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Hocking LJ, Andrews C, Armstrong C, Ansari M, Baty D, Berg J, Bradley T, Clark C, Diamond A, Doherty J, Lampe A, McGowan R, Moore DJ, O'Sullivan D, Purvis A, Santoyo-Lopez J, Westwood P, Abbott M, Williams N, Aitman TJ, Miedzybrodzka Z, Humphrey WI, Martin S, Meynert A, Murphy F, Nourse C, Semple CA, Williams N, Dean J, Foley P, Robertson L, Ross A, Williamson K, Berg J, Goudie D, McWilliam C, Fitzpatrick D, Fletcher E, Jackson A, Lam W, Porteous M, Barr K, Bradshaw N, Davidson R, Gardiner C, Gorrie J, Hague R, Hamilton M, Joss S, Kinning E, Longman C, Martin N, McGowan R, Paterson J, Pilz D, Snadden L, Tobias E, Wedderburn S, Whiteford M, Aitman TJ, Miedzybrodzka Z. Genome sequencing with gene panel-based analysis for rare inherited conditions in a publicly funded healthcare system: implications for future testing. Eur J Hum Genet 2023; 31:231-238. [PMID: 36474026 PMCID: PMC9905562 DOI: 10.1038/s41431-022-01226-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022] Open
Abstract
NHS genetics centres in Scotland sought to investigate the Genomics England 100,000 Genomes Project diagnostic utility to evaluate genome sequencing for in rare, inherited conditions. Four regional services recruited 999 individuals from 394 families in 200 rare phenotype categories, with negative historic genetic testing. Genome sequencing was performed at Edinburgh Genomics, and phenotype and sequence data were transferred to Genomics England for variant calling, gene-based filtering and variant prioritisation. NHS Scotland genetics laboratories performed interpretation, validation and reporting. New diagnoses were made in 23% cases - 19% in genes implicated in disease at the time of variant prioritisation, and 4% from later review of additional genes. Diagnostic yield varied considerably between phenotype categories and was minimal in cases with prior exome testing. Genome sequencing with gene panel filtering and reporting achieved improved diagnostic yield over previous historic testing but not over now routine trio-exome sequence tests. Re-interpretation of genomic data with updated gene panels modestly improved diagnostic yield at minimal cost. However, to justify the additional costs of genome vs exome sequencing, efficient methods for analysis of structural variation will be required and / or cost of genome analysis and storage will need to decrease.
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Affiliation(s)
- Lynne J Hocking
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Claire Andrews
- East of Scotland Regional Genetics Service, NHS Tayside, Ninewells Hospital, Dundee, Scotland, UK
| | - Christine Armstrong
- North of Scotland Medical Genetic Service, NHS Grampian, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK
| | - Morad Ansari
- South East Scotland Genetic Service, NHS Lothian, Western General Hospital, Edinburgh, Scotland, UK
| | - David Baty
- East of Scotland Regional Genetics Service, NHS Tayside, Ninewells Hospital, Dundee, Scotland, UK
| | - Jonathan Berg
- East of Scotland Regional Genetics Service, NHS Tayside, Ninewells Hospital, Dundee, Scotland, UK.,School of Medicine, University of Dundee, Dundee, Scotland, UK
| | - Therese Bradley
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Caroline Clark
- North of Scotland Medical Genetic Service, NHS Grampian, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK
| | - Austin Diamond
- South East Scotland Genetic Service, NHS Lothian, Western General Hospital, Edinburgh, Scotland, UK
| | - Jill Doherty
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Anne Lampe
- South East Scotland Genetic Service, NHS Lothian, Western General Hospital, Edinburgh, Scotland, UK
| | - Ruth McGowan
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Queen Elizabeth University Hospital, Glasgow, Scotland, UK.,School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland, UK
| | - David J Moore
- South East Scotland Genetic Service, NHS Lothian, Western General Hospital, Edinburgh, Scotland, UK
| | - Dawn O'Sullivan
- North of Scotland Medical Genetic Service, NHS Grampian, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK
| | - Andrew Purvis
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | | | - Paul Westwood
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Michael Abbott
- Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - Nicola Williams
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | | | - Timothy J Aitman
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK.
| | - Zosia Miedzybrodzka
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK. .,North of Scotland Medical Genetic Service, NHS Grampian, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK. .,North of Scotland Regional Genetic Service, NHS Grampian, Ashgrove House, Foresterhill, Aberdeen, Scotland, UK.
