在乳腺癌单一病例中,有限的家族结构和BRCA基因突变状态
Jeffrey N Weitzel1, Veronica I Lagos, Carey A Cullinane
1Department of Clinical Cancer Genetics, City of Hope, 1500 E Duarte Rd, Duarte, CA 91010, USA. jweitzel@coh.org
JAMA
|June 21, 2007
概括
家庭结构影响遗传性乳腺癌风险. 有限的家族病史增加了BRCA基因突变的患病率,这表明对早期乳腺癌病例需要更新基因测试指南.
科学领域:
- 遗传学 是一个遗传学.
- 在瘤学瘤学.
- 流行病学 流行病学
背景情况:
- 遗传性乳腺癌 (HBC) 的遗传模式可能被小家庭规模或男性传播所掩盖,因为性别有限的表达.
- 对HBC进行准确的风险评估对于早期检测和预防策略至关重要.
研究的目的:
- 调查BRCA基因突变是否比目前模型预测的更常见于早期发病的乳腺癌患者,其家族结构有限.
- 评估与家族结构相关的BRCA突变现有概率模型的预测准确性.
主要方法:
- 在美国高风险诊所对1543名接受基因癌症风险评估和BRCA基因检测的妇女进行前性注册表研究.
- 分析的重点是306名女性在50岁之前患有乳腺癌,没有受到影响的一级或二级亲属.
- 评估了家族结构 (有限与充分),并将其对BRCA突变状态的预测值与使用后勤回归和ROC分析的Couch,Myriad和BRCAPRO模型进行了比较.
主要成果:
- 在50%的病例中,观察到有限的家庭结构.
- 与适当的结构 (5.2%) 相比,在有限的家庭结构 (13.7%) 的参与者中,BRCA基因突变的发生率明显更高.
- 家庭结构是突变状态的重要预测因素 (OR,2.8;P = .02). 修改后的BRCAPRO模型包含了家庭结构,显示出更好的预测准确性 (AUC,0.72).
结论:
- 家庭结构是影响BRCA突变概率模型准确性的关键因素.
- 目前的基因测试指南可能需要修订,以便对早期发病的乳腺癌病例和有限的家族病史更具包容性.
- 对BRCA突变的概率模型需要重新校准,以纳入有限的家族史作为关键变量.
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