Study: What are the genetics underlying 12 different cancer types?
Summary
As gene sequencing has become more affordable, researchers and health care providers are now looking for mutations in many genes beyond BRCA1, BRCA2 and others that are associated with known hereditary cancer syndromes. By sequencing thousands of genes rather than just one or two, researchers can better understand which inherited mutations affect cancer risk. In this study, researchers sequenced thousands of genes in patients with one of 12 cancers, including breast, and catalogued which gene mutations are most commonly found in each cancer. (03/01/16)
Relevance
This article is most relevant for People diagnosed with cancer
Relevance: Medium
Strength of Science: Medium-High
Research Timeline: Post Approval
Media Ratings
Who covered this study?
New York Post
Scientists say cancer susceptibility is genetic
This article rates 3.5 out of 5 stars
Daily Mail UK
Revealed... 12 cancers that ARE inherited - and how the 'Angelina Jolie gene' could also trigger stomach and prostate tumors
This article rates 3.5 out of 5 stars
Contents
| At a glance | In-depth |
| Findings | Limitations |
| Questions for your doctor | Resources |
STUDY AT A GLANCE
This study is about:
Inherited gene mutations found in some patients with one of 12 different cancers.
Why is this study important?
Researchers believe that at least 3% of all cancer cases have a strong hereditary component. One example is mutations, which greatly increase the risk of breast cancer. Other gene mutations also increase cancer risk, but not to the same extent as . Understanding how often gene mutations that confer moderately higher cancer risk occur in patients is a priority, as these mutations can still be passed to sons and daughters, and may affect patients’ treatment decisions. According to the study authors, “Such discovery of new cancer susceptibility genes…will be an important step towards generating an actionable catalogue for personalized treatment of cancer.”
Study findings:
- The most commonly mutated genes that increase cancer risk are: , , , , and .
- The percentage of patients with gene mutations that increase cancer risk varies among cancers. For example, 19% of ovarian cancer patients in this study had an that increases cancer risk, compared to only 4% of acute myeloid leukemia patients.
What does this mean for me?
This study identifies and catalogues gene mutations that increase a person’s susceptibility to cancer. Ultimately, the goal is to understand which mutations are clinically relevant and how they increase cancer susceptibility, so that health care providers can determine their patients’ cancer risks and treatment plans. However, we have no national guidelines on how to care for patients with some of the newly discovered mutations, or for patients with mutations that have been studied less extensively than mutations or the mutated genes that cause . This study is an important step in helping researchers get a complete understanding of the role that inherited mutations play in different cancers. But more work needs to be done to fully assess the clinical relevance of these findings. Patients with mutations in genes that do not have national guidelines outlining risk management options should work with their health care providers to determine appropriate treatments and screenings for themselves and their families.
Posted 3/1/16
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References
Lu C, Xie M, Wendl MC, et al. “Patterns and functional implications of rare germline variants across 12 cancer types.” Nature Communications. Published online first on December 22, 2015.
Disclosure
FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
This article is relevant for:
People diagnosed with cancer
This article is also relevant for:
previvors
people with a genetic mutation linked to cancer risk
people with a family history of cancer
people newly diagnosed with cancer
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IN DEPTH REVIEW OF RESEARCH
Study background:
Some inherited gene mutations confer an extremely high risk of cancer, while others moderately increase cancer risk. In families with mutations in genes that moderately increase cancer risk, determining that cancer is hereditary may be more difficult. However, improved and more affordable genetic sequencing is helping researchers to learn more about these types of mutations.
In December 2015, Li Ding and colleagues from the Washington University School of Medicine in St. Louis and other institutions published in Nature Communications their study of gene mutations in cancer patients with one of 12 different types of cancer. Rather than sequencing a handful of genes known to be involved in cancer risk, the researchers used data from “exome sequencing,” which looks at the sequence of all genes used in the cell. Researchers then analyzed the data to find which mutations were inherited and known to be involved in cancer risk. This provides a more comprehensive catalog of the types of inherited gene mutations found in patients with these 12 types of cancer.
Researchers of this study wanted to know:
How genetics contributes to cancer development.
Population(s) looked at in the study:
The study looked at the sequences from 4,034 patients: about 88% of the patients were Caucasian, about 6% were African American, about 5% were Asian, and .4% were American Indian/Alaska Native. On average, patients were diagnosed at about 60 years old with one of the following 12 types of cancer:
- Breast cancer
- Glioblastoma, a type of brain cancer
- Low grade glioma, a type of brain cancer
- Head and neck cancer
- Kidney renal clear cell carcinoma
- Acute myeloid leukemia, a type of blood cancer
- Two different types of non-small cell lung cancer
- Ovarian cancer
- cancer
- Stomach cancer
- Uterine cancer
Study findings:
- Among the 12 cancers in this study, , , , , and genes were most associated with cancer predisposition.