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2
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Edmondson RJ, O'Connell RL, Banerjee S, Mileshkin L, Sykes P, Beale P, Fisher A, Bonaventura A, Millan D, Nottley S, Benson C, Hamilton A, Sjoquist K, Alexander L, Kelly C, Carty K, Divers L, Bradshaw N, Friedlander M. Phase 2 study of anastrozole in rare cohorts of patients with estrogen receptor/progesterone receptor positive leiomyosarcomas and carcinosarcomas of the uterine corpus: The PARAGON trial (ANZGOG 0903). Gynecol Oncol 2021; 163:524-530. [PMID: 34625284 DOI: 10.1016/j.ygyno.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aromatase inhibitors have been used empirically to treat a subset of patients with hormone receptor positive uterine leiomyosarcomas(LMS) and carcinosarcomas (UCS) mainly supported by retrospective data. We evaluated the activity of anastrozole in two rare cohorts; patients with recurrent/metastatic LMS and UCS enrolled in PARAGON, a basket trial of anastrozole in estrogen receptor (ER+)/progesterone receptor positive (PR+) gynecological cancers. METHOD An investigator-initiated, single-arm, prospective open-label trial of anastrozole 1 mg/day in patients with ER &/or PR + ve LMS or UCS with measurable disease, treated until progression or unacceptable toxicity. Primary endpoint was clinical benefit (complete/partial response + stable disease) rate (CBR) at 3 months. Secondary endpoints include progression-free survival (PFS), quality of life and toxicity. RESULTS 39 eligible patients were enrolled, 32 with LMS and 7 with UCS. For the LMS cohort CBR at 3 months was 35% (95% CI: 21-53%) with a median duration of clinical benefit of 5.8 months. Best response was a partial response in one patient. Two patients remained on treatment for more than one year. The median progression-free survival was 2.8 months (95% CI: 2.6-4.9). For the UCS cohort CBR at 3 months was 43% (95% CI: 16-75%) with a median duration of clinical benefit of 5.6 months. Stable disease was seen in 3 patients but no objective responses were seen. The median progression-free survival was 2.7 months (95% CI, 1.1-8.2). Safety was acceptable with 5/39 evaluable patients showing grade 3 toxicities. CONCLUSION Whilst objective response rates with anastrozole are low, the clinical benefit rate and good tolerance suggests that aromatase inhibitor therapy may have a role in a subset of patients with metastatic LMS and UCS.
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Affiliation(s)
- R J Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Level 5, Research, Oxford Road, Manchester, UK.
| | - R L O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust, London, UK
| | - L Mileshkin
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - P Sykes
- Dept of Obstetrics and Gynaecology, University of Otago, New Zealand
| | - P Beale
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - A Fisher
- Queen Elizabeth Hospital, Gateshead, UK
| | - A Bonaventura
- School of Medicine & Public Health, University of Newcastle, Australia
| | - D Millan
- Queen Elizabeth University Hospital, Glasgow, UK
| | - S Nottley
- Royal Hospital for Women/Prince of Wales Hospital and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - C Benson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A Hamilton
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - K Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - L Alexander
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - C Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - K Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Divers
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - N Bradshaw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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3
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Banerjee SN, Tang M, O'Connell RL, Sjoquist K, Clamp AR, Millan D, Nottley S, Lord R, Mullassery VM, Hall M, Gourley C, Bonaventura T, Goh JC, Sykes P, Grant PT, McNally O, Alexander L, Kelly C, Carty K, Divers L, Bradshaw N, Edmondson RJ, Friedlander M. A phase 2 study of anastrozole in patients with oestrogen receptor and/progesterone receptor positive recurrent/metastatic granulosa cell tumours/sex-cord stromal tumours of the ovary: The PARAGON/ANZGOG 0903 trial. Gynecol Oncol 2021; 163:72-78. [PMID: 34412908 DOI: 10.1016/j.ygyno.2021.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hormonal therapies are commonly prescribed to patients with metastatic granulosa cell tumours (GCT), based on high response rates in small retrospective studies. Aromatase inhibitors (AIs) are reported to have high response rates and an accepted treatment option. We report the results of a phase 2 trial of an AI in recurrent/metastatic GCTs. METHODS 41 patients with recurrent ER/PR + ve GCT received anastrozole 1 mg daily until progression or unacceptable toxicity. The primary endpoint was clinical benefit rate (CBR) at 12 weeks, evaluated by RECIST1.1 criteria. Secondary endpoints included progression-free survival (PFS), CBR duration, quality of life and toxicity. RESULTS The CBR at 12 weeks in 38 evaluable patients was 78.9%, which included one (2.6%; 95% CI: 0.5-13.5%) partial response and 76.3% stable disease. Two additional patients without measurable disease were stable, based on inhibin. Median PFS was 8.6 m (95% CI 5.5-13.5 m). There were delayed responses observed after 12 weeks with a total of 4 pts. (10.5%; 95% CI 4.2%-24.1%) with a RECIST partial response; 23 (59%) patients were progression-free at 6 months. The adverse effects were predominantly low grade. CONCLUSIONS This is the first prospective trial of hormonal therapy in GCTs. Although there was a high CBR, the objective response rate to anastrozole was much lower than the pooled response rates of >70% to AIs reported in most retrospective series and case reports. PARAGON demonstrates the importance of prospective trials in rare cancers and the need to reconsider the role of AIs as single agents in GCTs.
