TY - JOUR
T1 - Predictability of BRCA1/2 mutation status in patients with ovarian cancer
T2 - How to select women for genetic testing in middle-income countries
AU - Teixeira, Natalia
AU - Maistro, Simone
AU - Del Pilar Estevez Diz, Maria
AU - Mourits, Marian J
AU - Oosterwijk, Jan C
AU - Folgueira, Maria Aparecida Koike
AU - de Bock, Geertruida H
N1 - Copyright © 2017 Elsevier B.V. All rights reserved.
PY - 2017/11
Y1 - 2017/11
N2 - Objectives: To evaluate the accuracy of algorithms for predicting BRCAI/2 germ-line mutation carrier probability, and to identify factors that could improve their performance among Brazilian women with ovarian cancer (OC).Study design: In this cross-sectional study, we enrolled patients (unselected for family history of cancer) undergoing treatment or follow-up for OC in a single centre in Brazil. Clinical and demographic data, including family history of cancer, were obtained. Blood samples were collected for genetic testing.Main outcome measures: The entire coding sequence of BRCAI and BRCA2 was evaluated for mutations. Mutation carrier probability was calculated using BOADICEA, BRCAPRO, Myriad and the Manchester score. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curves (AUC) were calculated for each algorithm. Logistic regression was used to detect additional factors associated with BRCA1/2 status, and these were added to the algorithms before recalculating the AUCs.Results: BRCAI/2 mutations were identified in 19 of the 100 included patients. BOADICEA outperformed other algorithms (sensitivity, 73.7%; specificity, 87.7%; AUC, 0.87, with a threshold of a 10% risk of mutation). Later menarche was associated with the presence of a BRCAI/2 mutation. Although adding age at menarche resulted in a larger AUC for all models, this increase was significant only for the Myriad algorithm.Conclusion: A BOADICEA risk evaluation of 10% or more most accurately predicted BRCA1/2 status, and the inclusion of age at menarche tended to improve the performance of all algorithms. Using these tools could reduce the number of tests, but at the expense of missing a significant proportion of mutation carriers.
AB - Objectives: To evaluate the accuracy of algorithms for predicting BRCAI/2 germ-line mutation carrier probability, and to identify factors that could improve their performance among Brazilian women with ovarian cancer (OC).Study design: In this cross-sectional study, we enrolled patients (unselected for family history of cancer) undergoing treatment or follow-up for OC in a single centre in Brazil. Clinical and demographic data, including family history of cancer, were obtained. Blood samples were collected for genetic testing.Main outcome measures: The entire coding sequence of BRCAI and BRCA2 was evaluated for mutations. Mutation carrier probability was calculated using BOADICEA, BRCAPRO, Myriad and the Manchester score. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curves (AUC) were calculated for each algorithm. Logistic regression was used to detect additional factors associated with BRCA1/2 status, and these were added to the algorithms before recalculating the AUCs.Results: BRCAI/2 mutations were identified in 19 of the 100 included patients. BOADICEA outperformed other algorithms (sensitivity, 73.7%; specificity, 87.7%; AUC, 0.87, with a threshold of a 10% risk of mutation). Later menarche was associated with the presence of a BRCAI/2 mutation. Although adding age at menarche resulted in a larger AUC for all models, this increase was significant only for the Myriad algorithm.Conclusion: A BOADICEA risk evaluation of 10% or more most accurately predicted BRCA1/2 status, and the inclusion of age at menarche tended to improve the performance of all algorithms. Using these tools could reduce the number of tests, but at the expense of missing a significant proportion of mutation carriers.
KW - BRCAI gene
KW - BRCA2 gene
KW - Hereditary breast and ovarian cancer syndrome
KW - Genetic testing
KW - Risk assessment
KW - REDUCING SALPINGO-OOPHORECTOMY
KW - GERMLINE MUTATIONS
KW - SCORING SYSTEM
KW - BREAST
KW - RISK
KW - BOADICEA
KW - BRCAPRO
KW - SERIES
KW - BRAZIL
KW - AGE
U2 - 10.1016/j.maturitas.2017.06.002
DO - 10.1016/j.maturitas.2017.06.002
M3 - Article
C2 - 28619461
VL - 105
SP - 113
EP - 118
JO - Maturitas
JF - Maturitas
SN - 0378-5122
ER -