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3. Too much, too late: Aggressive measures and the timing of end of life care discussions in women with gynecologic malignancies

Author

Zakhour, M, Labrant, L, Rimel, BJ, Walsh, CS, Li, AJ, Karlan, BY, and Cass, I

Subjects
Oncology & Carcinogenesis, Oncology and Carcinogenesis, Paediatrics and Reproductive Medicine
Abstract

Objective This study describes the patterns of end of life (EOL) discussions and their impact on the use of aggressive measures in women with terminal gynecologic malignancies at a single institution. Methods An IRB-approved retrospective chart review identified 136 patients who died of gynecologic cancer between 2010 and 2012 with at least one interaction with their oncologists in the last 6 months of life. Aggressive measures were defined as chemotherapy within the last 14 days of life, emergency department (ED) visits, hospital and intensive care unit (ICU) admissions within the last 30 days of life, and inpatient deaths. The frequency and timing of EOL conversations were recorded. Utilization of hospice care was also described. Results In the last 30 days of life, 54 (40%) patients were evaluated in the ED, 67 (49%) were admitted into hospital, and 16 (12%) were admitted to the ICU. Thirteen patients (10%) had chemotherapy in the last 14 days of life. Ninety-seven (71%) patients had a documented EOL conversation, eighteen (19%) as outpatients, and 79 (81%) as inpatients. Thirty (22%) patients died in the hospital. At the time of death, 55 (40%) patients were enrolled in outpatient hospice care. The mean amount of time in hospice was 28 days. Conclusions End of life care discussions rarely occurred in the outpatient setting or > 30 days before death. Inpatient encounters led to discussions about hospice and code status. Evaluation in the ED frequently resulted in escalation of care. Earlier EOL care discussions resulted in less aggressive measures.

Published
2015

4. Long term follow up of BRCA1 and BRCA2 mutation carriers with unsuspected neoplasia identified at risk reducing salpingo-oophorectomy.

Author

Powell, CB, Swisher, EM, Cass, I, McLennan, J, Norquist, B, Garcia, RL, Lester, J, Karlan, BY, and Chen, L

Subjects
Humans, Carcinoma in Situ, Ovarian Neoplasms, Fallopian Tube Neoplasms, Neoplasm Invasiveness, Neoplasm Metastasis, Neoplasm Recurrence, Local, Genetic Predisposition to Disease, Treatment Outcome, Chemotherapy, Adjuvant, Ovariectomy, Survival Analysis, Follow-Up Studies, Mutation, Genes, BRCA1, Genes, BRCA2, Adult, Aged, Middle Aged, Female, Salpingectomy, Rare Diseases, Cancer, Breast Cancer, Clinical Research, Prevention, BRCA, Ovarian cancer, RRSO, Oncology and Carcinogenesis, Paediatrics and Reproductive Medicine, Oncology & Carcinogenesis
Abstract

ObjectivesThe reported incidence of neoplasia identified at the time of risk-reducing salpingo-oophorectomy (RRSO) in germline BRCA1/2 mutation carriers ranges from 4 to 12% but long-term outcomes have not been described. We evaluated recurrence and survival outcomes of mutation carriers with neoplastic lesions identified at RRSO.MethodsWe identified BRCA1/2 mutation carriers with neoplasia at RRSO at three institutions. Data was collected on clinical variables, adjuvant treatment and follow-up.ResultsWe identified 32 mutation carriers with invasive carcinomas (n=15) or high-grade intraepithelial neoplasia (n=17) that were not suspected prior to surgery. 26 occurred in BRCA1 and 6 in BRCA2 mutation carriers. Median and mean age for carcinomas were 50 years and 49.3 respectively, significantly younger than for intraepithelial neoplasm, median 53 years, and mean 55 years (p=0.04). For the 15 invasive carcinomas, median follow up was 88 months (range 45-172 months), 7 recurred (47%), median time to recurrence was 32.5 months and 3 have died of disease; 1 additional patient died of breast cancer. Overall survival was 73%, disease specific overall survival was 80% and disease free survival was 66%. For the 17 high-grade intraepithelial neoplasms, median follow up was 80 months (range 40-150), 4 were treated with chemotherapy. One recurred at 43 months and is currently not on therapy with a normal CA125, 16 months later. All patients with noninvasive neoplasia are alive.ConclusionsBRCA1 and BRCA2 mutation carriers with unsuspected invasive carcinoma at RRSO have a relatively high rate of recurrence despite predominantly early stage, small volume disease. High-grade intraepithelial neoplasms rarely recur as carcinoma and may not require adjuvant chemotherapy.

Published
2013

5. A multi-level investigation of the genetic relationship between endometriosis and ovarian cancer histotypes

Author

Mortlock, S, Corona, R, Kho, PF, Pharoah, P, Seo, J-H, Freedman, ML, Gayther, SA, Siedhoff, MT, Rogers, PAW, Leuchter, R, Walsh, CS, Cass, I, Karlan, BY, Rimel, BJ, Montgomery, GW, Lawrenson, K, Kar, SP, Mortlock, S, Corona, R, Kho, PF, Pharoah, P, Seo, J-H, Freedman, ML, Gayther, SA, Siedhoff, MT, Rogers, PAW, Leuchter, R, Walsh, CS, Cass, I, Karlan, BY, Rimel, BJ, Montgomery, GW, Lawrenson, K, and Kar, SP

Abstract

Endometriosis is associated with increased risk of epithelial ovarian cancers (EOCs). Using data from large endometriosis and EOC genome-wide association meta-analyses, we estimate the genetic correlation and evaluate the causal relationship between genetic liability to endometriosis and EOC histotypes, and identify shared susceptibility loci. We estimate a significant genetic correlation (rg) between endometriosis and clear cell (rg = 0.71), endometrioid (rg = 0.48), and high-grade serous (rg = 0.19) ovarian cancer, associations supported by Mendelian randomization analyses. Bivariate meta-analysis identified 28 loci associated with both endometriosis and EOC, including 19 with evidence for a shared underlying association signal. Differences in the shared risk suggest different underlying pathways may contribute to the relationship between endometriosis and the different histotypes. Functional annotation using transcriptomic and epigenomic profiles of relevant tissues/cells highlights several target genes. This comprehensive analysis reveals profound genetic overlap between endometriosis and EOC histotypes with valuable genomic targets for understanding the biological mechanisms linking the diseases.