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Affiliation(s)
- Susana N Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom.
| | - Monica Tang
- NHMRC Clinical Trials Centre, University of Sydney, NSW 2050, Australia
| | | | - Katrin Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, NSW 2050, Australia
| | - Andrew R Clamp
- The Christie NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - David Millan
- Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Steven Nottley
- Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Rosemary Lord
- The National Cancer Research Institute and the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | - Marcia Hall
- Mount Vernon Cancer Centre, Middlesex, United Kingdom
| | - Charlie Gourley
- Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Jeffrey C Goh
- Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Peter Sykes
- Christchurch Women's Hospital, Christchurch, New Zealand
| | - Peter T Grant
- Mercy Hospital for Women, Melbourne, VIC 3084, Australia
| | - Orla McNally
- Royal Women's Hospital, Melbourne, VIC 3052, Australia
| | - Laura Alexander
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Caroline Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Karen Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Laura Divers
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - N Bradshaw
- NHMRC Clinical Trials Centre, University of Sydney, NSW 2050, Australia
| | - Richard J Edmondson
- Manchester Academic Health Science Centre, St Mary's Hospital, Manchester, United Kingdom
| | - Michael Friedlander
- Prince of Wales Clinical School UNSW and Royal Hospital for Women, Sydney, NSW 2031, Australia
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4
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Friedlander M, Benson C, O'Connell RL, Reed N, Clamp A, Lord R, Millan D, Nottley S, Amant F, Steer C, Anand A, Mileshkin L, Beale P, Banerjee S, Bradshaw N, Kelly C, Carty K, Divers L, Alexander L, Edmondson R. Phase 2 study of anastrozole in patients with estrogen receptor/progesterone receptor positive recurrent low-grade endometrial stromal sarcomas: The PARAGON trial (ANZGOG 0903). Gynecol Oncol 2021; 161:160-165. [PMID: 33608144 DOI: 10.1016/j.ygyno.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/08/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Aromatase inhibitors are standard of care for low-grade endometrial stromal sarcomas (LGESS), based on very high response rates reported in retrospective studies. We evaluated the activity of anastrozole in recurrent/metastatic LGESS patients enrolled in PARAGON, a basket trial of anastrozole in estrogen receptor (ER±)/progesterone receptor (PR+) gynecological cancers. METHOD An investigator-initiated, single-arm, prospective open-label trial of anastrozole 1 mg/day in patients with ER ± PR + ve LGESS with measurable disease, treated until progressive disease or unacceptable toxicity. Primary endpoint was clinical benefit (complete/partial response + stable disease) rate (CBR) at 3 months. Secondary endpoints include progression-free survival (PFS), quality of life and toxicity. RESULTS 15 eligible patients were enrolled. CBR at 3 months was 73% (95% CI: 48-89.1%); unchanged at 6 months. Best response was 26.7%, including complete response in one (6.7%; 95% CI 1.2-29.8%), partial response in three (20%, 95% CI 7.1-45.2%) and stable disease in seven (46.7%). Four patients ceased treatment by 3 months due to progression. Median PFS was not reached (25th percentile: 2.9 months (95% CI: 1.2-NR)). PFS was 73.3%, 73.3% and 66% at 6, 12, and 18 months, respectively. Six patients remained on treatment for an average of 44.2 months (range 34.5-63.6) up until data cut. Toxicity was as expected, with 3 patients stopping due to adverse effects. CONCLUSION The 26.7% objective response rate with anastrozole is lower than reported in retrospective series, but the CBR was high and durable. The results underscore the importance of prospective trials in rare cancers.
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Affiliation(s)
- M Friedlander
- Royal Hospital for Women/Prince of Wales Hospital and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - C Benson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R L O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - N Reed
- Beatson Oncology Centre, Gartnavel General Hospital, Glasgow, UK
| | - A Clamp
- The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - R Lord
- The Clatterbridge Cancer Centre, Liverpool and Wirral, UK
| | - D Millan
- Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - S Nottley
- Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - F Amant
- Division of Gynecologic Oncology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - C Steer
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, Albury, NSW, Australia
| | - A Anand
- Nottingham City Hospital, Nottingham, UK
| | - L Mileshkin
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - P Beale
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust, London, UK
| | - N Bradshaw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - C Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - K Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Divers
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Alexander
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - R Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary''s Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary''s Hospital, Central Manchester NHS Foundation Trust; Manchester Academic Health Science Centre, Level 5, Research, Oxford Road, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary''s Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary''s Hospital, Central Manchester NHS Foundation Trust; Manchester Academic Health Science Centre, Level 5, Research, Oxford Road, Manchester, UK
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5
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Monahan KJ, Bradshaw N, Dolwani S, Desouza B, Dunlop MG, East JE, Ilyas M, Kaur A, Lalloo F, Latchford A, Rutter MD, Tomlinson I, Thomas HJW, Hill J. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020; 69:411-444. [PMID: 31780574 PMCID: PMC7034349 DOI: 10.1136/gutjnl-2019-319915] [Citation(s) in RCA: 221] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/25/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an individual's lifetime risk of gastrointestinal cancer may incorporate clinical and molecular data, and depends on accurate phenotypic assessment and genetic diagnosis. In turn this may facilitate targeted risk-reducing interventions, including endoscopic surveillance, preventative surgery and chemoprophylaxis, which provide opportunities for cancer prevention. This guideline is an update from the 2010 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland (BSG/ACPGBI) guidelines for colorectal screening and surveillance in moderate and high-risk groups; however, this guideline is concerned specifically with people who have increased lifetime risk of CRC due to hereditary factors, including those with Lynch syndrome, polyposis or a family history of CRC. On this occasion we invited the UK Cancer Genetics Group (UKCGG), a subgroup within the British Society of Genetic Medicine (BSGM), as a partner to BSG and ACPGBI in the multidisciplinary guideline development process. We also invited external review through the Delphi process by members of the public as well as the steering committees of the European Hereditary Tumour Group (EHTG) and the European Society of Gastrointestinal Endoscopy (ESGE). A systematic review of 10 189 publications was undertaken to develop 67 evidence and expert opinion-based recommendations for the management of hereditary CRC risk. Ten research recommendations are also prioritised to inform clinical management of people at hereditary CRC risk.
