Alternative splicing is a process that partly rejects the common definition of a gene – that one gene codes for one specific protein. By variable combination of coding regions (exons) and exclusion of non-coding regions (introns), formation of several different mRNA-transcripts, and consequently several different proteins, can derive from the same gene. Alternative splicing is an important condition for the development of complex life forms, but it is also a highly sensitive process and inaccurate splicing is the cause of approximately 15 % of mutations that cause genetic diseases. This article presents four genes, BRCA1, BRCA2, ERα and ERβ, and inaccurate splicing of these genes increases the risk of developing cancer, particularly breast cancer and ovarian cancer. Breast cancer is the second most common form of lethal cancer among women. After identifying the cancerogenic mutations, women of high-risk families can undergo genetic testing and preventive therapy can reduce the morbidity and mortality. The article also presents a short discussion around the ethical problems of genetic testing, and the social and psychological dilemmas women of high-risk families are facing when they are given the option to undergo genetic testing.

Det föreligger en ökad risk för att utveckla bröst- och äggstockscancer om kvinnan bär på mutation i BRöstCAncergen1 eller BRöstCAncergen2. Kvinnan ställs inför svåra beslut som kommer att påverka hälsan över tid. Syftet var att genom en allmänlitteraturstudie undersöka kvinnors upplevelse av att leva med den ärftliga mutationen i BRöstCAncergen1 eller BRöstCAncergen2. Efter en systematisk litteratursökning framkom 15 resultatartiklar, i dessa identifierades två kategorier med tillhörande underkategorier, Osäkerhet: rädsla för cancer och förändrad kroppsuppfattning samt Hanterbarhet: tankar om framtiden, stöd och acceptans. Genom att bära på genmutationen upplever kvinnorna att de befinner sig i ett livshotande tillstånd där den ökade risken för cancer skapar osäkerhet. Besluten är komplexa vilket ökar informationsbehovet hos kvinnorna, det framkom att informationen ansågs bristfällig. I denna process är det viktigt att sjuksköterskan ser kvinnan bakom genmutationen och tillämpar personcentrerad omvårdnad. Vidare forskning kring kvinnors upplevelse behövs, då behoven inte ansågs vara uppfyllda. Detta skulle ge förutsättningar för sjuksköterskor att erbjuda en mer personcentrerad omvårdnad. / There is an increased risk of developing breast- or ovarian cancer if a woman carries the deleterious mutation in BReastCAncer gene1 or BReastCAncer gene2. The woman faces severe decisions that will affect her health over time. The aim of this literature review was to investigate how women experience living with a genetic mutation in BReastCAncer gene1 or BReastCAncer gene2. After a systematic literature search, 15 results were found, in which two categories were identified with associated subcategories, uncertainty: fear of cancer and changed body perception, and manageability: thoughts about the future, support and acceptance. By carrying the genetic mutation women find themselves in a life-threatening condition where their increased risk of cancer creates uncertainty. The decisions are complex, which increases the information needs of the women. It was found that the information was considered to be insufficient. In this process it of great importance that the nurse sees the woman behind the genetic mutation and applies person-centered nursing. Further research on women's experience is required, since the needs were not considered to be met. This would provide better conditions for nurses to offer a person-centered care.

