Abstract
Abstract
Background
In the past two decades, genetic testing for cancer risk assessment has entered mainstream clinical practice due to the availability of low-cost panels of multiple cancer-associated genes. However, the clinical value of multiple-gene panels for cancer susceptibility is not well established, especially in cases where panel testing identifies more than one pathogenic variant. The risk for specific malignancies as a result of a mutated gene is complex and likely influenced by superimposed modifier variants and/or environmental effects. Recent data suggests that the combination of multiple pathogenic variants may be fewer than reported by chance, suggesting that some mutation combinations may be detrimental. Management of patients with “incidentally” discovered mutations can be particularly challenging, especially when established guidelines call for radical procedures (e.g. total gastrectomy in CDH1) in patients and families without a classic clinical history concerning for that cancer predisposition syndrome.
Case presentation
We present two cases, one of an individual and one of a family, with multiple pathogenic mutations detected by multi-gene panel testing to highlight challenges practitioners face in counseling patients about pathogenic variants and determining preventive and therapeutic interventions.
Conclusions
Ongoing investigation is needed to improve our understanding of inherited susceptibility to disease in general and cancer predisposition syndromes, as this information has the potential to lead to the development of more precise and patient-specific counseling and surveillance strategies. The real-world adoption of new or improved technologies into clinical practice frequently requires medical decision-making in the absence of established understanding of gene-gene interactions. In the meantime, practitioners must be prepared to apply a rationale based on currently available knowledge to clinical decision-making. Current practice is evolving to rely heavily on clinical concordance with personal and family history in making specific therapeutic decisions.
Funder
Division of Cancer Epidemiology and Genetics, National Cancer Institute
National Cancer Institute
Publisher
Springer Science and Business Media LLC
Subject
Genetics (clinical),Oncology
Reference41 articles.
1. Espenschied CR, LaDuca H, Li S, McFarland R, Gau C-L, Hampel H. Multigene panel testing provides a new perspective on lynch syndrome. J Clin Oncol. 2017;35(22):2568–75.
2. Palmirotta R, Lovero D, Stucci LS, Silvestris E, Quaresmini D, Cardascia A, Silvestris F. Double heterozygosity for BRCA1 pathogenic variant and BRCA2 polymorphic stop codon K3326X: a case report in a southern Italian family. Int J Mol Sci. 2018;19(1):285.
3. Esplin, E. Increasing Access for Patients With Pancreatic Cancer to Germline Genetic Testing: Clinical Impact Across Disease Stage and Ethnicity. Oral presenation at: 39th Annual National Society of Genetic Counselors Meeting; November 2020; Virtual.
4. Peltomäki P. Update on lynch syndrome. Familial Cancer. 2016;15(3):385–93.
5. Thompson BA, Spurdle AB, Plazzer J-P, et al. Application of a five-tiered scheme for standardized classification of 2,360 unique mismatch repair gene variants lodged on the InSiGHT locus-specific database. Nat Genet. 2014;46(2):107–15.
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