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Affiliation(s)
- Kevin J Monahan
- Family Cancer Clinic, St Mark's Hospital, London, UK
- Faculty of Medicine, Imperial College, London, UK
| | - Nicola Bradshaw
- Clinical Genetics, West of Scotland Genetics Services, Glasgow, Glasgow, UK
| | - Sunil Dolwani
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Bianca Desouza
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Mohammad Ilyas
- Faculty of Medicine & Health Sciences, Nottingham University, Nottingham, UK
| | - Asha Kaur
- Head of Policy and Campaigns, Bowel Cancer UK, London, UK
| | - Fiona Lalloo
- Genetic Medicine, Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | | | - Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Tomlinson
- Nuffield Department of Clinical Medicine, Wellcome Trust Centre for Human Genetics, Birmingham, UK
- Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Huw J W Thomas
- Family Cancer Clinic, St Mark's Hospital, London, UK
- Faculty of Medicine, Imperial College, London, UK
| | - James Hill
- Genetic Medicine, Central Manchester University Hospitals Foundation Trust, Manchester, UK
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6
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Andrews KA, Ascher DB, Pires DEV, Barnes DR, Vialard L, Casey RT, Bradshaw N, Adlard J, Aylwin S, Brennan P, Brewer C, Cole T, Cook JA, Davidson R, Donaldson A, Fryer A, Greenhalgh L, Hodgson SV, Irving R, Lalloo F, McConachie M, McConnell VPM, Morrison PJ, Murday V, Park SM, Simpson HL, Snape K, Stewart S, Tomkins SE, Wallis Y, Izatt L, Goudie D, Lindsay RS, Perry CG, Woodward ER, Antoniou AC, Maher ER. Tumour risks and genotype-phenotype correlations associated with germline variants in succinate dehydrogenase subunit genes SDHB, SDHC and SDHD. J Med Genet 2018; 55:384-394. [PMID: 29386252 PMCID: PMC5992372 DOI: 10.1136/jmedgenet-2017-105127] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Germline pathogenic variants in SDHB/SDHC/SDHD are the most frequent causes of inherited phaeochromocytomas/paragangliomas. Insufficient information regarding penetrance and phenotypic variability hinders optimum management of mutation carriers. We estimate penetrance for symptomatic tumours and elucidate genotype-phenotype correlations in a large cohort of SDHB/SDHC/SDHD mutation carriers. METHODS A retrospective survey of 1832 individuals referred for genetic testing due to a personal or family history of phaeochromocytoma/paraganglioma. 876 patients (401 previously reported) had a germline mutation in SDHB/SDHC/SDHD (n=673/43/160). Tumour risks were correlated with in silico structural prediction analyses. RESULTS Tumour risks analysis provided novel penetrance estimates and genotype-phenotype correlations. In addition to tumour type susceptibility differences for individual genes, we confirmed that the SDHD:p.Pro81Leu mutation has a distinct phenotype and identified increased age-related tumour risks with highly destabilising SDHB missense mutations. By Kaplan-Meier analysis, the penetrance (cumulative risk of clinically apparent tumours) in SDHB and (paternally inherited) SDHD mutation-positive non-probands (n=371/67 with detailed clinical information) by age 60 years was 21.8% (95% CI 15.2% to 27.9%) and 43.2% (95% CI 25.4% to 56.7%), respectively. Risk of malignant disease at age 60 years in non-proband SDHB mutation carriers was 4.2%(95% CI 1.1% to 7.2%). With retrospective cohort analysis to adjust for ascertainment, cumulative tumour risks for SDHB mutation carriers at ages 60 years and 80 years were 23.9% (95% CI 20.9% to 27.4%) and 30.6% (95% CI 26.8% to 34.7%). CONCLUSIONS Overall risks of clinically apparent tumours for SDHB mutation carriers are substantially lower than initially estimated and will improve counselling of affected families. Specific genotype-tumour risk associations provides a basis for novel investigative strategies into succinate dehydrogenase-related mechanisms of tumourigenesis and the development of personalised management for SDHB/SDHC/SDHD mutation carriers.