BRCA1 est l'un des deux gènes majeur de prédisposition au cancer du sein. Les multiples partenaires protéiques de BRCA1 lui confèrent de nombreuses fonctions par lesquelles elle peut assurer la surveillance de l'intégrité cellulaire. L'équipe dans laquelle j'ai mené ma thèse a identifié un nouveau partenaire protéique de BRCA1, la protéine de liaison au poly(A) des ARN messagers PABP1, et a ainsi mis en lumière l'implication de BRCA1 dans la régulation de la traduction. De plus, de récents travaux suggèrent que dans des conditions dangereuses pour la cellule et potentiellement oncogéniques, comme par exemple un stress endommageant l'ADN (génotoxique), la synthèse protéique est fortement altérée. Mon travail de thèse a eu pour objectif de démontrer que cette nouvelle fonction de BRCA1 contribue, comme ses fonctions nucléaires, à son rôle de suppresseur de tumeur. Durant ma thèse, j'ai identifié les ARNm « cibles » de BRCA1 par la technique d'immunoprécipitation des complexes ribonucléoprotéiques (RIP), j'ai validé que ces ARNm « cibles » de BRCA1 lui sont associés pour leur régulation traductionnelle en réalisant une analyse comparative du contenu des polysomes de cellules épithéliales mammaires MCF-7 exprimant de façon transitoire un ARN interférent dirigé contre BRCA1 par la technique que j'ai mise en place au laboratoire, les profils polysomiques. Par la suite, j'ai établi les conditions de stress génotoxique induisant la localisation cytoplasmique de BRCA1, et en collaboration avec des cliniciens du Centre Léon Bérard j'ai permis l'acquisition d'échantillons tumoraux. Ceci nous permettra d'identifier parmi ces cibles de nouveaux marqueurs diagnostiques ou encore de nouvelles cibles thérapeutiques pour les cancers du sein déficientes en BRCA1 / BRCA1 is one of the two major breast cancer susceptibility genes. The numerous binding partners of BRCA1 allow it to participate to several cellular pathways which globally contribute to its cell surveillance capacity. The team in which I performed my PhD identified a new binding partner of BRCA1, the Poly(A)-Binding Protein 1 and, consequently, a new function of this tumor suppressor, namely, the translation regulation. Moreover, recent studies suggest that under conditions dangerous for the cell and potentially oncogenic, such as a genotoxic stress, protein synthesis is strongly altered. My thesis work was aimed at demonstrating that this new function of BRCA1 contributes, like its nuclear functions, to its role of tumor suppressor. During my thesis, I identified the mRNAs "targets" of BRCA1 by the technique of immunoprecipitation of the ribonucleoprotein complexes (RIP), I validated that these mRNAs "targets" of BRCA1 are associated to it for their translational control by realizing a comparative analysis of the contents of the polysomes of MCF-7 mammary epithelial cells transiently expressing an interfering RNA directed against BRCA1 by the technique that I have set up in the laboratory, the polysomal profiles. Subsequently, I established the conditions of genotoxic stress inducing the cytoplasmic localization of BRCA1, and in collaboration with clinicians of the Center Léon Bérard Hospital, I allowed the acquisition of tumor samples. This will allow us to identify among these targets new diagnostic markers or new therapeutic targets for breast cancers deficient in BRCA1

The introduction of an increasing number of individualized molecular targeted therapies into clinical routine mirrors their importance in modern cancer prevention and treatment. Well-known examples for targeted agents are the monoclonal antibody trastuzumab and the selective estrogen receptor modulator tamoxifen. The identification of an unaltered gene in tumor tissue in colon cancer (KRAS) is a predictor for the patient’s response to targeted therapy with a monoclonal antibody (cetuximab). Targeted therapy for hereditary breast and ovarian cancer has become a reality with the approval of olaparib for platin-sensitive late relapsed BRCA-associated ovarian cancer in December 2014. This manuscript reviews the status quo of poly-ADP-ribose polymerase inhibitors (PARPi) in the therapy of breast and ovarian cancer as well as the struggle for carboplatin as a potential standard of care for triple-negative and, in particular, BRCA-associated breast cancer. Details of the mechanism of action with information on tumor development are provided, and an outlook for further relevant research is given. The efficacy of agents against molecular targets together with the identification of an increasing number of cancer-associated genes will open the floodgates to a new era of treatment decision-making based on molecular tumor profiles. Current clinical trials involving patients with BRCA-associated cancer explore the efficacy of the molecular targeted therapeutics platinum and PARPi.