Published
2022

28. Associations of common breast cancer susceptibility alleles with risk of breast cancer subtypes in BRCA1 and BRCA2 mutation carriers

Author

Kuchenbaecker, KB, Neuhausen, SL, Robson, M, Barrowdale, D, McGuffog, L, Mulligan, AM, Andrulis, IL, Spurdle, AB, Schmidt, MK, Schmutzler, RK, Engel, C, Wappenschmidt, B, Nevanlinna, H, Thomassen, M, Southey, M, Radice, P, Ramus, SJ, Domchek, SM, Nathanson, KL, Lee, A, Healey, S, Nussbaum, RL, Rebbeck, TR, Arun, BK, James, P, Karlan, BY, Lester, J, Cass, I, Terry, MB, Daly, MB, Goldgar, DE, Buys, SS, Janavicius, R, Tihomirova, L, Tung, N, Dorfling, CM, van Rensburg, EJ, Steele, L, v O Hansen, T, Ejlertsen, B, Gerdes, AM, Nielsen, FC, Dennis, J, Cunningham, J, Hart, S, Slager, S, Osorio, A, Benitez, J, Duran, M, Weitzel, JN, Tafur, I, Hander, M, Peterlongo, P, Manoukian, S, Peissel, B, Roversi, G, Scuvera, G, Bonanni, B, Mariani, P, Volorio, S, Dolcetti, R, Varesco, L, Papi, L, Tibiletti, MG, Giannini, G, Fostira, F, Konstantopoulou, I, Garber, J, Hamann, U, Donaldson, A, Brewer, C, Foo, C, Evans, DG, Frost, D, Eccles, D, Douglas, F, Brady, A, Cook, J, Tischkowitz, M, Adlard, J, Barwell, J, Ong, KR, Walker, L, Izatt, L, Side, LE, Kennedy, MJ, Rogers, MT, Porteous, ME, Morrison, PJ, Platte, R, Eeles, R, and Davidson, R

Subjects
skin and connective tissue diseases
Abstract

© 2014 Kuchenbaecker et al. Introduction: More than 70 common alleles are known to be involved in breast cancer (BC) susceptibility, and several exhibit significant heterogeneity in their associations with different BC subtypes. Although there are differences in the association patterns between BRCA1 and BRCA2 mutation carriers and the general population for several loci, no study has comprehensively evaluated the associations of all known BC susceptibility alleles with risk of BC subtypes in BRCA1 and BRCA2 carriers. Methods: We used data from 15,252 BRCA1 and 8,211 BRCA2 carriers to analyze the associations between approximately 200,000 genetic variants on the iCOGS array and risk of BC subtypes defined by estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and triple-negative- (TN) status; morphologic subtypes; histological grade; and nodal involvement. Results: The estimated BC hazard ratios (HRs) for the 74 known BC alleles in BRCA1 carriers exhibited moderate correlations with the corresponding odds ratios from the general population. However, their associations with ER-positive BC in BRCA1 carriers were more consistent with the ER-positive associations in the general population (intraclass correlation (ICC)=0.61, 95% confidence interval (CI): 0.45 to 0.74), and the same was true when considering ER-negative associations in both groups (ICC=0.59, 95% CI: 0.42 to 0.72). Similarly, there was strong correlation between the ER-positive associations for BRCA1 and BRCA2 carriers (ICC=0.67, 95% CI: 0.52 to 0.78), whereas ER-positive associations in any one of the groups were generally inconsistent with ER-negative associations in any of the others. After stratifying by ER status in mutation carriers, additional significant associations were observed. Several previously unreported variants exhibited associations at P

Published
2014
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42. Association between BRCA1 and BRCA2 Mutations and Survival in Women with Invasive Epithelial Ovarian Cancer

Author

Fridley, BL, Goode, EL, Høgdall, E, Jensen, A, Cass, I, Kjær, SK, Johnatty, SE, Nicoletto, MO, D'Andrea, E, Montagna, M, Blanco, I, Lázaro, C, Ma, ESK, Daly, MB, Godwin, AK, Eeles, R, Evans, DG, Frost, D, Peock, S, Hartge, P, Gail, MH, Neuhausen, S, García, MJ, Benítez, J, Sinilnikova, O, Easton, DF, Healey, S, McGuffog, L, Barrowdale, D, Despierre, E, Lambrechts, D, Karlan, BY, Ramus, SJ, Sadetzki, S, Goh, C, ChenevixTrench, G, Bolton, KL, Li, AJ, Walsh, C, Gross, J, Steele, L, Beattie, MS, Chan, S, Nussbaum, RL, Moysich, KB, Leuchter, R, Borg, Å, Olsson, H, Kristoffersson, U, Sieh, W, McGuire, V, Whittemore, AS, Tyrer, J, Song, H, Michie, CO, Gourley, C, Gore, ME, Senter, L, Toland, AE, Glendon, G, HirshYechezkel, G, Lubin, F, Chetrit, A, Mai, PL, Greene, MH, Loud, JT, Levine, DA, Gordon, O, GarciaClosas, M, Gayther, SA, Chanock, SJ, Antoniou, AC, Pharoah, PDP, Andrulis, IL, and Kwong, A

