Missense mutations in cancer predisposing genes: can we make sense of them?

In the analysis of genes associated with predispositions to malignancy the causative status of mutations can be made relatively easily where it is obvious that there is a clear disruption in the coding sequence of the gene. Difficulties arise, however, if missense mutations are identified, as these are not easily categorised into genetic variants that are not associated with disease risk or into clearly causative changes that impart a significant risk of disease.As more individuals are subject to DNA sequence analysis for the identification of causative changes in genes associated with cancer predisposition, an increasing number of missense mutations are being identified. Causative status assignment to missense mutations continues to be problematic especially where no functional assessment of the alteration can be made. As more information is gathered on missense mutations our predictive ability to assign significance will improve.In this report we review, in broad terms, what measures can be undertaken to categorise missense mutations into those that are clearly causative, probably causative and most likely not causative.