En France, le cancer de sein héréditaire représente environ 2500 nouveaux cas par an, dont prés de la moitié est attribuée à la mutation du gène BRCA1.La recherche de la mutation par biologie moléculaire est un travail fastidieux, coûteux et long (8 mois d’attente environ actuellement).Pour trouver une solution à ce délai, nous avons étudié en immunohistochimie une série initiale de 21 anticorps répartis en 5 groupes : anticorps antiBrca1 du commerce, liés à la perte de l’inactivation de l’X, liés à la signature basale ou myoépithéliale, anticorps dits classiques du cancer de sein et finalement dérivés de signatures établies par cDNAarray.Nous avons utilisé la technique de’ tissue microarrays’ en utilisant de manière comparative une population de 27 cas de cancer de sein présentant une mutation germinale de BRCA1, et 81 cas témoins de cancer de sein sporadiques appariés à l’âge, ainsi qu’à des lignées cellulaires d’origine mammaires. Dans une deuxième série indépendante de validation nous avons appliqué les résultats obtenus de la première série sur 28 cas de cancer mammaire muté, et 28 cas du cancer mammaire sporadique dans les mêmes conditions initiales.Nos résultats montrent pour la première fois sur des tissus tumoraux une probabilité forte d’une association entre la mutation Brca1 et la perte de l’inactivation de l’X ; confirment la valeur de MS110 comme un bon anticorps prédictif d’une mutation de Brca1 ; apportent un argument pour une participation myoépithéliale dans l’oncogenèse de cancer mammaire Brca1 muté; appuient la relation entre ce dernier et les récepteurs RE,RP ainsi que P53 , Bcl2,Ki67 et valident en protéomique la valeur discriminant de CDC47 correspondant à un des gènes de la signature génomique.Après confirmation des mêmes résultats dans la série de validation, nous soutenons en analyses multivariés un modèle qui comprend seulement Grade 3, MS110, Lys27H3 négative, Vimentine et KI67 positive. Cette équation correspond à une sensibilité de 82% et spécificité de 81% et propose une approche rapide économique de pré- ciblage de la mutation Brca1 ; ce qui améliorait la prise en charge préventive, thérapeutique et globale des patients et leurs familles. / Family structure, lack of reliable information, cost and delay are usual concerns faced with when deciding to perform BRCA analyses. Testing the breast cancer tissues with four antibodies (MS110, lys27H3, Vimentin, KI67) in addition to grade evaluation enabled to rapidly select patients to carry out genetic testing identification. We constituted an initial breast cancer tissue micro-array, considered as a learning set comprising 27 BRCA1 and 81 sporadic tumours. A second independent validation set of 28 BRCA1 tumours was matched to 28 sporadic tumours using the same original conditions.We have investigated morphological parameters and 21 markers by immunohistochemistry.A logistic regression model was used to select the minimal number of markers providing the best model to predict BRCA1 status. The model was applied to the validation set to estimate specificity and sensibility.In the initial set, the univariate analysis identified 11 markers significantly associated with BRCA1 status. Then the best multivariate model comprised only Grade 3, MS110, Lys27H3, Vimentin and KI67. When applied to the validation set, BRCA1 tumours were correctly classified with a sensitivity of 83% and a specificity of 81%. The performance of this model was superior when compared to other profiles.This work offers a new rapid and economic method for the pre-screening of patients at high risk of being BRCA1mutation carriers, then to guide genetic testing, and finally to provide appropriate preventive measure, advices and treatments including targeted therapy to patients and their families.

Le risque potentiel de cancer induit par les irradiations mammographiques est sujet de santé publique majeur, d’intérêt médical et scientifique. Le but de ce travail a été de quantifier les cassures double-brin (CDB) de l’ADN en conditions exactes d’irradiations mammographiques. Cette quantification a été effectuée sur des cellules épithéliales mammaires non transformées issues de biopsies échoguidées en tissu sain en utilisant l’immunofluorescence de la protéine histone H2AX phosphorylée (γH2AX), avant, 10 min et 24 h après irradiation . Deux populations de patientes ont été incluses dans l’étude 19 sans antécédent familial de cancer du sein et/ou de l’ovaire (faible risque, FR) et 11 à haut risque identifié par le généticien avec ou sans mutation (haut risque, HR). En effet, les gènes mutés suppresseurs de tumeurs (BRCA1, BRCA2, CHK2, ATM, p53, PTEN) sont également impliqués dans la signalisation et/ou réparation