Subjects
endocrine system diseases, skin and connective tissue diseases, female genital diseases and pregnancy complications
Abstract

Context: Approximately 10% of women with invasive epithelial ovarian cancer (EOC) carry deleterious germline mutations in BRCA1 or BRCA2. A recent article suggested that BRCA2-related EOC was associated with an improved prognosis, but the effect of BRCA1 remains unclear. Objective: To characterize the survival of BRCA carriers with EOC compared with noncarriers and to determine whether BRCA1 and BRCA2 carriers show similar survival patterns. Design, Setting, and Participants: A pooled analysis of 26 observational studies on the survival of women with ovarian cancer, which included data from 1213 EOC cases with pathogenic germline mutations in BRCA1 (n=909) or BRCA2 (n=304) and from 2666 noncarriers recruited and followed up at variable times between 1987 and 2010 (the median year of diagnosis was 1998). Main Outcome Measure: Five-year overall mortality. Results: The 5-year overall survival was 36% (95% CI, 34%-38%) for noncarriers, 44% (95% CI, 40%-48%) for BRCA1 carriers, and 52% (95% CI, 46%-58%) for BRCA2 carriers. After adjusting for study and year of diagnosis, BRCA1 and BRCA2 mutation carriers showed amore favorable survival than noncarriers (for BRCA1: hazard ratio [HR], 0.78; 95% CI, 0.68-0.89; P, link_to_OA_fulltext

Published
2012

43. Germline Mutation in BRCA1 or BRCA2 and Ten-Year Survival for Women Diagnosed with Epithelial Ovarian Cancer

Author

Candido-dos-Reis, FJ, Song, H, Goode, EL, Cunningham, JM, Fridley, BL, Larson, MC, Alsop, K, Dicks, E, Harrington, P, Ramus, SJ, de Fazio, A, Mitchell, G, Fereday, S, Bolton, KL, Gourley, C, Michie, C, Karlan, B, Lester, J, Walsh, C, Cass, I, Olsson, H, Gore, M, Benitez, JJ, Garcia, MJ, Andrulis, I, Mulligan, AM, Glendon, G, Blanco, I, Lazaro, C, Whittemore, AS, McGuire, V, Sieh, W, Montagna, M, Alducci, E, Sadetzki, S, Chetrit, A, Kwong, A, Kjaer, SK, Jensen, A, Hogdall, E, Neuhausen, S, Nussbaum, R, Daly, M, Greene, MH, Mai, PL, Loud, JT, Moysich, K, Toland, AE, Lambrechts, D, Ellis, S, Frost, D, Brenton, JD, Tischkowitz, M, Easton, DF, Antoniou, A, Chenevix-Trench, G, Gayther, SA, Bowtell, D, Pharoah, PDP, Candido-dos-Reis, FJ, Song, H, Goode, EL, Cunningham, JM, Fridley, BL, Larson, MC, Alsop, K, Dicks, E, Harrington, P, Ramus, SJ, de Fazio, A, Mitchell, G, Fereday, S, Bolton, KL, Gourley, C, Michie, C, Karlan, B, Lester, J, Walsh, C, Cass, I, Olsson, H, Gore, M, Benitez, JJ, Garcia, MJ, Andrulis, I, Mulligan, AM, Glendon, G, Blanco, I, Lazaro, C, Whittemore, AS, McGuire, V, Sieh, W, Montagna, M, Alducci, E, Sadetzki, S, Chetrit, A, Kwong, A, Kjaer, SK, Jensen, A, Hogdall, E, Neuhausen, S, Nussbaum, R, Daly, M, Greene, MH, Mai, PL, Loud, JT, Moysich, K, Toland, AE, Lambrechts, D, Ellis, S, Frost, D, Brenton, JD, Tischkowitz, M, Easton, DF, Antoniou, A, Chenevix-Trench, G, Gayther, SA, Bowtell, D, and Pharoah, PDP

Abstract

PURPOSE: To analyze the effect of germline mutations in BRCA1 and BRCA2 on mortality in patients with ovarian cancer up to 10 years after diagnosis. EXPERIMENTAL DESIGN: We used unpublished survival time data for 2,242 patients from two case-control studies and extended survival time data for 4,314 patients from previously reported studies. All participants had been screened for deleterious germline mutations in BRCA1 and BRCA2. Survival time was analyzed for the combined data using Cox proportional hazard models with BRCA1 and BRCA2 as time-varying covariates. Competing risks were analyzed using Fine and Gray model. RESULTS: The combined 10-year overall survival rate was 30% [95% confidence interval (CI), 28%-31%] for non-carriers, 25% (95% CI, 22%-28%) for BRCA1 carriers, and 35% (95% CI, 30%-41%) for BRCA2 carriers. The HR for BRCA1 was 0.53 at time zero and increased over time becoming greater than one at 4.8 years. For BRCA2, the HR was 0.42 at time zero and increased over time (predicted to become greater than 1 at 10.5 years). The results were similar when restricted to 3,202 patients with high-grade serous tumors and to ovarian cancer-specific mortality. CONCLUSIONS: BRCA1/2 mutations are associated with better short-term survival, but this advantage decreases over time and in BRCA1 carriers is eventually reversed. This may have important implications for therapy of both primary and relapsed disease and for analysis of long-term survival in clinical trials of new agents, particularly those that are effective in BRCA1/2 mutation carriers.

