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ABSTRACT: BRCA1 and BRCA2 Mutation Status and Tumor Characteristics
in Male Breast Cancer: A Population-based Study in Italy
To investigate at the population level the impact of BRCA1/BRCA2
gene alterations in male breast cancer, we analyzed a population-based
series of 25 male breast cancer cases from Florence, Central
Italy.
We combined mutational screening with the study of germ-line
allele transcript levels and of tumor-associated losses of heterozygosity.
Screening by protein truncation test and single-strand conformational
polymorphism assay, followed by sequencing, revealed 4 pathogenetic
mutations (4 of 25 = 16%; 95% confidence interval, 5-37%),
1 in BRCA1 and 3 in BRCA2, including mutations recurring in Central
Italy (BRCA1 3345delAG and BRCA2 6696delTC).
The a priori probability
of carrying a mutation, estimated using BRCAPRO software, showed
a good agreement between expected and observed mutations (14%
versus 16%). A 7-fold association between germ-line mutations
and family history of breast-ovarian cancer emerged.
To investigate
associations between BRCA1/BRCA2 status and clinicopathological
characteristics, we analyzed the histopathological and immunophenotypic
parameters of the tumors.
A significant association emerged between
mutation carrier status and high histological grade (P = 0.02).
Furthermore, one BRCA2 carrier was affected with Paget's disease,
an extremely rare male breast cancer histotype.
Overall, BRCA1/2
mutations were observed to be strongly associated with positive
c-erbB-2 immunostaining (P = 0.004). To evaluate germ-line allele
expression, we used primer extension assays targeting frequent
BRCA1 and BRCA2 polymorphisms. A BRCA2 allele transcript imbalance
was found in one of four heterozygotes tested, all of them negative
for germ-line mutations. BRCA1 transcript imbalances were not
detected in nine heterozygotes analyzed.
Losses of heterozygosity
at one or more of nine loci in the BRCA2 region were found in
8 of 22 tumors tested.
Interestingly, a case that was negative
for BRCA1/BRCA2 germ-line mutations and that had a priori mutation
probability <10% showed loss of heterozygosity at all three
of the intragenic BRCA2 markers analyzed, which could be related
to a somatic involvement of BRCA2.
No losses of heterozygosity
were detected at BRCA1.
In conclusion, constitutional BRCA1/BRCA2
mutations accounted for 16% of the male breast cancer cases in
this area of Central Italy.
The detection of a BRCA2 germ-line
transcript imbalance and of a somatic loss of BRCA2 among the
cases that resulted negative for germ-line mutations suggests
a role of this gene more relevant than indicated by conventional
mutational analysis.
A distinct pattern of characteristics indicative
of aggressive behavior, including high-grade and c-erbB-2 expression,
was evident in tumors from germ-line BRCA2 mutation carriers.
This suggests that phenotypic characteristics may contribute
to the identification of hereditary BRCA2-related male breast
cancers and that these tumors might share a unique molecular
pathway of cancer progression.
[01/29/2003; Cancer Research]
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