des CDB. Spontanément, les patientes HR ont montré significativement plus de CDB spontanées que les LR. Trois effets radiobiologiques majeurs ont été mis en évidence : 1) Un effet de la dose, plus important chez les HR ; 2) Une augmentation significative du nombre de foci γH2AX entre 10 min et 24 h après irradiation ; 3) Un effet de répétition de dose, plus marqué chez les HR. Ces constatations devraient conduire à la ré-évaluation des séquences de dépistages mammographiques dans les populations où le bénéfice en terme de mortalité n’a pas été prouvé, comme dans la tranche d’âge des 40-49 ans et dans la surveillance des patientes où sont recommandées de façon annuelle IRM et mammographie dès l’âge de 30 ans ou 35 ans, les hauts risques et les femmes aux antécédents d’irradiation thoracique dans l’enfance, l’adolescence ou jeune adulte. Une seule incidence mammographique en dépistage pourrait être préconisée en dépistage dans l’attente de travaux radiobiologiques complémentaires évaluant la carcinogenèse éventuelle des irradiations mammographiques / The potential risk of cancer induced by radiation mammography is a major public health issue, medical and scientific interest. The purpose of this study was to quantify the double-strand break (DSB) DNA in exact terms of mammographic radiation. This quantification was performed on untransformed mammary epithelial cells from ultrasound-guided biopsies in healthy tissue using fluorescent protein phosphorylated histone H2AX (γH2AX) before, 10 min and 24 h after irradiation. Two patient populations were included in the study : 19 with no family history of breast cancer and/or ovarian cancer (low risk, LR) and 11 high-risk identified by the geneticist with or without mutation (high risk, HR). Indeed, mutated tumor suppressor genes (BRCA1, BRCA2, CHK2, ATM, p53, PTEN) are also involved in signaling and/or repair of DSBs. Spontaneously, patients showed significantly higher HR of DSBs that spontaneous LR. Three major radiobiological effects were highlighted : 1) A dose low effect, higher in HR; 2) A significant increase in the number of γH2AX foci from 10 min to 24 h after irradiation; 3) An effect of repeated doses more pronounced in HR. These findings should lead to re-evaluate mammographics procedures in screnning in populations where the benefit in term of mortality has not been proved, as women with high familial risk, in the age of group of 40-49 years, and in women treated with chest radiation for childhood, adolescent, or young adult cancer. A single mammographic view could be indicated. Further works assessing the possible carcinogenesis effects of mammographic irradiations will be necessary

Dentre todos os tipos de câncer, excluindo-se o câncer de pele do tipo não melanoma, o de mama é o mais frequente em mulheres, sendo a segunda maior causa de morte por neoplasias nesse segmento da população. Em determinadas famílias, a incidência de câncer é superior à esperada para a população em geral, devido principalmente ao compartilhamento de fatores ambientais e/ou mutações genéticas responsáveis por facilitar ou dirigir a oncogênese. Os indivíduos que apresentam câncer de mama e histórico familial dessa patologia são descritos dentro do grupo câncer de mama familial (CMF), responsável por aproximadamente 5 a 10% do total de casos de câncer de mama. Atualmente, pacientes com CMF são frequentemente testados para mutações nos genes BRCA1 e BRCA2. Entretanto, estima-se que as variantes patogênicas presentes nos dois genes são responsáveis por somente 20% dos casos de CMF em que a etiologia genética é conhecida. Com relação aos testes genéticos para predisposição hereditária ao câncer de mama, torna-se relevante, portanto, a reavaliação da constituição dos painéis multigênicos frente ao estado do conhecimento científico atual, contemplando-se as mais recentes atualizações acerca dos genes e variantes genéticas associadas ao CMF. Neste trabalho, realizamos uma revisão bibliográfica que identificou 45 genes com associação estatística ao CMF, dentre eles 16 são frequentemente avaliados em painéis multigênicos brasileiros e internacionais. Em análise in silico, avaliamos as funções celulares e interações entre os produtos gênicos associados à patologia. Nossos resultados sugerem a adição de oito genes à composição de painéis multigênicos realizados no Brasil, EUA e Europa para avaliação da predisposição hereditária ao câncer de mama. Essa análise crítica pode auxiliar o aprimoramento de estratégias de prevenção, triagem, manejo clínico e determinação do risco de ocorrência e recorrência, com impactos sobre o aconselhamento genético (AG) oferecido aos pacientes afetados pelo câncer familial e seus