BRCA Is Not the Only Common Variant for Breast and Ovarian Cancer

Researchers retrospectively sequenced the following variants in 2,806 individuals undergoing hereditary breast and ovarian cancer testing at their institution between March 2016 and August 2017: BARD1, BRCA1, BRCA2, BRIP1, RAD51C, RAD51D, TP53, MRE11A, RAD50, NBN, FAM175A, ATM, PALB2, STK11, MEN1, PTEN, CDH1, MUTYH, CHEK2, BLM, XRCC2, EPCAM, MLH1, MSH6, PMS2, and MSH2.

Among the cohort, 11.9% had a detectable germline pathogenic alteration. BRCA1 and BRCA2 were the most common detections (3.35% and 2.92%, respectively). Other common germline alterations included CHEK2 (2.5%), ATM (1.1%), PALB2 (0.5%), and TP53 (0.1%); 1% of patients had germline alterations that contribute to ovarian cancer risk (BRIP, RAD51C, or RAD51D). 

The median age at onset of breast cancer in patients with CHEK2, ATM, or PALB2 variants was 47, 53, and 39 years, respectively; however, the age of breast cancer diagnosis in those with germline TP53 alterations was significantly younger (33 years) than patients with CHEK2, ATM, or PALB2 variants. 

Among patients with CHEK2, PALB2, or TP53 variants, researchers detected in situ carcinomas in 9%, 11%, and 11% of patients, respectively. Researchers observed T3 or higher tumors among 33% of patients with PALB2, 22% with TP53, 13% with CHEK2, and 12% with ATM variants.  

Forty to 60% of patients with those four variants had negative nodal status. More than half of patients with CHEK2, ATM, or PALB2 variants had luminal tumors compared to 22% of patients with TP53 alterations. 

“Almost half of the pathogenic variants detected are alterations in genes other than BRCA1 and BRCA2,” the researchers concluded. “CHEK2 variants are by far the most prevalent, followed by ATM, PALB2, and TP53.”