Published
2015

47. Associations of common breast cancer susceptibility alleles with risk of breast cancer subtypes in BRCA1 and BRCA2 mutation carriers

Author

Kuchenbaecker, K.B. (Karoline), Neuhausen, S.L. (Susan), Robson, M. (Mark), Barrowdale, D. (Daniel), McGuffog, L. (Lesley), Mulligan, A.M. (Anna Marie), Andrulis, I.L. (Irene), Spurdle, A.B. (Amanda), Schmidt, M.K. (Marjanka), Schmutzler, R.K. (Rita), Engel, C. (Christoph), Wapenschmidt, B. (Barbara), Nevanlinna, H. (Heli), Thomassen, M. (Mads), Southey, M.C. (Melissa), Radice, P. (Paolo), Ramus, S.J. (Susan), Domchek, S.M. (Susan), Nathanson, K.L. (Katherine), Lee, A. (Andrew), Healey, S. (Sue), Nussbaum, R. (Robert), Rebbeck, R. (Timothy), Arun, B.K. (Banu), James, M. (Margaret), Karlan, B.Y. (Beth), Lester, K.J. (Kathryn), Cass, I. (Ilana), Terry, M.B. (Mary Beth), Daly, M.J. (Mark), Goldgar, D. (David), Buys, S.S. (Saundra), Janavicius, R. (Ramunas), Tihomirova, L. (Laima), Tung, N. (Nadine), Dorfling, C.M. (Cecilia), Rensburg, E.J. (Elizabeth) van, Steele, L. (Linda), Overeem Hansen, T. (Thomas) van, Ejlertsen, B. (Bent), Gerdes, A-M. (Anne-Marie), Nielsen, F. (Finn), Dennis, J. (Joe), Cunningham, J.M. (Julie), Hart, S. (Stewart), Slager, S. (Susan), Osorio, A. (Ana), Benítez, J. (Javier), Duran, M. (Mercedes), Weitzel, J.N. (Jeffrey), Tafur, I. (Isaac), Hander, M. (Mary), Peterlongo, P. (Paolo), Manoukian, S. (Siranoush), Peissel, B. (Bernard), Roversi, G. (Gaia), Scuvera, G. (Giulietta), Bonnani, B. (Bernardo), Mariani, P. (Paolo), Volorio, S. (Sara), Dolcetti, R. (Riccardo), Varesco, L. (Liliana), Papi, L. (Laura), Tibiletti, M.G. (Maria Grazia), Giannini, G. (Giuseppe), Fostira, F. (Florentia), Konstantopoulou, I. (I.), Garber, J. (Judy), Hamann, U. (Ute), Donaldson, A. (Alan), Brewer, C. (Carole), Foo, C. (Claire), Evans, D.G. (Gareth), Frost, D. (Debra), Eccles, D. (Diana), Douglas, F. (Fiona), Brady, A. (A.), Cook, J. (Jackie), Tischkowitz, M. (Marc), Adlard, L., Barwell, J. (Julian), Ong, K., Walker, L.J. (Lisa), Izatt, L. (Louise), Side, L. (Lucy), Kennedy, M.J. (John), Rogers, M.T. (Mark), Porteous, M.E. (Mary), Morrison, P.J. (Patrick), Platte, R. (Radka), Eeles, R. (Ros), Davidson, R. (Rosemarie), Hodgson, S. (Shirley), Ellis, S.D. (Steve), Godwin, A.K. (Andrew), Rhiem, K. (Kerstin), Meindl, A. (Alfons), Ditsch, N. (Nina), Arnold, N. (Norbert), Plendl, H. (Hansjoerg), Niederacher, D. (Dieter), Sutter, C. (Christian), Steinemann, D. (Doris), Bogdanova-Markov, N. (Nadja), Kast, K. (Karin), Varon-Mateeva, R. (Raymonda), Wang-Gohrke, S. (Shan), Gehrig, P.A. (Paola A.), Markiefka, B. (Birgid), Buecher, B. (Bruno), Lefol, C. (Cédrick), Stoppa-Lyonnet, D. (Dominique), Rouleau, E. (Etienne), Prieur, F. (Fabienne), Damiola, F. (Francesca), Barjhoux, L. (Laure), Faivre, L. (Laurence), Longy, M. (Michel), Sevenet, N. (Nicolas), Sinilnikova, O. (Olga), Mazoyer, S. (Sylvie), Bonadona, V. (Valérie), Caux-Moncoutier, V. (Virginie), Isaacs, C. (Claudine), Van Maerken, T. (Tom), Claes, K.B.M. (Kathleen B.M.), Piedmonte, M. (Marion), Andrews, L. (Lesley), Hays, J. (John), Rodriguez, G.C. (Gustavo), Caldes, T. (Trinidad), Hoya, M. (Miguel) de La, Khan, S. (Sofia), Hogervorst, F.B.L. (Frans), Aalfs, C.M. (Cora), Lange, J.L. (J.) de, Meijers-Heijboer, E.J. (Hanne), Hout, A.H. (Annemarie) van der, Wijnen, J.T. (Juul), Roozendaal, K.E. (Kees) van, Mensenkamp, A.R. (Arjen), Ouweland, A.M.W. (Ans) van den, Deurzen, C.H.M. (Carolien) van, Luijt, R.B. (Rob) van der, Olah, E., Díez, O. (Orland), Lázaro, C. (Conxi), Blanco, I. (Ignacio), Teulé, A. (A.), Menéndez, M. (Mireia), Jakubowska, A. (Anna), Lubinski, J. (Jan), Cybulski, C. (Cezary), Gronwald, J. (Jacek), Jaworska-Bieniek, K. (Katarzyna), Durda, K. (Katarzyna), Arason, A. (Adalgeir), Maugard, C., Soucy, P. (Penny), Montagna, M. (Marco), Agata, S. (Simona), Teixeira, P.J., Olswold, C. (Curtis), Lindor, N.M. (Noralane), Pankratz, V.S. (Shane), Hallberg, B. (Boubou), Wang, X. (Xianshu), Szabo, C. (Csilla), Vijai, J. (Joseph), Jacobs, L. (Lauren), Corines, M. (Marina), Lincoln, A. (Anne), Berger, A. (Andreas), Fink-Retter, A. (Anneliese), Singer, C.F. (Christian), Rappaport, C. (Christine), Kaulich, D.G. (Daphne Gschwantler), Pfeiler, G. (Georg), Tea, M.