Unexpected findings in cancer predisposition genes detected by array comparative genomic hybridisation: what are the issues?
- Gabriella Pichert1,
- Shehla Nilofer Mohammed1,
- Joo Wook Ahn2,
- Caroline Mackie Ogilvie2,
- Louise Izatt1
- 1Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
- 2Department of Cytogenetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Correspondence to Dr Gabriella Pichert, Clinical Genetics Department, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK;
Contributors GP and LI selected genes for inclusion in the study and drafted the manuscript; SNM advised on report wording and policy; JWA extracted the data; CO compiled patient information. All authors contributed to collation and review of the data, contributed to the critical revision of the manuscript and approved the final version. LI is guarantor.
- Received 24 November 2010
- Revised 12 January 2011
- Accepted 24 January 2011
- Published Online First 23 March 2011
Objective To calculate and discuss the percentage of imbalance for selected cancer predisposition genes in patients referred for routine diagnostic array comparative genomic hybridisation (CGH).
Design Audit of findings from application of array CGH for patients referred for developmental delay, behavioural abnormalities and birth defects in 4805 patients referred to Guy's and St Thomas' NHS Foundation Trust for cytogenetic investigation from South East London, Kent and East Sussex and other genetic centres across the UK.
Results 29 of 4805 (0.6%) patients examined by array CGH had genomic imbalance of <5 Mb involving cancer predisposition genes. Six patients were referred for syndromes involving cancer predisposition genes; none of the other 23 patients with array CGH findings in cancer predisposition genes had any symptoms/family history stated on their referral form suggestive for the respective syndrome. Twelve whole gene deletions, two partial deletions, 12 duplications, two partial duplications, and one mosaic duplication were observed. In 17/29 patients (59%), inheritance could not be established, eight imbalances were de novo, and four inherited.
Conclusions This new technology raises the possibility of unexpected findings in cancer predisposition genes. Therefore, the possibility of such findings has to be addressed in pre-test and post-test counselling by genetically trained healthcare professionals. As many of these findings have not been described previously, their clinical significance is unknown and patients need long-term follow-up to determine their clinical relevance. This will enable genetic healthcare professionals to advise such people about their cancer risks and appropriate cancer risk management options.
- Array CGH
- cancer predisposition genes
- genomic imbalances
- diagnostics tests
- getting research into practice
- molecular genetics
Funding The study was funded internally by the genetics and cytogenetics departments.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.