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Affiliation(s)
- Katrina A Andrews
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Cancer Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David B Ascher
- Department of Biochemistry, University of Cambridge, Cambridge, UK
- Department of Biochemistry and Molecular Biology, Bio21 Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Eduardo Valente Pires
- Department of Biochemistry, University of Cambridge, Cambridge, UK
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Daniel R Barnes
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lindsey Vialard
- West Midlands Regional Genetics service, Birmingham Women's Hospital, Birmingham, UK
| | - Ruth T Casey
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Cancer Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nicola Bradshaw
- Department of Clinical Genetics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Julian Adlard
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK
| | - Simon Aylwin
- Department of Endocrinology, King's College Hospital, London, UK
| | - Paul Brennan
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Carole Brewer
- Peninsula Clinical Genetics Service, Royal Devon & Exeter Hospital, Exeter, UK
| | - Trevor Cole
- West Midlands Regional Genetics service, Birmingham Women's Hospital, Birmingham, UK
| | - Jackie A Cook
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Rosemarie Davidson
- Department of Clinical Genetics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alan Donaldson
- Department of Clinical Genetics, St Michael's Hospital, Bristol, UK
| | - Alan Fryer
- Department of Clinical Genetics, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Lynn Greenhalgh
- Department of Clinical Genetics, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Shirley V Hodgson
- Department of Medical Genetics, St. George's University of London, London, UK
| | - Richard Irving
- Queen Elizabeth Medical Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Michelle McConachie
- East of Scotland Regional Genetics Service, Ninewells Hospital and Medical School, Dundee, UK
| | - Vivienne P M McConnell
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - Patrick J Morrison
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - Victoria Murday
- Department of Clinical Genetics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Soo-Mi Park
- Department of Clinical Genetics, Addenbrooke's Treatment Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen L Simpson
- The Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Katie Snape
- Department of Medical Genetics, St. George's University of London, London, UK
| | - Susan Stewart
- West Midlands Regional Genetics service, Birmingham Women's Hospital, Birmingham, UK
| | - Susan E Tomkins
- Department of Clinical Genetics, St Michael's Hospital, Bristol, UK
| | - Yvonne Wallis
- West Midlands Regional Genetics service, Birmingham Women's Hospital, Birmingham, UK
| | - Louise Izatt
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - David Goudie
- East of Scotland Regional Genetics Service, Ninewells Hospital and Medical School, Dundee, UK
| | - Robert S Lindsay
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Colin G Perry
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Emma R Woodward
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Cancer Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- The Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Rigby J, Bradshaw N, Carr B, Matsa R. Epidemiology of unplanned intensive care admissions through inhospital referrals at a tertiary referral centre university hospital. Crit Care 2014. [PMCID: PMC4068757 DOI: 10.1186/cc13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Davidson DF, Bradshaw N, Perry CG, Lindsay R, Freel EM. Urinary free (unconjugated) metadrenalines in different hereditary forms of catecholamine-secreting phaeochromocytoma/paraganglioma. Ann Clin Biochem 2012; 49:486-90. [DOI: 10.1258/acb.2012.012021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Catecholamine-producing neuroendocrine tumours are found in chromaffin cells of the adrenal medulla (phaeochromocytoma) or extra-adrenal paraganglia (paraganglioma), known collectively as PPGLs. In approximately a quarter or more of cases of PPGL, these rare tumours arise as a result of germline mutations of several tumour susceptibility genes. At the Crosshouse laboratory, urine tests include free metadrenalines (fMAs) (also known as free metanephrines) which demonstrate superior sensitivity over that obtained by urinary vanillyl mandelic acid, catecholamines or plasma catecholamines in the diagnosis of PPGL. This retrospective audit was to determine if urinary fMAs offered discrimination among the hereditary forms of PPGL. Methods Retrospective biochemical and genetic data were gathered from 1997 to 2011. The identified urine specimens were those obtained at the time of first diagnosis or recurrence of PPGL. Results of catecholamines and metabolites were standardized as multiples of their respective relevant upper reference limits (URLs). Results Results were available for 29 affected patients (15 females and 14 males), median age 26 (range 9–63) years, comprising three mutation groups: succinate dehydrogenase subunit B or D ([SDHB/D] 16 patients), multiple endocrine neoplasia type 2 ([MEN 2] 6 patients) and von Hippel–Lindau disease ([VHL] 7 patients). The parent catecholamines exhibited increased values for noradrenaline (NA) and/or adrenaline (AD) for 25/29 (86.2%) patients. Either or both free normetadrenaline (fNMA) and fMA were elevated in 29/29 (100%) patients. Conclusions The ratio of the multiples of URL for fMA/fNMA displayed a clearer separation of MEN 2 patients from those with SDHB/D or VHL than did the equivalent AD/NA ratio.