-K., Phelan, C. (Catherine), Mai, P.L. (Phuong), Greene, M.H. (Mark), Rennert, G. (Gad), Imyanitov, E.N. (Evgeny), Glendon, G. (Gord), Toland, A.E. (Amanda), Bojesen, A. (Anders), Pedersen, I.S. (Inge Sokilde), Jensen, U.B., Caligo, M.A. (Maria), Friedman, E. (Eitan), Berger, R. (Raanan), Laitman, Y. (Yael), Rantala, J. (Johanna), Arver, B. (Brita Wasteson), Loman, N. (Niklas), Borg, Å. (Åke), Ehrencrona, H. (Hans), Olopade, O.I. (Olofunmilayo), Simard, J. (Jacques), Easton, D.F. (Douglas), Chenevix-Trench, G. (Georgia), Offit, K. (Kenneth), Couch, F.J. (Fergus), Antoniou, A.C. (Antonis), Kuchenbaecker, K.B. (Karoline), Neuhausen, S.L. (Susan), Robson, M. (Mark), Barrowdale, D. (Daniel), McGuffog, L. (Lesley), Mulligan, A.M. (Anna Marie), Andrulis, I.L. (Irene), Spurdle, A.B. (Amanda), Schmidt, M.K. (Marjanka), Schmutzler, R.K. (Rita), Engel, C. (Christoph), Wapenschmidt, B. (Barbara), Nevanlinna, H. (Heli), Thomassen, M. (Mads), Southey, M.C. (Melissa), Radice, P. (Paolo), Ramus, S.J. (Susan), Domchek, S.M. (Susan), Nathanson, K.L. (Katherine), Lee, A. (Andrew), Healey, S. (Sue), Nussbaum, R. (Robert), Rebbeck, R. (Timothy), Arun, B.K. (Banu), James, M. (Margaret), Karlan, B.Y. (Beth), Lester, K.J. (Kathryn), Cass, I. (Ilana), Terry, M.B. (Mary Beth), Daly, M.J. (Mark), Goldgar, D. (David), Buys, S.S. (Saundra), Janavicius, R. (Ramunas), Tihomirova, L. (Laima), Tung, N. (Nadine), Dorfling, C.M. (Cecilia), Rensburg, E.J. (Elizabeth) van, Steele, L. (Linda), Overeem Hansen, T. (Thomas) van, Ejlertsen, B. (Bent), Gerdes, A-M. (Anne-Marie), Nielsen, F. (Finn), Dennis, J. (Joe), Cunningham, J.M. (Julie), Hart, S. (Stewart), Slager, S. (Susan), Osorio, A. (Ana), Benítez, J. (Javier), Duran, M. (Mercedes), Weitzel, J.N. (Jeffrey), Tafur, I. (Isaac), Hander, M. (Mary), Peterlongo, P. (Paolo), Manoukian, S. (Siranoush), Peissel, B. (Bernard), Roversi, G. (Gaia), Scuvera, G. (Giulietta), Bonnani, B. (Bernardo), Mariani, P. (Paolo), Volorio, S. (Sara), Dolcetti, R. (Riccardo), Varesco, L. (Liliana), Papi, L. (Laura), Tibiletti, M.G. (Maria Grazia), Giannini, G. (Giuseppe), Fostira, F. (Florentia), Konstantopoulou, I. (I.), Garber, J. (Judy), Hamann, U. (Ute), Donaldson, A. (Alan), Brewer, C. (Carole), Foo, C. (Claire), Evans, D.G. (Gareth), Frost, D. (Debra), Eccles, D. (Diana), Douglas, F. (Fiona), Brady, A. (A.), Cook, J. (Jackie), Tischkowitz, M. (Marc), Adlard, L., Barwell, J. (Julian), Ong, K., Walker, L.J. (Lisa), Izatt, L. (Louise), Side, L. (Lucy), Kennedy, M.J. (John), Rogers, M.T. (Mark), Porteous, M.E. (Mary), Morrison, P.J. (Patrick), Platte, R. (Radka), Eeles, R. (Ros), Davidson, R. (Rosemarie), Hodgson, S. (Shirley), Ellis, S.D. (Steve), Godwin, A.K. (Andrew), Rhiem, K. (Kerstin), Meindl, A. (Alfons), Ditsch, N. (Nina), Arnold, N. (Norbert), Plendl, H. (Hansjoerg), Niederacher, D. (Dieter), Sutter, C. (Christian), Steinemann, D. (Doris), Bogdanova-Markov, N. (Nadja), Kast, K. (Karin), Varon-Mateeva, R. (Raymonda), Wang-Gohrke, S. (Shan), Gehrig, P.A. (Paola A.), Markiefka, B. (Birgid), Buecher, B. (Bruno), Lefol, C. (Cédrick), Stoppa-Lyonnet, D. (Dominique), Rouleau, E. (Etienne), Prieur, F. (Fabienne), Damiola, F. (Francesca), Barjhoux, L. (Laure), Faivre, L. (Laurence), Longy, M. (Michel), Sevenet, N. (Nicolas), Sinilnikova, O. (Olga), Mazoyer, S. (Sylvie), Bonadona, V. (Valérie), Caux-Moncoutier, V. (Virginie), Isaacs, C. (Claudine), Van Maerken, T. (Tom), Claes, K.B.M. (Kathleen B.M.), Piedmonte, M. (Marion), Andrews, L. (Lesley), Hays, J. (John), Rodriguez, G.C. (Gustavo), Caldes, T. (Trinidad), Hoya, M. (Miguel) de La, Khan, S. (Sofia), Hogervorst, F.B.L. (Frans), Aalfs, C.M. (Cora), Lange, J.L. (J.) de, Meijers-Heijboer, E.J. (Hanne), Hout, A.H. (Annemarie) van der, Wijnen, J.T. (Juul), Roozendaal, K.E. (Kees) van, Mensenkamp, A.R. (Arjen), Ouweland, A.M.W. (Ans) van den, Deurzen, C.H.M. (Carolien) van, Luijt, R.B. (Rob) van der, Olah, E., Díez, O. (Orland), Lázaro, C. (Conxi), Blanco, I. (Ignacio), Teulé, A. (A.), Menéndez, M. (Mireia), Jakubowska, A. (Anna), Lubinski, J. (Jan), Cybulski, C. (Cezary), Gronwald, J. (Jacek), Jaworska-Bieniek, K. (Katarzyna), Durda, K. (Katarzyna), Arason, A. (Adalgeir), Maugard, C., Soucy, P. (Penny), Montagna, M. (Marco), Agata, S. (Simona), Teixeira, P.J., Olswold, C. (Curtis), Lindor, N.M. (Noralane), Pankratz, V.S. (Shane), Hallberg, B. (Boubou), Wang, X. (Xianshu), Szabo, C. (Csilla), Vijai, J. (Joseph), Jacobs, L. (Lauren), Corines, M. (Marina), Lincoln, A. (Anne), Berger, A. (Andreas), Fink-Retter, A. (Anneliese), Singer, C.F. (Christian), Rappaport, C. (Christine), Kaulich, D.G. (Daphne Gschwantler), Pfeiler, G. (Georg), Tea, M.-K., Phelan, C. (Catherine), Mai, P.L. (Phuong), Greene, M.H. (Mark), Rennert, G. (Gad), Imyanitov, E.N. (Evgeny), Glendon, G. (Gord), Toland, A.E. (Amanda), Bojesen, A. (Anders), Pedersen, I.S. (Inge Sokilde), Jensen, U.B., Caligo, M.A. (Maria), Friedman, E. (Eitan), Berger, R. (Raanan), Laitman, Y. (Yael), Rantala, J. (Johanna), Arver, B. (Brita Wasteson), Loman, N. (Niklas), Borg, Å. (Åke), Ehrencrona, H. (Hans), Olopade, O.I. (Olofunmilayo), Simard, J. (Jacques), Easton, D.F. (Douglas), Chenevix-Trench, G. (Georgia), Offit, K. (Kenneth), Couch, F.J. (Fergus), and Antoniou, A.C. (Antonis)

