herpes simplex virus could not be identified. We suggest that, in patients without known prior corneal disease or trauma, acute diffuse corneal stroma edema may stem from severe iridocyclitis or a primary endotheliitis due either to herpetic infection, the recently described presumed autoimmune corneal endotheliopathy, or a condition which we herein designate acute idiopathic corneal endotheliitis.