familiares. Complementarmente, avaliamos as variantes gênicas presentes em pacientes com câncer de mama que realizaram o painel multigênico para predisposição hereditária ao câncer no Centro de Pesquisa sobre o Genoma Humano e Células-Tronco (CEGH-CEL). As frequências de mutações da coorte do CEGH-CEL são semelhantes às obtidas em estudos internacionais, possibilitando a utilização de painéis multigênicos com composições similares em populações de diversas localidades / Of all types of cancer, except for non-melanoma skin cancer, breast cancer is the most common among women, and it\'s the second leading cause of death by neoplasia in this segment of the population. In some families, the incidence rates of cancer are higher than expected for the general population because of the environmental factors and/or genetic mutations responsible for facilitating or driving oncogenesis. The individuals who have breast cancer and a family history of this pathology fall into the group of familial breast cancer (FBC), which is responsible for approximately 5-10% of all breast cancer cases. Currently, patients with FBC are frequently tested for mutations in the BRCA1 and BRCA2 genes. It is estimated, however, that the pathogenic variants of these genes account for only 20% of all FBC cases in which the genetic etiology is known. In relationship to the genetic tests for inherited predisposition for breast cancer, therefore it is relevant to reassess the multi-gene panel composition, considering the state of scientific knowledge today, including the most recent research on the genes and its variants associated with FBC. In this paper we did a literature review, which identified 45 genes statistically associated with FBC, out of which 16 are frequently assessed in multi-gene panels in Brazil and abroad. Through in silico analysis we were able to evaluate cell functions and interactions with gene products associated with cancer. Our results suggest the addition of eight genes to the multi-gene panel composition carried out in Brazil, in the USA and in Europe to assess hereditary predisposition to breast cancer. This critical analysis can assist in the development of preventive actions, triage, clinical management and in determining the risk of occurrence and recurrence, which impacts on the genetic counseling (GC) offered to the patients of familial cancer and their relatives. Additionally, we evaluated the genetic variants in patients diagnosed with breast cancer who have undergone multi-gene panel testing for hereditary predisposition to cancer at the Centro de Pesquisa sobre o Genoma Humano e Células-Tronco (CEGH-CEL). These cohort\'s mutation frequencies are similar to the results in international studies, which could enable the use of multi-gene panels with similar compositions in populations from various locations

Submitted by admin tede (tede@pucgoias.edu.br) on 2018-06-19T18:25:16Z No. of bitstreams: 1 DANIEL RODRIGUES DE BASTOS.pdf: 1922893 bytes, checksum: 51e3aa82ceb630f944c3c65627dcffaa (MD5) / Made available in DSpace on 2018-06-19T18:25:16Z (GMT). No. of bitstreams: 1 DANIEL RODRIGUES DE BASTOS.pdf: 1922893 bytes, checksum: 51e3aa82ceb630f944c3c65627dcffaa (MD5) Previous issue date: 2017-05-04 / Introduction: Breast cancer is the most frequent neoplasm among women worldwide and represents the leading cause of death in this population. Important biomarkers have been studied in order to better define the prognosis of patients affected by this cancer. MicroRNAs are small molecules of non-coding RNAs composed of 21 to 25 nucleotides that play an important role in the post-transcriptional regulation of several genes. Objective: The objective of this study was to evaluate the expression of microRNAs (miRNAs: hsa-miR-7 and hsa-miR-10b) and BRCA1 protein in breast cancer samples, as well as the possible associations between expression of these markers with clinicopathological and prognostic aspects. Method: The study included 92 cases of breast carcinoma from Hospital Araújo Jorge, Associação de Combate ao Câncer em Goiás. Formalin fixed paraphin embedded samples were used for the analisis. MicroRNA was extracted from the samples and used for cDNA synthesis. The cDNA samples were adjusted to the same concentration and submitted to quantitative real-time PCR (qRT-PCR). Samples were further evaluated by immunohistochemistry for BRCA1 expression. Results: From a group of 234 immunohistochemical records, 56 cases of non-triple-negative and 36 triple-negative breast carcinomas were selected. Five-year overall survival was significantly associated to triple negative phenotype (p = 0.044), advanced stages (p = 0.005), lymph node involvement (p = 0.038), presence of