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      Cumulative BRCA mutation analysis in the Greek population confirms that homogenous ethnic background facilitates genetic testing

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          Abstract

          Screening for BRCA 1 and BRCA 2 mutations has long moved from the research lab to the clinic as a routine clinical genetic testing. BRCA molecular alteration pattern varies among ethnic groups which makes it already a less straightforward process to select the appropriate mutations for routine genetic testing on the basis of known clinical significance.

          The present report comprises an in depth literature review of the so far reported BRCA 1 and BRCA 2 molecular alterations in Greek families. Our analysis of Greek cumulative BRCA 1 and 2 molecular data, produced by several independent groups, confirmed that six recurrent deleterious mutations account for almost 60 % and 70 % of all BRCA 1 and 2 and BRCA 1 mutations, respectively.

          As a result, it makes more sense to perform BRCA mutation analysis in the clinic in two sequential steps, first conventional analysis for the six most prevalent pathogenic mutations and if none identified, a second step of New Generation Sequencing-based whole genome or whole exome sequencing would follow. Our suggested approach would enable more clinically meaningful, considerably easier and less expensive BRCA analysis in the Greek population which is considered homogenous.

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          Hereditary ovarian and breast cancer: what have we learned?

          An autosomal-dominant inherited trait predisposing women to both breast cancer (BC) and ovarian cancer (OC) was first described in 1971. Subsequent strides were made in identifying mutations in the eventually cloned genes BRCA1 and BRCA2 as being responsible for hereditary BC and OC (HBOC) in many women with early-onset HBOC. More recently, modifiers of BC risk have also been identified and are under study. The biological and molecular genetic pathways for malignant transformation in OC (ovarian epithelium and/or epithelium of the fallopian tube or, possibly, the endometrium and endocervix) remain elusive. The answer to the question 'What have we learned?' which is part of our chapter title unfortunately remains incomplete. However, intensive worldwide research indicates that its malignant transformation is the product of a multi-step process where there is an array of mutations which account for three or more classes of genes, inclusive of proto-oncogenes, tumor suppressor genes and mutator genes. This causal uncertainty heralds an enormous clinical-pathology dilemma, given the fact that epithelial OC, together with related Müllerian duct carcinoma, harbor the highest fatality rates of all gynecologic malignancies.
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            Genetic/familial high-risk assessment: breast and ovarian.

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              A Paternally Inherited BRCA1 Mutation Associated with an Unusual Aggressive Clinical Phenotype

              This report highlights the necessity of genetic testing, at least for BRCA1 mutations, of young females diagnosed with triple negative breast cancer, even in the absence of or limited family history. A 34-year-old female with a locally advanced, triple negative tumour, which perforated the skin, is described. At the time of diagnosis, the patient had already multiple lung metastases and although chemotherapy was started immediately, she died with rapid systemic disease progression. The patient was found to carry the BRCA1 p.E1060X mutation, which is located on exon 11 of the gene. The high penetrance of BRCA1 gene is not represented in the patient's family, since the mutation was paternally inherited. It is evident that females belonging to small families, along with paternal inheritance of pathogenic BRCA mutations that predispose for breast cancer, in most cases will probably be genetically tested only after being diagnosed with cancer.
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                Author and article information

                Contributors
                atsigginou@outlook.com.gr
                fotios_vlachopoulos@hotmail.com
                d.arzimanoglou@gmail.com
                florazagouri@yahoo.co.uk
                dimitrac@mail.nih.gov
                Journal
                Hered Cancer Clin Pract
                Hered Cancer Clin Pract
                Hereditary Cancer in Clinical Practice
                BioMed Central (London )
                1731-2302
                1897-4287
                19 August 2015
                19 August 2015
                2015
                : 13
                : 1
                : 17
                Affiliations
                [ ]Breast Unit of the 1st Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece
                [ ]Genomedica, S.A, Piraeus, Greece
                [ ]Department of Clinical Therapeutics, Alexandra Hospital, Athens University Medical School, Athens, Greece
                Article
                37
                10.1186/s13053-015-0037-y
                4545329
                fb6a880b-f084-4873-a428-da94e7f1844b
                © Tsigginou et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 January 2015
                : 14 July 2015
                Categories
                Review
                Custom metadata
                © The Author(s) 2015

                Oncology & Radiotherapy
                brca,molecular alteration,pathogenic mutation,molecular genetic testing,family/personal history,inherited breast cancer,greece

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