- The most commonly detected inherited gene mutations in breast cancer patients were in , , FANCM, and .
- The most commonly detected inherited gene mutations in ovarian cancer patients were in , , PIK3C2G, , CNKSR1, , , and .
- Mutations in and were significantly associated with ovarian cancer.
- The percentage of patients with risk-increasing gene mutations varies among cancers.
- 19% of ovarian cancer patients in this study had an in a gene that increases cancer risk, compared to only 4% of acute myeloid leukemia patients, indicating that inherited mutations play a greater role in ovarian cancer than acute myeloid leukemia.
- 11% of stomach cancer patients in this study carried an .
Limitations:
Researchers did not have information on the family histories of the cancer patients in this study, which would have provided more insight regarding the cancer risk conferred by the patients’ mutations. While the study looked at a sizeable group of patients, only a small number of them had some of the individual cancers. For example, only 178 cancer patients were identified, compared to 770 breast cancer patients, which makes it difficult to draw conclusions about cancer from the limited sample size. Additionally, because the majority of the study population was Caucasian, the results are more relevant to that population, and not as relevant to individuals of other backgrounds.
Conclusions:
It is important to remember that this single study does not prove that inherited mutations in some of these genes are directly associated with specific cancers. According to the study authors, “This study is the largest to date that has integrated somatic and germline alterations to identify important genes across 12 major types contributing to cancer susceptibility, and our results provide a promising list of candidate genes for definitive association and functional analysis.” This means that the researchers found many new genes to study, but more work needs to be done before their data becomes clinically relevant. People with mutations in one of the genes highlighted in this study should talk to their health care providers about their cancer risk and how to manage it.
Posted 03/01/16
Expert Guidelines
The National Comprehensive Cancer Network has guidelines on who should undergo genetic counseling and testing. If you have been diagnosed with breast cancer, you should speak with a genetics expert about genetic testing if any of the following apply to you:
- You have a blood relative who has tested positive for an
- You have any of the following:
- Breast cancer at age 50 or younger
- Male breast cancer at any age
- Ovarian cancer at any age
- at any age
- Two separate breast cancer diagnoses
- Eastern European Jewish ancestry and breast cancer at any age
- Lobular breast cancer and a family history of diffuse gastric cancer
- For treatment decisions for people with breast cancer or people with early , breast cancer who are at high-risk for recurrence
- Testing of your tumor shows a mutation in a gene that is associated with
OR
- You have one or more close family members who have had:
- Young-onset or rare cancers
- Breast cancer at age 50 or younger
- Male breast cancer, ovarian cancer, pancreatic cancer, or cancer at any age
- Two separate cancer diagnoses
- prostate cancer or cancer that is high-risk or very-high-risk group.
The American Society of Breast Cancer Surgeons (ASBrS) released guidelines in 2019 that recommend all women diagnosed with breast cancer have access to genetic testing for inherited mutations in breast cancer genes.
If you are uncertain whether you meet the guidelines above and you are interested in or considering genetic testing, you should speak with a cancer genetics expert.
Updated: 07/28/2023
Expert Guidelines
The National Comprehensive Cancer Network (NCCN) guidelines recommend genetic counseling and testing for anyone diagnosed at any age with epithelial ovarian, or primary peritoneal cancer.
Updated: 11/13/2023
Expert Guidelines
The National Comprehensive Cancer Network guidelines recommend genetic counseling and testing for the following people with cancer who have:
- a tumor test result that suggests an inherited mutation
- for example, a tumor with a , or mutation may indicate an in one of those genes
- a blood relative who tested positive for an in a gene linked to cancer
- cancer diagnosed at any age
- cancer that has spread to the
- localized cancer (hasn’t spread beyond the ) that is considered very high-risk or high-risk
- intermediate-risk cancer with intraductal or cribriform features listed on the
- a diagnosis of male breast cancer
- Eastern European (Ashkenazi) Jewish ancestry
- one or more relatives with:
- breast, colorectal or endometrial cancer diagnosed at age 50 or younger
- male breast cancer, triple negative breast cancer, ovarian cancer or pancreatic cancer at any age
- , regional, very-high-risk, or high-risk cancer at any age
- one or more close relatives with cancer diagnosed at age 60 or younger
- three or more relatives on the same side of the family with biliary tract, breast, colorectal, endometrial, glioblastoma, or other cancers
Speak with a genetic counselor if you have questions about whether you meet guidelines for genetic testing.
Updated: 02/01/2024
Expert Guidelines
The National Comprehensive Cancer Network (NCCN) has guidelines for genetic counseling and testing for people diagnosed with colorectal or endometrial cancer. People who have any of the following should speak with a genetics expert about genetic testing:
- A tumor test result that suggests an (for example, an MSI-H or tumor).