distant metastasis (p = 0, 0008) and absence of BRCA1 expression (p = 0.039). Significant associations were demonstrated between the absence of BRCA1 and the triple-negative phenotype (p = 0.0346), as well as the absence of estrogen receptor expression (p = 0.006) and absence of progesterone receptor expression (p = 0.0163). The analysis by qRTPCR demonstrated different levels of miR-10b and miR-7 expression in the tumors, with significant associations with triple-negative phenotype (p = 0.021, p = 0.042) and the absence of BRCA1 (p = 0.039, p = 0.006). The comparison between absence and presence of human epidermal growth factor receptor expression showed a significant difference for miR-7 (p = 0.031), and the expression of miR-10b in these cases was not statistically different (p = 0.926). Conclusion: Significant associations were demonstrated between the absence of BRCA1 and the triple-negative phenotype. Five-year overall survival was reduced for the triple-negative phenotype patients, clinical stages III and IV, the presence of lymph node metastasis, the presence of distant metastasis and the absence of BRCA1 expression. This study also demonstrated that hsa-miR-7 and hsa-miR-10b are significantly associated with the absence of BRCA1 expression and triple-negative phenotype, with poorer survival in these patient profiles. Studies with more cases and with cell lines should be performed in order to confirm the role of hsa-miR-7 and hsa-miR-10b in the modulation of BRCA1 expression. / Introdução: O câncer de mama é a neoplasia mais frequente entre as mulheres de todo o mundo e representa a principal causa de morte nesta população. Importantes biomarcadores têm sido estudados, a fim de definir melhor o prognóstico de pacientes acometidas por esta doença. Os microRNAs são pequenas moléculas de RNAs não codificantes, compostos por 21 a 25 nucleotídeos e desempenham importante papel na regulação pós-transcricional de diversos genes. Objetivo: O objetivo do estudo foi avaliar a expressão de microRNAs (miRNAs: hsa-miR-7 e hsamiR- 10b) e da proteína BRCA1 em amostras de câncer de mama, bem como as possíveis associações entre a expressão desses marcadores e os aspectos clinicopatológicos e prognósticos. Método: O estudo foi composto por 92 casos de carcinoma de mama, provenientes do Hospital Araújo Jorge, da Associação de Combate ao Câncer em Goiás. Foram utilizados fragmentos de tumores incluídos em parafina. A extração de microRNA das amostras foi realizada e o produto gerado foi utilizado para a síntese de cDNA. As amostras de cDNA foram ajustadas para igual concentração e submetidas à PCR quantitativa em tempo real (qRT-PCR). As amostras foram avaliadas ainda por meio de imuno-histoquímica para expressão de BRCA1. Resultados: Um total de 234 registros de imuno-histoquímica foi avaliado, resultando em 56 casos de carcinomas de mama apresentando fenótipo não triplonegativo e 36 com fenótipo triplo-negativo. A sobrevida das pacientes em função das características clinicopatológicas demonstrou associações com os casos triplonegativos (p=0,044), estádios mais avançados (p=0,005), acometimento linfonodal (p=0,038), presença de metástase à distância (p=0,0008) e ausência da expressão de BRCA1 (p=0,039). Associações significativas foram demonstradas entre a ausência de BRCA1 e o fenótipo triplo-negativo (p=0,0346), entre a ausência da expressão do receptor de estrógeno e ausência da expressão de BRCA1 (p=0,006), e entre o receptor de progesterona e a ausência da expressão de BRCA1 (p=0,0163). A análise por qRT-PCR demonstrou diferentes níveis de expressão de miR-10b e de miR-7, com associações significativas ao fenótipo triplo-negativo (p=0,021; p=0,042) e à ausência de BRCA1 (p=0,039; p=0,006). A comparação entre ausência e presença da expressão do receptor do fator de crescimento epidérmico humano demonstrou diferença significativa para miR-7 (p=0,031), sendo que a expressão de miR-10b nestes casos não foi estatisticamente diferente (p=0,926). Conclusão: Associações significativas foram demonstradas entre a ausência de BRCA1 e o fenótipo triplo-negativo. A sobrevida em cinco anos foi inversamente associada ao fenótipo triplo-negativo, aos estádios clínicos III e IV, à presença de metástase linfonodal, à presença de metástase à distância e à ausência da expressão de BRCA1. Este estudo demonstrou ainda que hsa-miR-7 e hsa-miR- 10b estão significativamente associados à ausência da expressão de BRCA1 e ao fenótipo triplo-negativo, sendo observada pior sobrevida nestes perfis de pacientes. Estudos com maior número de casos e com linhagens celulares devem ser realizados para constatar o papel de hsa-miR-7 e hsa-miR-10b na modulação da expressão de BRCA1.

