Familial Cancer最新文献

NF2-related schwanomatosis (NF2-SWN) (previously Neurofibromatosis 2) as characterised by bilateral vestibular schwannomas (VS) was first described in 1822. However, due to the erroneous conflation of individuals with bilateral eighth nerve tumours with von Recklinghausen disease (currently Neurofibromatosis 1, NF1) in 1917 the literature was confusing for much of the 20th century. Even when the conditions were separated officially in 1987 (with separate localisation of the genes), NF2-SWN remained classified as a neurofibromatosis despite the tumours pathognomonic for NF1, neurofibromas, not being a feature of NF2-schwannomatosis. It is only in 2022 that NF2-SWN was correctly delineated as a schwannomatosis. The epidemiology of NF2-SWN has only been possible to delineate after the separation of NF2-SWN from the much more frequent nerve sheath predisposing tumour condition NF1. Two research groups have published on the birth prevalence and population prevalence of NF2-SWN in the UK and Finland. The most highly ascertained assessment of NF2-SWN cases from the Manchester region of England (population 4.8 million) gave a diagnostic prevalence of 1 in 50,500 and calculated birth prevalences of 1 in 27,956 respectively. However, an updated prevalence across England in 2024 (population 55 million) gave a prevalence of at least 1 in 58,000. NF2-SWN usually presents with bilateral vestibular schwannoma, but can present with meningioma or spinal tumour or ophthalmic features before a VS diagnosis or with a unilateral VS and other tumours and rarely with a unilateral VS alone. Molecular testing is now extremely helpful in confirming the diagnosis of mosaic (present in up to 50% of de novo cases) versus germline NF2 and distinguishing from other tumour predisposition conditions especially in childhood or cases with less common presentation. This chapter summarises the clinical epidemiology of NF2-SWN differentiating the condition from the overlapping non NF2-SWN.

Lynch syndrome (LS) is a hereditary cancer predisposition syndrome caused by a pathogenic germline variant in one of the mismatch repair (MMR) genes. There is a lack of evidence supporting surveillance for urothelial carcinoma (UC) in LS, however several surveillance strategies have been proposed in recent years. This has led to a variety of practices. This study reports on the current practice for UC surveillance in LS in the Netherlands. Individuals with LS from two university hospitals and a large comprehensive cancer center were selected. Data on UC surveillance and UC diagnoses were recorded. Cumulative incidence was calculated. Of 235 individuals with LS, 40% underwent UC surveillance. Individuals with a pathogenic MSH2 variant were under surveillance significantly more often than those with other pathogenic variants. Of the individuals who underwent surveillance 10% had annual testing and continued surveillance up until the last known follow up date. None of the surveillance tests led to a UC diagnosis. Of eight patients with UC, two were under active surveillance, but were diagnosed due to macroscopic hematuria after normal cytology results. Cumulative UC incidence was 9% at age 75. Currently, most individuals with LS in this cohort are not part of a surveillance program for UC. Cumulative UC risk is high, up to 9%, and none of the UC were detected by surveillance. Given the lack of evidence that a suitable surveillance test is available, we do not recommend surveillance for UC.

Only 67% of eligible patients with breast cancer currently undergo genetic testing. Mainstream genetic testing (i.e. healthcare professionals (HCPs) from outside the genetics field providing genetic counselling), also referred to asmainstreaming, leads to increased uptake of genetic testing. Unlike surgical oncologists, medical oncologists have not yet widely adopted mainstreaming. This study aims to identify barriers and facilitators for HCPs, in particular medical oncologists, in advancing the implementation of mainstreaming. Structured interviews were conducted with HCPs (predominantly medical oncologists) using the Constructive Technology Assessment (CTA) framework. Participants were recruited from all regions of the Netherlands, ensuring representation from academic medical centres, teaching hospitals and general hospitals. The interview data was analysed using thematic analysis. In this qualitative study, 12 medical oncologists, three nurse practitioners, three clinical geneticists, two clinical laboratory geneticists and one representative of a health insurer were interviewed. Lack of time and limited knowledge were the most commonly mentioned barriers, whilst effective cross-departmental collaboration and education were the most important facilitators. For medical oncologists specifically, financial compensation for the increased workload and the increasing importance of genetic testing for guiding therapy choices were found to be encouraging factors. This study identified several barriers and facilitators to mainstreaming being implemented by medical oncologists. Education to strengthen oncologists' skills in discussing germline genetic testing may address knowledge gaps and time barriers. Alongside cross-departmental collaboration, these strategies could streamline genetic testing pathways. Further research should evaluate their implementation and effects on patient experience and equitable access.