- A blood relative who tested positive for an linked to cancer.
- Colorectal or endometrial cancer diagnosed before age 50.
- Diagnoses of more than one cancer.
- A family history of one or more first- or second-degree relatives with any of the following types of cancer diagnosed before age 50 or two or more first- or second-degree relatives with any of the following cancers diagnosed at any age:
- colorectal
- endometrial
- ovarian
- gastric
- small bowel
- biliary tract
- pancreatic
- urothelial
- brain (usually glioblastoma)
- Colorectal cancer and a personal history of polyps:
- 10 or more adenomatous
- 2 or more hamartomatous
- 5 or more serrated close to the rectum
Updated: 11/12/2023
Questions To Ask Your Doctor
- I carry a mutation in (, , , , , or ) What does this mean for me and my family?
- I have an extensive family history of breast cancer, but my family does not carry a mutation. Should I consider genetic testing that looks for mutations in other genes?
- I had breast cancer before age 50 but tested negative for a mutation in . Should I consider genetic testing that looks for mutations in other genes?
Open Clinical Trials
The following clinical trials include genetic counseling and testing.
- NCT02620852: WISDOM Study: Women Informed to Screen Depending on Measures of Risk offers women ages 40-74 the opportunity to undergo risk assessment and genetic testing in order to determine the best breast screening options based on their situation.
- NCT05562778: Chatbot to maximize genetic risk assessment. Researchers are testing whether a mobile health platform, known as a "chatbot" can improve rates of genetic testing among Medicaid patients with an elevated risk having an .
- NCT05427240: eHealth Delivery Alternative for Cancer Genetic Testing for (eReach2). This study will look at the effectiveness of offering web-based options for pre/post-test genetic counseling to provide equal or improved timely uptake of genetic services and testing.
- NCT05694559: Connecting Black Families in Houston, Texas to Genetic Counseling, Genetic Testing, and Cascade Testing by Using a Simple Genetic Risk Screening Tool and Telegenetics. This study will provide genetic testing to 150 Black individuals and families and provide genetic counseling and risk reduction resources to individuals with a mutation linked to increased cancer risk.
Other genetic counseling or testing studies may be found here.
Updated: 02/29/2024
Peer Support
FORCE offers many peer support programs for people with inherited mutations.
- Our Message Boards allow people to connect with others who share their situation. Once registered, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Our moderated, private Facebook group allows you to connect with other community members 24/7.
- Check out our virtual and in-person support meeting calendar.
- Join one of our Zoom community group meetings.
Updated: 08/06/2022
Find Experts
The following resources can help you locate a genetics expert near you or via telehealth.
Finding genetics experts
- The National Society of Genetic Counselors website has a search tool for finding a genetic counselor by specialty and location or via telehealth.
- InformedDNA is a network of board-certified genetic counselors providing this service by telephone. They can also help you find a qualified expert in your area for face-to-face genetic counseling if that is your preference.
- Gene-Screen is a third-party genetic counseling group that can help educate, support and order testing for patients and their families.
- JScreen is a national program from Emory University that provides low-cost at-home genetic counseling and testing with financial assistance available.
- Grey Genetics provides access to genetic counselors who offer genetic counseling by telephone.
- The Genetic Support Foundation offers genetic counseling with board-certified genetic counselors.
Related experts
Genetics clinics
- The American College of Medical Genetics website has a tool to find genetics clinics by location and specialty.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers have genetic counselors who specialize in cancer.
- FORCE's toll-free helpline (866-288-RISK, ext. 704) will connect you with a volunteer board-certified genetic counselor who can help you find a genetics expert near you.
Updated: 07/21/2023
Related Resources
The following organizations have resources related to genetic counseling and testing:
- FORCE related resources:
- Book: Living with Risk
- Information: What is genetic testing?
- Information: How to get genetic testing
- Information: , genes and risk
- Video: ABC of Cancer Genetics
- Blogs: Genetic testing
- National Society of Genetic Counseling
- JScreen
Updated: 11/13/2023
Who covered this study?
New York Post
Scientists say cancer susceptibility is genetic
This article rates 3.5 out of 5 stars
Daily Mail UK
Revealed... 12 cancers that ARE inherited - and how the 'Angelina Jolie gene' could also trigger stomach and prostate tumors
This article rates 3.5 out of 5 stars
Oncotherapy Network
Investigators identify patterns of rare germline variants in 12 cancer types
This article rates 3.5 out of 5 stars
Medical News Today
Study reveals how hereditary gene mutations affect risk of certain cancers
This article rates 3.5 out of 5 stars