Abstract

Introduction: More than 70 common alleles are known to be involved in breast cancer (BC) susceptibility, and several exhibit significant heterogeneity in their associations with different BC subtypes. Although there are differences in the association patterns between BRCA1 and BRCA2 mutation carriers and the general population for several loci, no study has comprehensively evaluated the associations of all known BC susceptibility alleles with risk of BC subtypes in BRCA1 and BRCA2 carriers. Methods: We used data from 15,252 BRCA1 and 8,211 BRCA2 carriers to analyze the associations between approximately 200,000 genetic variants on the iCOGS array and risk of BC subtypes defined by estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and triple-negative- (TN) status; morphologic subtypes; histological grade; and nodal involvement. Results: The estimated BC hazard ratios (HRs) for the 74 known BC alleles in BRCA1 carriers exhibited moderate correlations with the corresponding odds ratios from the general population. However, their associations with ER-positive BC in BRCA1 carriers were more consistent with the ER-positive ass

Published
2014
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48. Associations of common breast cancer susceptibility alleles with risk of breast cancer subtypes in BRCA1 and BRCA2 mutation carriers

Author

Kuchenbaecker, K, Neuhausen, S, Robson, M, Barrowdale, D, Mcguffog, L, Mulligan, A, Andrulis, I, Spurdle, A, Schmidt, M, Schmutzler, R, Engel, C, Wappenschmidt, B, Nevanlinna, H, Thomassen, M, Southey, M, Radice, P, Ramus, S, Domchek, S, Nathanson, K, Lee, A, Healey, S, Nussbaum, R, Rebbeck, T, Arun, B, James, P, Karlan, B, Lester, J, Cass, I, Breast Cancer Family, R, Terry, M, Daly, M, Goldgar, D, Buys, S, Janavicius, R, Tihomirova, L, Tung, N, Dorfling, C, van Rensburg, E, Steele, L, v. O. Hansen, T, Ejlertsen, B, Gerdes, A, Nielsen, F, Dennis, J, Cunningham, J, Hart, S, Slager, S, Osorio, A, Benitez, J, Duran, M, Weitzel, J, Tafur, I, Hander, M, Peterlongo, P, Manoukian, S, Peissel, B, Roversi, G, Scuvera, G, Bonanni, B, Mariani, P, Volorio, S, Dolcetti, R, Varesco, L, Papi, L, Tibiletti, M, Giannini, G, Fostira, F, Konstantopoulou, I, Garber, J, Hamann, U, Donaldson, A, Brewer, C, Foo, C, Evans, D, Frost, D, Eccles, D, Embrace, S, Douglas, F, Brady, A, Cook, J, Tischkowitz, M, Adlard, J, Barwell, J, Ong, K, Walker, L, Izatt, L, Side, L, Kennedy, M, Rogers, M, Porteous, M, Morrison, P, Platte, R, Eeles, R, Davidson, R, Hodgson, S, Ellis, S, Godwin, A, Rhiem, K, Meindl, A, Ditsch, N, Arnold, N, Plendl, H, Niederacher, D, Sutter, C, Steinemann, D, Bogdanova Markov, N, Kast, K, Varon Mateeva, R, Wang Gohrke, S, Gehrig, A, Markiefka, B, Buecher, B, Lefol, C, Stoppa Lyonnet, D, Rouleau, E, Prieur, F, Damiola, F, GEMO Study, C, Barjhoux, L, Faivre, L, Longy, M, Sevenet, N, Sinilnikova, O, Mazoyer, S, Bonadona, V, Caux Moncoutier, V, Isaacs, C, Van Maerken, T, Claes, K, Piedmonte, M, Andrews, L, Hays, J, Rodriguez, G, Caldes, T, de la Hoya, M, Khan, S, Hogervorst, F, Aalfs, C, de Lange, J, Meijers Heijboer, H, van der Hout, A, Wijnen, J, van Roozendaal, K, Mensenkamp, A, van den Ouweland, A, van Deurzen, C, van der Luijt, R, Hebon, Olah, E, Diez, O, Lazaro, C, Blanco, I, Teulé, A, Menendez, M, Jakubowska, A, Lubinski, J, Cybulski, C, Gronwald, J, Jaworska Bieniek, K, Durda, K, Arason, A, Maugard, C, Soucy, P, Montagna, M, Agata, S, Teixeira, M, Kconfab, I, Olswold, C, Lindor, N, Pankratz, V, Hallberg, E, Wang, X, Szabo, C, Vijai, J, Jacobs, L, Corines, M, Lincoln, A, Berger, A, Fink Retter, A, Singer, C, Rappaport, C, Kaulich, D, Pfeiler, G, Tea, M, Phelan, C, Mai, P, Greene, M, Rennert, G, Imyanitov, E, Glendon, G, Toland, A, Bojesen, A, Pedersen, I, Jensen, U, Caligo, M, Friedman, E, Berger, R, Laitman, Y, Rantala, J, Arver, B, Loman, N, Borg, A, Ehrencrona, H, Olopade, O, Simard, J, Easton, D, Chenevix Trench, G, Offit, K, Couch, F, Antoniou, A, Cimba, Kuchenbaecker, KB, Neuhausen, SL, McGuffog, L, Mulligan, AM, Andrulis, IL, Spurdle, AB, Schmidt, MK, Schmutzler, RK, Ramus, SJ, Domchek, SM, Nathanson, KL, Nussbaum, RL, Rebbeck, TR, Arun, BK, Karlan, BY, Breast Cancer Family Registry, Terry, MB, Daly, MB, Goldgar, DE, Buys, SS, Dorfling, CM, van