Early-onset breast cancer in a woman prompted referral for genetic counseling, due to suspected hereditary cancer predisposition. After collecting a detailed personal and family medical history and providing comprehensive pre-test counseling, the patient consented to a multigene panel test for breast cancer susceptibility. Genetic analysis revealed a germline variant, c.662 C > T p.(Pro221Leu), in the STK11 gene, initially classified as a variant of unknown significance (VUS). Given the possibility of Peutz-Jeghers syndrome (PJS), a thorough review of the patient's extended family history was undertaken to identify clinical features consistent with the syndrome. The maternal grandmother's lineage revealed a striking aggregation of malignancies, including eight cases of breast cancer (ages 34-73), one suspected gastric cancer before age 50, and five individuals with colorectal polyps. On the maternal grandfather's side, nine breast cancer cases (ages 34-77), one childhood skin cancer, and one endometrial cancer at age 56 were described. Segregation studies in multiple relatives demonstrated co-segregation of the STK11 variant with disease. This evidence supported the reclassification of the STK11 c.622 C > T p.(Pro221Leu) variant as likely pathogenic. Consequently, carriers were enrolled in syndrome-specific surveillance protocols for PJS. This case underscores the essential role of comprehensive clinical and familial assessment, alongside segregation studies, in refining variant interpretation and enabling personalized, syndrome-specific management strategies.

This study aimed to characterize, for the first time, the cancer spectrum associated with the most frequent pathogenic CHEK2 variant-NM_007194.4(CHEK2):c.707T > C p.(Leu236Pro)-in Mexican individuals. Although this variant is frequently detected through multi-gene panel testing, limited data on its associated cancer risks complicates genetic counseling and surveillance strategies. We retrospectively analyzed 5,759 patients who underwent multi-gene panel testing between August 2015 and August 2024 due to suspected hereditary cancer syndromes. Among them, 58 CHEK2 p.(Leu236Pro) carriers with confirmed cancer diagnoses were identified. Geographical clustering was observed, with 81% of patients originating from central Mexico, suggesting a possible founder effect. Ten distinct clinical indications for genetic testing were identified, with hereditary breast and ovarian cancer (HBOC) syndrome being the most common (74.1%). The mean age at first diagnosis among carriers was 43.8 ± 12 years, and 61.1% of them reported a family history of cancer in first- or second-degree relatives. A second or third primary cancer occurred in 20.7% of cases. Tumors were identified in 12 anatomical sites. Breast cancer predominated (67.6%, including one male case), followed by ovarian (8.1%), prostate (6.7%), gastric (4.1%), thyroid (2.7%), and endometrial (2.7%) cancers. Lymphoma, lung, sacrococcygeal bone, colorectal, and non-melanoma skin cancers each occurred in a single patient. Significant risk association was identified only for breast, ovarian, and gastric cancers. These results highlight the need for personalized surveillance, especially for breast cancer. Incorporating CHEK2 p.(Leu236Pro) into clinical decision-making tools may enhance risk assessment in the Mexican population, but larger studies are needed to refine risk estimates and to clarify the possible founder effect.

Li-Fraumeni syndrome (LFS) is an early-onset cancer syndrome caused by pathogenic germline TP53 variants. Adolescents and young adults (AYAs) with LFS may have challenges navigating new romantic partnerships given the significant effects of LFS on multiple life domains that also affect partners (e.g., reproductive decision-making). Disclosing LFS-related information to new partners may be especially difficult given the uncertainty, complexity, and chronicity of LFS. This qualitative-descriptive study aimed to explore AYAs' LFS disclosure decisions and experiences in new romantic partnerships. Participants were individuals with LFS aged 15-39 years at enrollment in a National Cancer Institute study. The analytic sample included 33 AYAs who completed at least one telephone interview. Greene's disclosure decision-making model guided thematic analysis. Participants were mostly female (67%) and married/in a long-term relationship (58%), with mean age 29 years and ≥ 1 primary cancer (61%). Key factors in LFS disclosure decision-making included perceived relevancy to partners (e.g., future children's genetic risk), partner traits (e.g., trustworthiness), and relationship quality (e.g., closeness). AYAs described LFS disclosures in new partnerships as a process. Disclosing LFS diagnosis often occurred early to fulfill a sense of moral obligation and emotionally self-protect from future rejection, while subsequent LFS disclosures depended on relationship quality and the topic's emotional valence or complexity. Partners often earned AYAs' trust by demonstrating a willingness to learn about and try to understand LFS. Clinicians and LFS communities could support AYAs by providing opportunities to discuss, normalize, and ameliorate challenges with LFS disclosures in new romantic partnerships (e.g., peer support groups, psychotherapy).