Study: Study identifies genes associated with risk of triple-negative breast cancer
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This study is about:
The identification of genes that increase risk of .
Why is this study important?
National guidelines currently recommend and testing for women diagnosed with () at age 60 or younger or those who meet criteria based on a personal or family history of cancer. However, there are no guidelines for genetic testing for other genes in patients. This study suggests that other non-BRCA genes also contribute to risk of .
Panel testing in 10,901 patients revealed:
- Inherited mutations were detected in approximately 14.5% of all participants.
- Of these, approximately 9% of participants had mutations that were not in or .
- Inherited mutations in the , , , , and genes were associated with a high risk of .
- Inherited mutations in , , and were associated with moderate risk of .
What does this mean for me?
Genetic testing can help people with breast cancer learn if their cancer was caused by an inherited mutation. Panel testing, which tests for inherited mutations in many genes versus gene by gene testing, can identify those at increased risk for . Knowing that you are at increased risk for may impact your risk management strategies. Panel testing can also identify those patients who would benefit from targeted treatments such as patients with .
It is important to remember that this study only applied to risk and that some of the genes studied here could be associated with greater or different overall breast cancer risk or risk of other cancers such as ovarian or pancreatic cancer.
Results of this study suggest that all individuals with should undergo panel testing. If you have been diagnosed with , ask your health care providers if panel testing is right for you.
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Shimelis H, LaDuca H, Hu C, Hart SN, Na J, Thomas A, Akinhanmi M, Moore RM, Brauch H, Cox A, Eccles DM, Ewart-Toland A, Fasching PA, Fostira F, Garber J, Godwin AK, Konstantopoulou I, Nevanlinna H, Sharma P, Yannoukakos D, Yao S, Feng BJ, Tippin Davis B, Lilyquist J, Pesaran T, Goldgar DE, Polley EC, Dolinsky JS, Couch FJ.. " Risk Genes Identified by Multigene Panel Testing." J Natl Cancer Inst. 2018. 110: 855–862.
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 triple-negative breast cancer
This article is also relevant for:
Breast cancer survivors
People with a genetic mutation linked to cancer risk
Triple negative breast cancer
Women under 45
Women over 45
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IN-DEPTH REVIEW OF RESEARCH
() is aggressive. These cancers lack estrogen, progesterone, and human epidermal growth factor () receptors, making them particularly difficult to treat given current treatment options.
TNBC accounts for about 35% of breast cancer in African Americans and about 15% in whites. At diagnosis, it is usually more advanced and is associated with an increased risk of recurrence and worse 5-year survival rates than other types of breast cancers.
Currently, NCCN guidelines recommend testing for patients diagnosed age 60 or younger. However, there are no recommendations for testing for other known breast cancer genes, because the risk of associated with other genes is unknown.
Researchers of this study wanted to better understand gene-specific risks for . Knowing who is at risk for should result in better clinical management for those at increased risk.
Researchers of this study wanted to know:
Of the genes known to increase breast cancer risk, which are associated with increased risk of ?
Researchers used panel testing to identify genes associated with increased risk of .
- Between March 2012 and June 2016, 10,901 patients with were tested using panel testing.
- A clinical cohort of 8,753 patients was tested for 21 genes by Ambry, a clinical testing laboratory.
- A Consortium cohort of 2,148 was tested for 17 genes by a Consortium of researchers.
Panel test results in the clinical cohort revealed:
- 14.4% of participants had pathogenic mutations in the one of the 21 genes tested.
- 8.4% of patients had pathogenic mutations in or
- 6% in non-BRCA genes.
Panel test results in the Consortium cohort revealed:
- 14.5% of participants had pathogenic mutations in one of 17 genes tested.
- 10.4% of participants had pathogenic mutations in or .
- 4 % in non-BRCA genes.
- (1.0%-1.6%) and (0.5%-0.7%) were the most common mutated non-BRCA genes.
Compared to controls, mutations were associated with high risk of (this finding supports previous studies). Similarly, was associated with high risk of in both cohorts. In the clinical cohort, mutations in , , and were also associated with high risk of .
In this study, and mutations were associated with an 18% and 10% lifetime risk of , respectively, followed by mutations in the (7%), (6%), and (5%) genes.
Moderate-risk risk genes were and , which were previously only associated with increased risk of ovarian cancer. Mutations in the gene, were also associated with modest risk of , consistent with the twofold increase in overall breast cancer risk shown in a recent study (the topic of a recent XRAYS review).
Mutations in , , , and were not associated with increased risk of .
While this study identifies genes associated with an increased risk of , more research will need to be done to refine the actual risk associated with each gene. The control data used in this study came from publicly available sequencing databases. Patients were not matched to controls (i.e. age, race, etc.). However, these large sequencing databases likely provide reasonable population mutation frequencies and have been used successfully in other similar studies.
Panel testing can identify women who are at increased risk of . Mutations in BRCA1/2, , PAB2, and are associated with high risk of . Women with mutations in these genes may benefit from increased screening and cancer prevention strategies. Patients with may also benefit from panel testing when considering targeted therapies such as pembrolizumab (Keytruda) for .
