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Fanconi anaemia, BRCA2 mutations and childhood cancer: a developmental perspective from clinical and epidemiological observations with implications for genetic counselling
  1. Stefan Meyer1,2,3,4,5,
  2. Marc Tischkowitz6,
  3. Kate Chandler4,7,8,
  4. Alan Gillespie9,10,
  5. Jillian M Birch5,11,
  6. D Gareth Evans7,8
  1. 1Department of Paediatric and Adolescent Oncology, University of Manchester, Manchester, UK
  2. 2Department of Paediatric Haematology and Oncology, Royal Manchester Children's Hospital, Manchester, UK
  3. 3Young Oncology Unit, The Christie NHS Foundation Trust, UK
  4. 4Stem Cell and Leukaemia Proteomics Laboratory, University of Manchester, Manchester, UK
  5. 5Manchester Academic Health Sciences Centre. Manchester, UK
  6. 6Department of Medical Genetics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
  7. 7Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester UK
  8. 8Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  9. 9Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  10. 10Fanconi Hope Charity, Southsea, UK
  11. 11Cancer Research UK Paediatric and Familial Cancer Research Group, University of Manchester, Manchester, UK
  1. Correspondence to Dr Marc Tischkowitz, Department of Medical Genetics, University of Cambridge, Box 134, Level 6 Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK; mdt33{at}cam.ac.uk Dr Stefan Meyer MD PhD FRCPCH Academic Unit of Paediatric and Adolescent Oncology, University of Manchester c/o Young Oncology Unit The Christie NHS Foundation Trust Wilmslow Road Manchester M20 6XB United Kingdom stefan.meyer{at}manchester.ac.uk

Abstract

Fanconi anaemia (FA) is an inherited condition characterised by congenital and developmental abnormalities and a strong cancer predisposition. In around 3–5% of cases FA is caused by biallelic mutations in the BRCA2 gene. Individuals heterozygous for BRCA2 mutations have an increased risk of inherited breast and ovarian cancer. We reviewed the mutation spectrum in BRCA2-associated FA, and the spectrum and frequency of BRCA2 mutations in distinct populations. The rarity of FA due to biallelic BRCA2 mutations supports a fundamental role of BRCA2 for prevention of malignant transformation during development. The spectrum of malignancies seen associated with FA support the concept of a tissue selectivity of BRCA2 mutations for development of FA-associated cancers. This specificity is illustrated by the distinct FA-associated BRCA2 mutations that appear to predispose to specific brain or haematological malignancies. For some populations, the number of FA-patients with biallelic BRCA2 disruption is smaller than that expected from the carrier frequency, and this implies that some pregnancies with biallelic BRCA2 mutations do not go to term. The apparent discrepancy between expected and observed incidence of BRCA2 mutation-associated FA in high-frequency carrier populations has important implications for the genetic counselling of couples with recurrent miscarriages from high-risk populations.

  • Cancer: breast
  • Haematology (incl Blood transfusion)
  • Genetic epidemiology

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