FA gene pathogenic variant carrier status can have implications for reproductive decision making because pathogenic variants in these genes can lead to serious childhood onset of disease if both parents are carriers of pathogenic variants in the same gene.
Five-year follow-up in the same cohort showed improved survival for carriers of both BRCA1 and BRCA2 pathogenic variants(54 months) versus noncarriers(38 months), which was most pronounced for women with stages III and IV ovarian cancer and for women with high-grade tumors.
In contrast, prostate cancer risk associated with the BRCA2 pathogenic variant began to rise at later ages, reaching 5% by age 70 years and 36% by age 80 years(numeric values were provided by the author[written communication, April 2005]).
The need for effective ovarian cancer screening is particularly important for women carrying BRCA1 and BRCA2 pathogenic variants, and the mismatch repair(MMR) genes(e.g., MLH1, MSH2, MSH6, PMS2), disorders in which the risk of ovarian cancer is high.
Subsequently, in a study of 89 BRCA1 carriers and 175 noncarriers with triple-negative breast cancer, BRCA1 pathogenic variant status was not an independent predictor of survival after adjusting for age, oophorectomy, and risk-reducing mastectomy.
In a group of 148 carriers of BRCA1 and BRCA2 pathogenic variants with unilateral breast cancer, 79 of whom underwent CRRM, the risk of CBC was reduced by 91% and was independent of the effect of risk-reducing oophorectomy.
The Cancer Genetics Studies Consortium task force has recommended that female carriers of a BRCA1 pathogenic variant undergo annual or semiannual screening using TVUS and serum CA-125 levels, beginning at age 25 to 35 years.
With the routine use of magnetic resonance imaging(MRI) in carriers of BRCA1 and BRCA2 pathogenic variants, any potential benefit of mammographic screening must be carefully weighed against potential risks, particularly in young women.
Some individuals diagnosed with HLRCC have an affected parent, while others have unaffected parents, suggesting that some individuals have HLRCC as the result of a de novo pathogenic variant or parental mosaicism.
However, recent technological advances have resulted in the widespread availability of multigene(panel) testing, which can simultaneously test for pathogenic variants in many genes at once, often at costs comparable to single-gene testing.
In a study of 480 German families characterized by breast and ovarian cancers who were negative for BRCA1 and BRCA2 pathogenic variants, six monoallelic variants in RAD51C were found(frequency of 1.3%).
In that study of 1,993 carriers of BRCA1 and BRCA2 pathogenic variants from the United Kingdom, France, and the Netherlands, age-specific total diagnostic radiation exposure(e.g., chest x-rays, mammography, fluoroscopy, and computed tomography) estimates were derived from self-reported questionnaires.
Given the current limitations of screening for ovarian cancer and the high risk of the disease in carriers of BRCA1 and BRCA2 pathogenic variants, NCCN Guidelines recommend RRSO between the ages of 35 and 40 years or upon completion of childbearing, as an effective risk-reduction option.
One study has suggested that the most cost-effective screening strategy in carriers of BRCA1 and BRCA2 pathogenic variants may be annual MRI beginning at age 25 years, with alternating MRI and digital mammography(so that each test is done annually but screening occurs every 6 months) beginning at age 30 years.
Two relatively small studies- one of 77 BRCA1/BRCA2 pathogenic variant- negative probands with a personal or family history of pancreatic cancer, one-half of whom were of AJ descent, and another study of 29 Italian pancreatic cancer patients with a personal or family history of breast or ovarian cancer- failed to detect any PALB2 pathogenic variants..
Multi-Society Task Force on Colorectal Cancer(2014)b 20- 25 y or 2- 5 y before youngest case of CRC in family if before age 25 y 1- 2 y(annual for carriers of MMR pathogenic variants) Colonoscopy For MSH6 and PMS2 carriers, consider starting screening at ages 30 y and 35 y, respectively, unless an early-onset cancer occurs in the family.
生殖細胞FLCN病原性多様体。
Germline FLCN pathogenic variant.
Denovo病原性多様体とモザイク現象。
De novo pathogenic variants and mosaicism.
CDKN2A病原性多様体キャリアにおける膵がんスクリーニング。
Pancreatic cancer screening in CDKN2A pathogenic variant carriers.
証拠レベル(BRCA病原性多様体キャリアにおけるスクリーニング):3。
Level of evidence(screening in carriers of BRCA pathogenic variants): 3.
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