Perspective on BRCA1

In a very real sense, the search for a breast cancer susceptibility gene reflects the rapid evolution of molecular genetics as a field and the power of molecular technology to accelerate the pace of discovery. This search began with the study of blood proteins through biochemical analysis; the number of loci accessible was limited, and very few consistent results were obtained (1). Then came recombinant DNA technology. The number of available markers, and the information they provide, has grown rapidly over the years. The same is true for the development of new, high-throughput genotyping methods and associated informatics systems and statistical methods, making gene mapping more feasible. For BRCA1, it took five years and 183 markers to identify the chromosomal location as 17q21 (2). It took an additional four years before BRCA1 was cloned (3). In contrast, BRCA2 was localized to chromosome 13q12-13 two months before the cloning of BRCA1 was reported; less than two years later, BRCA2 was cloned (4,5). Characterization of these two genes is still underway, in part, because of unanticipated complexity. This complexity plays out at multiple levels, including the relationship between phenotype and genotype within and between the populations studied, biological function(s), and social consequences. The reviews presented in this issue reflect the breadth of impact that the discovery of the BRCA genes has had on science, medicine, and law. As with most great discoveries, the identification of BRCA1 has forced us to question the fundamentals of our belief systems: what is a mutation, what is a tumor suppressor, what is righteous, and what is ethical?