Rensburg, EJ, Gerdes, AM, Nielsen, FC, Weitzel, JN, ROVERSI, GAIA, Tibiletti, MG, Evans, DG, EMBRACE Study, Ong, KR, Side, LE, Kennedy, MJ, Rogers, MT, Porteous, ME, Morrison, PJ, Godwin, AK, GEMO Study Collaborators, Sinilnikova, OM, Rodriguez, GC, Hogervorst, FB, Aalfs, CM, de Lange, JL, Meijers Heijboer, HE, van der Hout, AH, Wijnen, JT, van Roozendaal, KE, Mensenkamp, AR, van den Ouweland, AM, van Deurzen, CH, van der Luijt, RB, HEBON, Teixeira, MR, KConFab, Investigators, Pankratz, VS, Szabo, CI, Singer, CF, Kaulich, DG, Tea, MK, Phelan, CM, Mai, PL, Greene, MH, Imyanitov, EN, Toland, AE, Pedersen, IS, Jensen, UB, Caligo, MA, Olopade, OI, Easton, DF, Couch, FJ, Antoniou, AC, CIMBA, Kuchenbaecker, K, Neuhausen, S, Robson, M, Barrowdale, D, Mcguffog, L, Mulligan, A, Andrulis, I, Spurdle, A, Schmidt, M, Schmutzler, R, Engel, C, Wappenschmidt, B, Nevanlinna, H, Thomassen, M, Southey, M, Radice, P, Ramus, S, Domchek, S, Nathanson, K, Lee, A, Healey, S, Nussbaum, R, Rebbeck, T, Arun, B, James, P, Karlan, B, Lester, J, Cass, I, Breast Cancer Family, R, Terry, M, Daly, M, Goldgar, D, Buys, S, Janavicius, R, Tihomirova, L, Tung, N, Dorfling, C, van Rensburg, E, Steele, L, v. O. Hansen, T, Ejlertsen, B, Gerdes, A, Nielsen, F, Dennis, J, Cunningham, J, Hart, S, Slager, S, Osorio, A, Benitez, J, Duran, M, Weitzel, J, Tafur, I, Hander, M, Peterlongo, P, Manoukian, S, Peissel, B, Roversi, G, Scuvera, G, Bonanni, B, Mariani, P, Volorio, S, Dolcetti, R, Varesco, L, Papi, L, Tibiletti, M, Giannini, G, Fostira, F, Konstantopoulou, I, Garber, J, Hamann, U, Donaldson, A, Brewer, C, Foo, C, Evans, D, Frost, D, Eccles, D, Embrace, S, Douglas, F, Brady, A, Cook, J, Tischkowitz, M, Adlard, J, Barwell, J, Ong, K, Walker, L, Izatt, L, Side, L, Kennedy, M, Rogers, M, Porteous, M, Morrison, P, Platte, R, Eeles, R, Davidson, R, Hodgson, S, Ellis, S, Godwin, A, Rhiem, K, Meindl, A, Ditsch, N, Arnold, N, Plendl, H, Niederacher, D, Sutter, C, Steinemann, D, Bogdanova Markov, N, Kast, K, Varon Mateeva, R, Wang Gohrke, S, Gehrig, A, Markiefka, B, Buecher, B, Lefol, C, Stoppa Lyonnet, D, Rouleau, E, Prieur, F, Damiola, F, GEMO Study, C, Barjhoux, L, Faivre, L, Longy, M, Sevenet, N, Sinilnikova, O, Mazoyer, S, Bonadona, V, Caux Moncoutier, V, Isaacs, C, Van Maerken, T, Claes, K, Piedmonte, M, Andrews, L, Hays, J, Rodriguez, G, Caldes, T, de la Hoya, M, Khan, S, Hogervorst, F, Aalfs, C, de Lange, J, Meijers Heijboer, H, van der Hout, A, Wijnen, J, van Roozendaal, K, Mensenkamp, A, van den Ouweland, A, van Deurzen, C, van der Luijt, R, Hebon, Olah, E, Diez, O, Lazaro, C, Blanco, I, Teulé, A, Menendez, M, Jakubowska, A, Lubinski, J, Cybulski, C, Gronwald, J, Jaworska Bieniek, K, Durda, K, Arason, A, Maugard, C, Soucy, P, Montagna, M, Agata, S, Teixeira, M, Kconfab, I, Olswold, C, Lindor, N, Pankratz, V, Hallberg, E, Wang, X, Szabo, C, Vijai, J, Jacobs, L, Corines, M, Lincoln, A, Berger, A, Fink Retter, A, Singer, C, Rappaport, C, Kaulich, D, Pfeiler, G, Tea, M, Phelan, C, Mai, P, Greene, M, Rennert, G, Imyanitov, E, Glendon, G, Toland, A, Bojesen, A, Pedersen, I, Jensen, U, Caligo, M, Friedman, E, Berger, R, Laitman, Y, Rantala, J, Arver, B, Loman, N, Borg, A, Ehrencrona, H, Olopade, O, Simard, J, Easton, D, Chenevix Trench, G, Offit, K, Couch, F, Antoniou, A, Cimba, Kuchenbaecker, KB, Neuhausen, SL, McGuffog, L, Mulligan, AM, Andrulis, IL, Spurdle, AB, Schmidt, MK, Schmutzler, RK, Ramus, SJ, Domchek, SM, Nathanson, KL, Nussbaum, RL, Rebbeck, TR, Arun, BK, Karlan, BY, Breast Cancer Family Registry, Terry, MB, Daly, MB, Goldgar, DE, Buys, SS, Dorfling, CM, van Rensburg, EJ, Gerdes, AM, Nielsen, FC, Weitzel, JN, ROVERSI, GAIA, Tibiletti, MG, Evans, DG, EMBRACE Study, Ong, KR, Side, LE, Kennedy, MJ, Rogers, MT, Porteous, ME, Morrison, PJ, Godwin, AK, GEMO Study Collaborators, Sinilnikova, OM, Rodriguez, GC, Hogervorst, FB, Aalfs, CM, de Lange, JL, Meijers Heijboer, HE, van der Hout, AH, Wijnen, JT, van Roozendaal, KE, Mensenkamp, AR, van den Ouweland, AM, van Deurzen, CH, van der Luijt, RB, HEBON, Teixeira, MR, KConFab, Investigators, Pankratz, VS, Szabo, CI, Singer, CF, Kaulich, DG, Tea, MK, Phelan, CM, Mai, PL, Greene, MH, Imyanitov, EN, Toland, AE, Pedersen, IS, Jensen, UB, Caligo, MA, Olopade, OI, Easton, DF, Couch, FJ, Antoniou, AC, and CIMBA

