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Prevalence and Distribution of Unexpected Actionable Germline Pathogenic Variants Identified on Broad-Based Multigene
Kara K Landry1, Michael J DeSarno2, Lindsay Kipnis3
1Division of Hematology and Oncology, Department of Medicine, University of Vermont Medical Center, Burlington, VT.
Multigene panel testing (MGPT) in cancer patients revealed pathogenic variants (PVs) in 1.7% of cases, even when not predicted by personal or family history. These unexpected findings in actionable cancer genes may impact patient management.
Area of Science:
- Oncology
- Genetics
- Cancer Predisposition
Background:
- Multigene panel testing (MGPT) is increasingly used in cancer patients.
- Clinical utility depends on identifying actionable variants.
- Predicting variants solely on personal/family history has limitations.
Purpose of the Study:
- To determine the frequency of pathogenic/likely pathogenic variants (PVs) identified by MGPT that were unexpected based on patient and family cancer history.
- To assess the clinical implications of unexpected PVs in cancer predisposition genes.
Main Methods:
- Retrospective review of 10,975 cancer patients undergoing broad-based MGPT (≥20 genes).
- Exclusion of low-penetrance and recessive genes.
- Analysis of deidentified pedigrees to assess clinical suspicion of PVs.
Main Results:
- 10.3% of patients had at least one PV in a moderate/highly penetrant gene.
- 1.7% of patients had PVs unsuspected even after considering personal and family history.
- Unexpected PVs represented 16.9% of all identified PVs, with common genes including MITF, PMS2, and ATM.
Conclusions:
- MGPT identifies unexpected actionable cancer predisposition variants in 1.7% of cancer patients.
- Broader MGPT panels may be warranted due to implications for surveillance, cascade testing, and treatment.
- These findings highlight the value of comprehensive genetic testing beyond traditional risk assessment.
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