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Affiliation(s)
- D Fraser Davidson
- Biochemistry Department, University Hospital Crosshouse, Kilmarnock KA2 0BE
| | - Nicola Bradshaw
- West of Scotland Regional Genetics Service, Ferguson Smith Centre for Clinical Genetics, Glasgow G3 8SJ
| | - Colin G Perry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK
| | - Robert Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK
| | - E Marie Freel
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK
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Tobias ES, Yeap PM, Mavraki E, Fletcher A, Freel ME, Cooke A, Bradshaw N, Murday VA, Davidson R, Perry C, Lindsay RS. Abstract 3673: Molecular analysis of pheochromocytoma after maternal transmission of SDHD mutation elucidates mechanism of parent-of-origin effect. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-3673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In SDHD mutation families, paragangliomas and pheochromocytomas usually occur only after paternal transmission of the mutation. This important but unexplained parent-of-origin effect is not due to imprinting of SDHD itself, as was initially suspected, since SDHD is biallelically expressed in several tissues. In clinically affected individuals who possess a paternally inherited SDHD mutation, there is loss of the entire maternal chromosome 11 in tumour DNA, implying that tumorigenesis requires loss of not only maternal (wild type) SDHD but also a further, imprinted, tumor suppressor gene (TSG). We report the second case of an SDHD-related tumor (a pheochromocytoma in a 33 year old woman possessing the common pathogenic mutation, p.Pro81Leu) occurring after maternal transmission. It is the first reported investigation of tumor DNA in this situation. Tumor DNA revealed loss of heterozygosity (LOH) at paternal 11q23 causing loss of the wild-type SDHD allele and also LOH affecting maternal 11p15, including H19. These two LOH regions were separated by a region exhibiting clearly retained heterozygosity, containing SDHAF2 (a recently reported paraganglioma TSG), which therefore appears uninvolved here. This case provides strong molecular evidence that the tumorigenic requirement for maternal 11p15 loss (in addition to inactivation of both SDHD alleles) drives the observed parent-of-origin effect. Thus, SDHD-related tumorigenesis most likely involves a “three-hit” mechanism that includes (as one of the hits) loss of an imprinted (paternally silenced and maternally active) TSG from chromosome 11, such as H19). Tumor formation more commonly results from paternal inheritance of SDHD mutations, as the necessary loss of both the wild type SDHD allele and maternal 11p15 can then occur by a single event (loss of maternal chromosome 11). These findings have important implications regarding the clinical management of carriers of maternally inherited SDHD mutations, who we confirm can develop pheochromocytomas, and the understanding of the parent-of-origin effect.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3673. doi:1538-7445.AM2012-3673
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Affiliation(s)
| | - Phey M. Yeap
- 2Glasgow Royal Infirmary, Glasgow, United Kingdom
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Yeap PM, Tobias ES, Mavraki E, Fletcher A, Bradshaw N, Freel EM, Cooke A, Murday VA, Davidson HR, Perry CG, Lindsay RS. Molecular analysis of pheochromocytoma after maternal transmission of SDHD mutation elucidates mechanism of parent-of-origin effect. J Clin Endocrinol Metab 2011; 96:E2009-13. [PMID: 21937622 DOI: 10.1210/jc.2011-1244] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Pheochromocytoma/paraganglioma occurs almost exclusively after paternal transmission of succinate dehydrogenase D (SDHD) mutations. This parent-of-origin effect has not been fully explained but is accompanied by obligate loss of the maternal copy of chromosome 11. Loss of wild-type SDHD and an additional imprinted gene (hypothesized to be H19) appears necessary for tumor formation. Two previous reports suggested tumor formation after maternal transmission of SDHD mutation, but histological and molecular characterization was unavailable. OBJECTIVE We report the first kindred in which histologically confirmed pheochromocytoma/paraganglioma occurred after maternal transmission of an SDHD mutation and investigate the molecular mechanism of tumor formation. DESIGN The design of the investigation was the study of a three-generation family with SDHD c.242C>T (p.Pro81Leu) mutation. RESULTS The index patient had a histologically confirmed pheochromocytoma and an identical SDHD germline mutation (p.Pro81Leu) to her mother (who had a glomus jugulare tumor) and paraganglioma tissue from her maternal grandfather. Tumor DNA from the index patient revealed loss of heterozygosity (LOH) at 11q23, causing loss of the wild-type paternal SDHD allele and LOH affecting maternal 11p15, including H19. These two regions of LOH were separated by a region exhibiting clearly retained heterozygosity, including SDHAF2, a recently reported paraganglioma susceptibility gene. CONCLUSIONS Tumor formation can occur after maternal transmission of SDHD, a finding with important clinical implications for SDHD families. Tumor formation in SDHD mutation requires the loss of both the wild-type SDHD allele and maternal 11p15, leading to the predominant but now not exclusive pattern of disease inheritance after paternal SDHD transmission.
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Affiliation(s)
- Phey M Yeap
- Department of Endocrinology, Western Infirmary, Glasgow G11 6NT, United Kingdom
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Saldanha JD, Garrett RM, Snaddon L, Longmuir M, Bradshaw N, Watt C, George WD, Wilson CR, Doughty JC, Stallard S, Reid I, Murday V, Davidson R. Impact of national guidelines on family history breast cancer surveillance. Scott Med J 2011; 56:203-5. [PMID: 22089040 DOI: 10.1258/smj.2011.011158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The breast cancer risk of women already under family history surveillance was accurately assessed according to national guidelines in an attempt to rationalize the service. Women attending two breast units in Glasgow between November 2003 and February 2005 were included. One thousand and five women under annual surveillance were assessed and had their relatives diagnoses verified. Four hundred and ninety-seven women were at significantly increased risk and eligible for follow-up. Five hundred and eight (50%) women attending were not eligible for family history surveillance, and 498 (98%) of these women accepted discharge. In conclusion, national guidelines have helped to more clearly define women who should undergo surveillance. This avoids unnecessary and potentially harmful routine investigations, and the service has been improved.