Neste trabalho, medimos o impacto da avaliação do risco de mutações dos genes BRCA1/2 na qualidade de vida de pacientes com câncer de mama, avaliada pelos questionários EORTC QLQ-C30 e QLQ-BR23. Convidamos 282 pacientes a participar, respondendo aos questionários antes e depois da avaliação do risco pelos métodos de Frank, Evans e BRCAPRO. Consideramos risco elevado pelo menos 10%. 272 foram incluídas e 198 completaram o estudo. Nas 180 avaliáveis, a idade mediana das pacientes foi de 53 anos com desvio padrão de 11,5 anos e, em 89, o tempo desde o diagnóstico de menos de 36 meses. 40 pacientes estavam em seguimento e 137 em hormonioterapia. Não detectamos alterações significativas da qualidade de vida com a determinação do risco para mutações. Houve diferença significativa entre imagem corporal negativa e cirurgia conservadora da mama (p<0,001). Classificamos 45 como risco elevado pelo método de Frank, 35 pelo BRCAPRO e 21 por Evans, sendo que em 12 dessas pacientes houve concordância dos três métodos juntos. Concluímos que, apesar do grande interesse demonstrado pelas pacientes em participar no estudo, a determinação do risco não interferiu na qualidade de vida dessas pacientes. Aparentemente, as informações sobre hereditariedade são desejadas, mas não acarretam estresse adicional e deveriam ser prestadas, pois o número de pacientes com risco elevado é semelhante ao indicado em outras populações. Além disso, a baixa concordância entre os métodos utilizados indica a necessidade de definir parâmetros para determinação de risco em nosso meio. / Here we evaluated the “impact of breast cancer hereditary cancer risk evaluation’ on the quality of life in a population of breast cancer patients, as measured by the EORTC questionnaires QLQ-C30 and QLQ-BR23. Of the 282 invited patients, 272 agree to participate and answered QLQ before and after the risk determination by Frank, Evans and BRCAPRO methods. High risk was defined as at least 10%. Overall 198 pts completed the study. In the 180 evaluable patients, median age was 53 (+11,5) years old and time since diagnosis was less than 36 months in 89. We did not detected significant differences in quality of life parameters after risk determination, except for negative body image and mastectomy/conservative surgery (p<0.001) There were 45 patients classified as high risk by Frank, 35 by the BRCAPRO and 21 by Evans, agreement being reached in 12. We conclude that pts wish to know about their hereditary breast cancer risk, and this do not cause necessarily more stress. Apart from that, there is a need for local methods of risk calculation.

Contexte: La grande majorité des mutations délétères identifiées sur le gène BRCA1 sont des mutations « privées ». Cependant, certaines d’entre elles proviennent d’un ancêtre commun, à l’origine d’un effet fondateur. Ainsi, la mutation BRCA1-3600del11 (c.3481_3491del11, p.Glu1161Phefs*3) est localisée en France pour 82% des familles porteuses et 85% d’entre elles sont originaires du quart Nord-Est. En 2006, cette mutation représentait respectivement 51,5% et 42,0% de toutes les mutations du gène BRCA1 identifiées dans les familles lorraines et alsaciennes atteintes d’un cancer du sein et/ou de l’ovaire. En 2004, parmi les 27 cas-index ayant consulté en Alsace et présentant une mutation de BRCA1, 37% sont porteurs de cette mutation, tous issus de familles originaires des Vosges, suggérant l’existence d’un effet fondateur. L’identification d’un haplotype commun est venue confirmer l’existence de cette hypothèse. Une équipe alsacienne a mentionné dans deux publications en 2000 et 2004 sur la mise en évidence de la mutation 3600del11 que les caractéristiques des cancers associés à cette mutation, ne plaidaient pas en faveur d’une relation génotype-phénotype. Or, les caractéristiques anatomo-pathologiques des cancers associés à cette mutation n’ont pas été abordées par ces deux publications. Nous nous sommes alors posés la question de caractéristiques anatomo-pathologiques particulières des cancers du sein et des cancers de l’ovaire diagnostiqués chez les femmes porteuses de cette mutation dans notre région. Nous nous sommes également posés la question de l’existence d’un phénomène d’anticipation génétique dans ces familles. L’anticipation génétique est la survenue plus précoce d’une pathologie et/ou l’aggravation de ses signes cliniques lors de la transmission d’une mutation d’une génération à la suivante au sein d’une même famille. Très peu d’études ont cherché à mettre en évidence ce phénomène d’anticipation dans des cohortes issues de familles de syndrome sein-ovaire associées à une mutation de BRCA1 ou BRCA2. Les études publiées présentaient des biais de sélection du fait de l’inclusion de patients non testés dans leur analyse. Les études publiées sur des cohortes issues de familles présentant une mutation sur le gène BRCA1/2 suggéraient que le dépistage ciblé et l’excès de surveillance pourraient avoir une influence sur l’âge au diagnostic d’un cancer du sein chez les jeunes femmes incluses.Les améliorations majeures au niveau de la mammographie et du traitement du cancer du sein, de même que le programme de dépistage