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Lynch syndrome caused by germline PMS2 mutations

Journal Contribution - Journal Article

Subtitle:delineating the cancer risk

PURPOSE: The clinical consequences of PMS2 germline mutations are poorly understood compared with other Lynch-associated mismatch repair gene (MMR) mutations. The aim of this European cohort study was to define the cancer risk faced by PMS2 mutation carriers.

METHODS: Data were collected from 98 PMS2 families ascertained from family cancer clinics that included a total of 2,548 family members and 377 proven mutation carriers. To adjust for potential ascertainment bias, a modified segregation analysis model was used to calculate colorectal cancer (CRC) and endometrial cancer (EC) risks. Standardized incidence ratios (SIRs) were calculated to estimate risks for other Lynch syndrome-associated cancers.

RESULTS: The cumulative risk (CR) of CRC for male mutation carriers by age 70 years was 19%. The CR among female carriers was 11% for CRC and 12% for EC. The mean age of CRC development was 52 years, and there was a significant difference in mean age of CRC between the probands (mean, 47 years; range, 26 to 68 years) and other family members with a PMS2 mutation (mean, 58 years; range, 31 to 86 years; P < .001). Significant SIRs were observed for cancers of the small bowel, ovaries, breast, and renal pelvis.

CONCLUSION: CRC and EC risks were found to be markedly lower than those previously reported for the other MMR. However, these risks embody the isolated risk of carrying a PMS2 mutation, and it should be noted that we observed a substantial variation in cancer phenotype within and between families, suggesting the influence of genetic modifiers and lifestyle factors on cancer risks.

Journal: J Clin Oncol
ISSN: 0732-183X
Issue: 4
Volume: 33
Pages: 319-325
Publication year:2015
Keywords:Adenosine Triphosphatases/genetics, Adult, Aged, Aged, 80 and over, Cohort Studies, Colorectal Neoplasms/genetics, Colorectal Neoplasms, Hereditary Nonpolyposis/genetics, DNA Mutational Analysis, DNA Repair Enzymes/genetics, DNA-Binding Proteins/genetics, Endometrial Neoplasms/genetics, Family Health, Female, Gene Frequency, Genetic Predisposition to Disease/genetics, Genotype, Germ-Line Mutation, Humans, Male, Middle Aged, Mismatch Repair Endonuclease PMS2, Risk Factors