Risk and penetrance of mutations from breast cancer testing panels.

描述（由申请人提供）：乳腺癌是美国最常见的癌症之一。大约15%至20%的病例表现出该病的家族史，表明有很强的遗传成分。乳腺癌易感性与BRCA1、BRCA2、PTEN、STK11、CDH1和TP53的高外显率种系突变有关。此外，其他几个基因的遗传失活突变与家族性乳腺癌有关。包括ATM、CHEK2、PALB2、BRIP1、BARD1、RAD51C、RAD51D、XRCC2、NBN、RAD50和MRE11A。虽然ATM和CHEK2的失活突变与乳腺癌风险增加3至7倍相关，终生风险在20%至50%之间，但这些风险估计并不精确，而且对与其他易感基因失活突变相关的乳腺癌和其他癌症的风险知之甚少。所有这些高风险和中度易感基因的临床基因检测现在都是可用的。许多患有乳腺癌、卵巢癌或其他癌症的个人和家族病史的女性都在使用这些检测面板进行突变检测，在“安吉丽娜的故事”之后，这种检测面板的需求激增。初步数据表明，约10%的小组试验发现截断突变和

DESCRIPTION (provided by applicant): Breast cancer is one of the most common cancers in the US. Approximately 15% to 20% of cases exhibit a family history of the disease suggesting a strong heritable component. Susceptibility to breast cancer is associated with high-penetrance germline mutations in BRCA1, BRCA2, PTEN, STK11, CDH1, and TP53. In addition, inherited inactivating mutations in several other genes have been associated with familial breast cancer. These include ATM, CHEK2, PALB2, BRIP1, BARD1, RAD51C, RAD51D, XRCC2, NBN, RAD50, and MRE11A. While inactivating mutations in ATM and CHEK2 have been associated with moderate 3 to 7-fold increased risk of breast cancer with lifetime risks of between 20% and 50%, these risk estimates are imprecise and little is known about the risk of breast and other cancers associated with inactivating mutations in the other predisposition genes. Clinical genetic testing for all of these high and moderate risk predisposition genes is now available. Many women, with personal and family history of breast, ovarian or other cancers, are pursuing testing for mutations with these panels, which has seen an upsurge in demand in response to 'Angelina's story'. Initial data suggest that ~10% of panel tests identify truncating mutations and 20% yield variants of uncertain significance (VUS) in the form of missense and intronic changes of undefined clinical relevance in the known predisposition genes. Although potentially useful for establishing the etiology of breast cancer in a patient's family, there remain significant limitatins in the clinical interpretation of the results from the panel testing. In particular, the age-relate risk of breast and other cancers associated with mutations in the genes are largely undefined. Furthermore, clear medical management recommendations for mutation carriers have not been developed. Thus, the results of these tests can lead to confusion and uninformed medical decisions that can result in significant harm. We propose to use high-throughput mutation screening of known breast cancer predisposition genes in breast cancer case-control studies and high-risk breast cancer families to establish the risks of breast and other cancers associated with deleterious mutations in these genes as follows: Aim 1) Establish the risk of breast cancer in the general population associated with mutations in known predisposition genes using large cohort-based case-control studies; Aim 2) Define the penetrance of cancers associated with inactivating mutations in panel-based predisposition genes through breast cancer family studies; Aim 3) Determine the clinical relevance of VUS in the known predisposition genes. At the conclusion of the study, we expect to establish risk estimates associated with deleterious mutations in the genes for the general population and breast cancer families, leading to much improved risk assessment for mutation carriers. In addition, we expect to establish the clinical relevance of many VUS in the known predisposition genes. The results of this study will also provide the necessary data to establish standard of care medical management recommendations for carriers of deleterious mutations in moderate penetrance genes, a critical unmet need.