organisé pour les femmes de 50 ans et plus sont apparues en France, après 1980. A notre connaissance, à ce jour, aucune étude n’a été réalisée en France visant à identifier un phénomène d’anticipation génétique dans les familles associées à une mutation sur BRCA1ou BRCA2 et à analyser ce phénomène.Objectif: Notre premier objectif est de constituer une première cohorte lorraine de patientes porteuses de la mutation 3600del11 et d’analyser les caractéristiques anatomo-pathologiques des cancers du sein et de l’ovaire liés à cette mutation. Notre deuxième objectif rechercher l’existence d’une anticipation génétique dans des familles présentant la mutation fondatrice BRCA1-3600del11.Patientes: Quatre cent quatre patientes sont porteuses d’une mutation BRCA1 à l’Institut de Cancérologie de Lorraine (ICL) sur la période s’étendant de 1994 à 2012, parmi elles, nous avons identifié les patientes porteuses de la mutation BRCA1-3600del11. Nous avons identifié à l’Institut de Cancérologie de Lorraine, 38 paires mères-filles atteintes d’un cancer du sein ou de l’ovaire issues de 37 familles présentant le syndrome sein-ovaire associé à cette mutation dont 25 paires mères-filles atteintes d’un cancer du sein et 13 paires mères-filles atteintes d’un cancer de l’ovaire [...] / Introduction: Over 1000 alterations in the BRCA1 gene have been documented. Most of these are frameshifts and ~10% are missense mutations that generate stop codons leading to a truncated and therefore inactive BRCA1 protein. In the French population, prevalence of BRCA1 mutations has been reported in few studies; In a preliminary study of 14 breast and/or ovarian cancer families, a frequent BRCA1 mutation was detected in five unrelated families; the c.3481_3491del11 mutation (BIC: 3600del11), an 11 base-pair deletion in exon 11 leading to a premature stop codon at 1165. In a second study carried out in 2004 involving 27 index cases, the c.3481_3491del11 mutation accounted for 37%. The haplotype analysis of the families carrying the mutation c.3481_3491del11, all originating from Alsace-Lorraine (North-East of France), revealed the presence of a common allele, indicating a founder effect. Purpose: To an attempt to better define the clinical and pathologic characteristics of breast and ovarian cancer related with the 3600del11 BRCA1 mutation, we report our experience with breast and ovarian cancer patients carrying the 3600del11 mutation at the Lorraine Oncology Institute in France. The aim of the current analysis is also to evaluate any differences of breast or ovarian cancer age at diagnosis between mothers and daughters carrying the c.3481_3491del11 mutation in the BRCA1 gene.Patients: Within the population who were referred between 1994 and 2012 to our oncogenetic clinic at the Lorraine oncology institute and who underwent genetic testing for BRCA1 and BRCA2, we identified 404 women carrying a BRCA1 mutation. Interestingly, 45% (180 of 404) of women with detected BRCA1 mutation had the germline 3600del11 mutation. These women were members of 89 different families with breast and or ovarian cancer cases. A study cohort of 38 women carrying the c.3481_3491del11 mutation and affected by first breast or ovarian cancer who reported a first breast or ovarian cancer in their mother carrying the c.3481_3491del11 mutation, was identified in 37 different families including members with breast and/or ovarian cancer at the Oncology Institute of Lorraine. Twelve mothers underwent genetic testing. Twenty five pairs of the 38 mothers-daughters pairs with c.3481_3491del11 mutation were affected by breast cancer and 13 pairs by ovarian cancer.Methods: Clinical and genetic data were collected from medical files and family pedigrees. Analyses were conducted for each cancer type. We investigated an early breast cancer detection effect due to early screening programs and also an increased breast tumor aggression. Since major improvements in breast cancer clinical management and imaging techniques appeared after 1980, we compared the age at breast cancer diagnosis and the age at death in mothers and daughters before and after 1980, first, in the group of women including mothers and daughters taken together and then in mothers and daughters separately. Genetic data were retrieved from familial files and clinical and pathological data from medical files. Descriptive statistics for the study population were calculated using the SPSS software (version 20.0). Results: Ninety one patients (71, 7%) were affected by first breast cancer and 31 (24,4%) by ovarian cancer. Breast tumors were identified in 37.4% of cases aged <40 years. Estrogen receptor status and progesterone receptor status were reported to 67 patients. Hormonal receptors status was positive in 31.4% of breast tumors. A triple-negative subtype was found in 21 cases, which accounts for 65.6% of the 32 patients with 3600del11 mutation for whom HER2 status was available. Ovarian tumors of the serous type, which constitute about 71 percent of all epithelial ovarian carcinomas, predominate among patients with 3600del11 mutation. Eighty six per cent of carriers were diagnosed at advanced stages III/IV [...]