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Affiliation(s)
- J D Saldanha
- Victoria Infirmary, Langside Road, Glasgow G42 9TY, Scotland, UK
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12
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Ricketts CJ, Forman JR, Rattenberry E, Bradshaw N, Lalloo F, Izatt L, Cole TR, Armstrong R, Kumar VKA, Morrison PJ, Atkinson AB, Douglas F, Ball SG, Cook J, Srirangalingam U, Killick P, Kirby G, Aylwin S, Woodward ER, Evans DGR, Hodgson SV, Murday V, Chew SL, Connell JM, Blundell TL, Macdonald F, Maher ER. Tumor risks and genotype-phenotype-proteotype analysis in 358 patients with germline mutations in SDHB and SDHD. Hum Mutat 2010; 31:41-51. [PMID: 19802898 DOI: 10.1002/humu.21136] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Succinate dehydrogenase B (SDHB) and D (SDHD) subunit gene mutations predispose to adrenal and extraadrenal pheochromocytomas, head and neck paragangliomas (HNPGL), and other tumor types. We report tumor risks in 358 patients with SDHB (n=295) and SDHD (n=63) mutations. Risks of HNPGL and pheochromocytoma in SDHB mutation carriers were 29% and 52%, respectively, at age 60 years and 71% and 29%, respectively, in SDHD mutation carriers. Risks of malignant pheochromocytoma and renal tumors (14% at age 70 years) were higher in SDHB mutation carriers; 55 different mutations (including a novel recurrent exon 1 deletion) were identified. No clear genotype-phenotype correlations were detected for SDHB mutations. However, SDHD mutations predicted to result in loss of expression or a truncated or unstable protein were associated with a significantly increased risk of pheochromocytoma compared to missense mutations that were not predicted to impair protein stability (most such cases had the common p.Pro81Leu mutation). Analysis of the largest cohort of SDHB/D mutation carriers has enhanced estimates of penetrance and tumor risk and supports in silicon protein structure prediction analysis for functional assessment of mutations. The differing effect of the SDHD p.Pro81Leu on HNPGL and pheochromocytoma risks suggests differing mechanisms of tumorigenesis in SDH-associated HNPGL and pheochromocytoma.
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Affiliation(s)
- Christopher J Ricketts
- Cancer Research UK Renal Molecular Oncology Group, Department of Medical and Molecular Genetics, University of Birmingham, Institute of Biomedical Research, Birmingham, United Kingdom
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Anderson E, Berg J, Black R, Bradshaw N, Campbell J, Carnaghan H, Cetnarkyj R, Drummond S, Davidson R, Dunlop J, Fordyce A, Gibbons B, Goudie D, Gregory H, Holloway S, Longmuir M, McLeish L, Murday V, Miedzybrodska Z, Nicholson D, Pearson P, Porteous M, Reis M, Slater S, Smith K, Smyth E, Snadden L, Steel M, Stirling D, Watt C, Whyte C, Young D. Prospective surveillance of women with a family history of breast cancer: auditing the risk threshold. Br J Cancer 2008; 98:840-4. [PMID: 18283300 PMCID: PMC2259176 DOI: 10.1038/sj.bjc.6604155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To evaluate current guidelines criteria for inclusion of women in special ‘breast cancer family history’ surveillance programmes, records were reviewed of women referred to Scottish breast cancer family clinics between January 1994 and December 2003 but discharged as at ‘less than ‘moderate’ familial risk’. The Scottish Cancer Registry was then interrogated to determine subsequent age-specific incidence of breast cancer in this cohort and corresponding Scottish population figures. Among 2074 women, with an average follow-up of 4.0 years, 28 invasive breast cancers were recorded up to December 2003, where 14.4 were expected, a relative risk (RR) of 1.94. Eleven further breast cancers were recorded between January 2004 and February 2006 (ascertainment incomplete for this period). The overall RR for women in the study cohort exceeded the accepted ‘cutoff’ level (RR=1.7) for provision of special counselling and surveillance. The highest RR was found for the age group 45–59 years and this group also generated the majority of breast cancers. The National Institute for Clinical Excellence (‘NICE’) guidelines appear to be more accurate than those of the Scottish Intercollegiate Guidelines Network (‘SIGN’) in defining ‘moderate’ familial risk, and longer follow-up of this cohort could generate an evidence base for further modification of familial breast cancer services.
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Affiliation(s)
- E Anderson
- Edinburgh Breast Cancer Family Service, Department of Clinical Genetics and Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK
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Bradshaw N, Lentink D. Aerodynamic performance of a bio-inspired flapping micro air vehicle with flexible wings. Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bradshaw N, Flood-Shaffer K, Rodriguez E, Johnson-Rubio A, Porter K, Prien S. Early outcomes from the West Texas Early Pregnancy and Chlamydia Project: Potential impact on future fertility. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Individuals with first degree relatives affected with colorectal cancer (CRC) at a young age, or more than one relative affected but who do not fulfil the Amsterdam criteria for a diagnosis of hereditary non-polyposis colon cancer (HNPCC), are believed to be at an increased risk of CRC. However, there is a paucity of prospective data on the potential benefit of colonoscopic surveillance in such groups categorised by empiric family history criteria. We report a prospective study of 448 individuals seeking counselling about their perceived family history of CRC. PATIENTS AND METHODS Following pedigree tracing, verification, and risk assignment by genetic counsellors, colonoscopy was undertaken for those at a moderate or high risk (HNPCC). Those classified as low risk were reassured and discharged without surveillance. Here we report our findings at the prevalence screen in the 176 patients of the 448 assessed who underwent colonoscopy. RESULTS Fifty three individuals had a family history that met Amsterdam criteria (median age 43 years) and 123 individuals were classed as moderate risk (median age 43 years). No cancers were detected at colonoscopy in any group. Four individuals (8% (95% confidence limits (CL) 0.4-15%)) in the high risk group had an adenoma detected at a median age of 46 years and all four were less than 50 years of age. Five (4% (95% CL 0.6- 8%)) of the moderate risk individuals had an adenoma at a median age of 54 years, two of whom were less than 50 years of age. CONCLUSIONS These findings indicate that the prevalence of significant neoplasia in groups defined by family history is low, particularly in younger age groups. These prospective data call into question the value of colonoscopy before the age of 50 years in moderate risk individuals.