Abstract

Introduction: More than 70 common alleles are known to be involved in breast cancer (BC) susceptibility, and several exhibit significant heterogeneity in their associations with different BC subtypes. Although there are differences in the association patterns between BRCA1 and BRCA2 mutation carriers and the general population for several loci, no study has comprehensively evaluated the associations of all known BC susceptibility alleles with risk of BC subtypes in BRCA1 and BRCA2 carriers. Methods: We used data from 15,252 BRCA1 and 8,211 BRCA2 carriers to analyze the associations between approximately 200,000 genetic variants on the iCOGS array and risk of BC subtypes defined by estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and triple-negative- (TN) status; morphologic subtypes; histological grade; and nodal involvement. Results: The estimated BC hazard ratios (HRs) for the 74 known BC alleles in BRCA1 carriers exhibited moderate correlations with the corresponding odds ratios from the general population. However, their associations with ER-positive BC in BRCA1 carriers were more consistent with the ER-positive associations in the general population (intraclass correlation (ICC)=0.61, 95% confidence interval (CI): 0.45 to 0.74), and the same was true when considering ER-negative associations in both groups (ICC=0.59, 95% CI: 0.42 to 0.72). Similarly, there was strong correlation between the ER-positive associations for BRCA1 and BRCA2 carriers (ICC=0.67, 95% CI: 0.52 to 0.78), whereas ER-positive associations in any one of the groups were generally inconsistent with ER-negative associations in any of the others. After stratifying by ER status in mutation carriers, additional significant associations were observed. Several previously unreported variants exhibited associations at P <10-6 in the analyses by PR status, HER2 status, TN phenotype, morphologic subtypes, histological grade and nodal involvement. Con

Published
2014

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