Pathogenic and likely pathogenic variant prevalence among the first 10,000 patients referred for next-generation cancer panel testing

• Published in: Genetics in medicine Vol. 18; no. 8; pp. 823 - 832
• Main Authors: Susswein, Lisa R., Marshall, Megan L., Nusbaum, Rachel, Vogel Postula, Kristen J., Weissman, Scott M., Yackowski, Lauren, Vaccari, Erica M., Bissonnette, Jeffrey, Booker, Jessica K., Cremona, M. Laura, Gibellini, Federica, Murphy, Patricia D., Pineda-Alvarez, Daniel E., Pollevick, Guido D., Xu, Zhixiong, Richard, Gabi, Bale, Sherri, Klein, Rachel T., Hruska, Kathleen S., Chung, Wendy K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016; Elsevier Limited; Nature Publishing Group
• Subjects: Adult; Aged; BRCA1/2; Female; Genetic Predisposition to Disease; Genetic Testing; Germ-Line Mutation; hereditary breast and ovarian cancer; hereditary cancer panels; High-Throughput Nucleotide Sequencing - methods; Humans; Lynch syndrome; Male; Middle Aged; Neoplasms - genetics; next generation sequencing; Original; Prevalence; Sequence Analysis, DNA - methods; BRCA1/2; hereditary cancer panels; hereditary breast and ovarian cancer; next generation sequencing; Lynch syndrome
• ISSN: 1098-3600; 1530-0366
• DOI: 10.1038/gim.2015.166

Germ-line testing for panels of cancer genes using next-generation sequencing is becoming more common in clinical care. We report our experience as a clinical laboratory testing both well-established, high-risk cancer genes (e.g., BRCA1/2, MLH1, MSH2) as well as more recently identified cancer genes (e.g., PALB2, BRIP1), many of which have increased but less well-defined penetrance. Clinical genetic testing was performed on over 10,000 consecutive cases referred for evaluation of germ-line cancer genes, and results were analyzed for frequency of pathogenic or likely pathogenic variants, and were stratified by testing panel, gene, and clinical history. Overall, a molecular diagnosis was made in 9.0% of patients tested, with the highest yield in the Lynch syndrome/colorectal cancer panel. In patients with breast, ovarian, or colon/stomach cancer, positive yields were 9.7, 13.4, and 14.8%, respectively. Approximately half of the pathogenic variants identified in patients with breast or ovarian cancer were in genes other than BRCA1/2. The high frequency of positive results in a wide range of cancer genes, including those of high penetrance and with clinical care guidelines, underscores both the genetic heterogeneity of hereditary cancer and the usefulness of multigene panels over genetic tests of one or two genes.