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Affiliation(s)
- N Bradshaw
- South East of Scotland Genetic Service, Western General Hospital, Crewe Rd, Edinburgh, UK.
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Segers G, Bradshaw N, Archer D, Blissett K, Oliver RP. Alcohol oxidase is a novel pathogenicity factor for Cladosporium fulvum, but aldehyde dehydrogenase is dispensable. Mol Plant Microbe Interact 2001; 14:367-77. [PMID: 11277434 DOI: 10.1094/mpmi.2001.14.3.367] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Cladosporiumfulvum is a mitosporic ascomycete pathogen of tomato. A study of fungal genes expressed during carbon starvation in vitro identified several genes that were up regulated during growth in planta. These included genes predicted to encode acetaldehyde dehydrogenase (Aldh1) and alcohol oxidase (Aox1). An Aldh1 deletion mutant was constructed. This mutant lacked all detectable ALDH activity, had lost the ability to grow with ethanol as a carbon source, but was unaffected in pathogenicity. Aox1 expression was induced by carbon starvation and during the later stages of infection. The alcohol oxidase enzyme activity has broadly similar properties (Km values, substrate specificity, pH, and heat stability) to yeast enzymes. Antibodies raised to Hansenula polymorpha alcohol oxidase (AOX) detected antigens in Western blots of starved C. fulvum mycelium and infected plant material. Antigen reacting with the antibodies was localized to organelles resembling peroxisomes in starved mycelium and infected plants. Disruption mutants of Aox1 lacked detectable AOX activity and had markedly reduced pathogenicity as assayed by two different measures of fungal growth. These results identify alcohol oxidase as a novel pathogenicity factor and are discussed in relation to peroxisomal metabolism of fungal pathogens during growth in planta.
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Affiliation(s)
- G Segers
- Department of Physiology, Carlsberg Laboratory, Copenhagen Valby, Denmark
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Campbell H, Bradshaw N, Davidson R, Dean J, Goudie D, Holloway S, Porteous M. Evidence based medicine in practice: lessons from a Scottish clinical genetics project. J Med Genet 2000; 37:684-91. [PMID: 10978360 PMCID: PMC1734678 DOI: 10.1136/jmg.37.9.684] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To establish national clinical guidelines and integrated care pathways for five conditions (tuberous sclerosis (TS), Huntington's disease (HD), myotonic dystrophy (MD), neurofibromatosis type 1 (NF1), and Marfan syndrome (MS)) and audit their use in Scotland. DESIGN Systematic review of published reports followed by consensus conferences to prepare clinical guidelines and integrated care pathways. Structured review of medical records before and after introduction of integrated care pathways to document changes in practice. Survey of staff views on procedures adopted. SETTING All four clinical genetics centres in Scotland. RESULTS Project resulted in reduced variation in practice across centres, improved data recording in medical records, and improved communication with other professional groups. A very poor evidence base for management of patients with the conditions studied was found. CONCLUSIONS A collaborative structure for undertaking clinical research would improve the evidence base for current practice. National discussion of the boundaries of responsibility of care for the long term management of patients with these disorders is required. The integrated care pathway approach shows promise as a means of facilitating the development of audit within clinical genetics services.
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Affiliation(s)
- H Campbell
- Department of Clinical Genetics, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
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Bradshaw N, Brewer C, FitzPatrick D, Murray G, Rodgers F, Porteous M, Campbell H. Guidelines and care pathways for genetic diseases: the Scottish collaborative project on tuberous sclerosis. Eur J Hum Genet 1998; 6:445-58. [PMID: 9801869 DOI: 10.1038/sj.ejhg.5200208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In Scotland a national audit project has been undertaken to devise evidence-based guidelines for the clinical management of patients with tuberous sclerosis (TS), a dominantly inherited multisystem disorder. In order to facilitate the audit and use of these guidelines a 'Care Pathway' was devised to form the patient records. We describe the process of guideline development for TS and our TS Care Pathway.
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Affiliation(s)
- N Bradshaw
- Department of Clinical Genetics, Western General Hospital, Edinburgh, Scotland.
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Bradshaw N, Walker R. Prescription of statins: cost implications of evidence-based treatment applied to a health authority population. J Clin Pharm Ther 1997. [DOI: 10.1046/j.1365-2710.1997.00118.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bradshaw N, Walker R. Prescription of statins: cost implications of evidence-based treatment applied to a health authority population. J Clin Pharm Ther 1997; 22:379-89. [DOI: 10.1111/j.1365-2710.1997.tb00021.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bradshaw N, Bradshaw J, Burrows R. Area variations in the prevalence of lone parent families in England and Wales: a research note. Reg Stud 1996; 30:811-815. [PMID: 12347795 DOI: 10.1080/00343409612331350118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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