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 inherited mutation
- 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
- breast cancer
- Testing of your tumor shows a mutation in a gene that is associated with
- breast cancer and high risk for recurrence
- Lobular breast cancer and a family history of diffuse gastric cancer
- 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
- cancer at age 55 or younger or prostate cancer
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.
- Should I consider genetic testing?
- Can you refer me to a genetics expert?
- I had testing which was negative. Should I consider panel testing?
- Are there different risk management strategies that would benefit me?
- Are there targeted treatments that are appropriate for me?
The following are studies enrolling people with , .
- NCT04915755: Using Blood Test to Screen for Cancer after Treatment for TNBC and/or an Inherited or Tumor Mutation; Followed by Study Comparing with for People with Cancer found in their Blood (ZEST).This study will enroll people with triple negative breast cancer or people with an inherited or acquired or mutation who have completed treatment (or are still in treatment with hormone therapy) for screening using a blood test known as circulating tumor (). People who test positive for may be eligible to participate in a study to receive the , or a and undergo close monitoring with imaging (CT scans).
- NCT03498716: A Study Comparing Atezolizumab (Anti Antibody) In Combination With Anthracycline/Taxane-Based Chemotherapy Versus Chemotherapy Alone In Patients With Operable . This study will evaluate the efficacy, safety, and pharmacokinetics of atezolizumab (an ) in combination with chemotherapy in patients with II-III (Triple Negative Breast Cancer).
- NCT04584255: Treating BRCA, or PALB2-Associated Breast Cancer with a () and (Dostarlimab). This research study involves pre-operative therapy that is specifically targeted for breast cancer in individuals with mutations.
- NCT04674306: Therapy With an Alpha-lactalbumin Vaccine in . The purpose of this study is to determine the safety as well as the most effective dose of the alpha-lactalbumin vaccine (aLA breast cancer vaccine) to treat patients with non-metastatic triple negative breast cancer.
- NCT03872388: Atorvastatin in Treating Patients With IIb-III Triple Negative Breast Cancer Who Did Not Achieve a Pathologic Complete Response After Receiving Chemotherapy. This phase II trial studies how well atorvastatin works in treating patients with stages IIb-III triple negative breast cancer who did not achieve a pathologic complete response to chemotherapy. Atorvastatin is used for the treatment of high cholesterol and may reduce the risk of triple negative breast cancer from coming back.
- NCT03562637: Study of Adagloxad Simolenin (OBI-822)/OBI-821 in the Treatment of Patients With Globo H Positive . The GLORIA study is a Phase III, trial looking at the use of the drug adagloxad simolenin (OBI-822) in combination with the drug OBI-821 in the treatment of patients with high-risk TNBC.
A number of other clinical trials for patients with TNBC can be found here.
Below are clinical trials that include genetic counseling and testing.
- NCT02665195: Registry Of MultiPlex Testing (PROMPT). PROMPT is an online research registry. The goal of PROMPT is to help researchers to better understand the risks that are linked to mutations in less well-studied genes.
- NCT04245176: Genetic Testing for All Breast Cancer Patients (GET FACTS). This study looks at the impact of a novel genetic counseling method on surgical decisions in people with newly diagnosed breast cancer. This study involves genetic counseling about risk.
- NCT02620852: WISDOM Study: Women Informed to Screen Depending on Measures of Risk offers women age 40-74 the opportunity to undergo risk assessment and genetic testing in order to determine the best breast screening options based on their situation.
- Enhancing Genetic Risk Assessment in Underserved Blacks and Latinas at Risk of Hereditary Breast Cancer. This study will test how well educational materials increase the use of knowledge about risk.
- NCT04476654: Improving Uptake of Genetic Cancer Risk Assessment in African American Women-Video. This study looks at the usefulness of intervention with a culturally-tailored video to improve uptake of genetic counseling in Black women who are at increased risk of .
Other genetic counseling or testing studies may be found here.
The following organizations offer peer support services for people with, or at high risk for breast cancer:
- FORCE peer support:
- Our Message Boards allow people to connect with others who share their situation. Once you register, 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.
- Connect online with our Private Facebook Group.
- Join our virtual and in-person support meetings.
- Other organizations that offer breast cancer support:
Health care providers who are specially trained in genetics can help you more clearly understand your risk for . The following resources can help you locate a genetics expert in your area.
- The National Society of Genetic Counselor website offers a searchable directory for finding a genetic counselor by state and specialty. To find a genetic counselor who specializes in cancer genetics, choose "cancer" under the options "Area of Practice/Specialization."
- 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.
- JScreen is a national program based out of 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.
- FORCE's toll-free helpline at: 866-288-RISK, ext. 704 will connect you with a volunteer board-certified genetic counselor who can answer general questions about genetic testing and cancer and help you find a genetics expert near you.
- FORCE Peer Navigator Program will match you with a volunteer who has undergone genetic counseling and can help you navigate resources to find a genetic counselor near you.
- Ask your doctor for a referral to a genetics expert.
Who covered this study?
Triple-negative: Genes associated with risk for aggressive breast cancer This article rates 4.5 out of 5 stars
Researchers identify genes linked to aggressive breast cancer This article rates 1.0 out of 5 stars
New genes discovered that may increase risk for triple-negative breast cancer This article rates 0.5 out of 5 stars