Toggle Main Menu Toggle Search

Open Access padlockePrints

Analysis of rare disruptive germline mutations in 2135 enriched BRCA-negative breast cancers excludes additional high-impact susceptibility genes

Lookup NU author(s): Dr Fiona Douglas, Kate Bailey



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022 The Author(s). Background: Breast cancer has a significant heritable basis, of which ∼60% remains unexplained. Testing for BRCA1/BRCA2 offers useful discrimination of breast cancer risk within families, and identification of additional breast cancer susceptibility genes could offer clinical utility. Patients and methods: We included 2135 invasive breast cancer cases recruited via the Breast and Ovarian Cancer Susceptibility study, a retrospective UK study of familial breast cancer. Eligibility criteria: female, BRCA-negative, white European ethnicity, and one of: (i) breast cancer family history, (ii) bilateral disease, (iii) young age of onset (<30 years), and (iv) concomitant ovarian cancer. We undertook exome sequencing of cases and carried out gene-level burden testing of rare damaging variants against those from 51 377 ethnicity-matched population controls from gnomAD. Results: 159/2135 (7.4%) cases had a qualifying variant in an established breast cancer susceptibility gene, with minimal evidence of signal in other cancer susceptibility genes. Known breast cancer susceptibility genes PALB2, CHEK2, and ATM were the only genes to retain statistical significance after correcting for multiple testing. Due to the enrichment of hereditary cases in the series, we had good power (>80%) to detect a gene of BRCA1-like risk [odds ratio (OR) = 10.6] down to a population minor allele frequency of 4.6 × 10−5 (1 in 10 799, less than one-tenth that of BRCA1)and of PALB2-like risk (OR = 5.0) down to a population minor allele frequency of 2.8 × 10−4 (1 in 1779, less than half that of PALB2). Power was lower for identification of novel moderate penetrance genes (OR = 2-3) like CHEK2 and ATM. Conclusions: This is the largest case-control whole-exome analysis of enriched breast cancer published to date. Whilst additional breast cancer susceptibility genes likely exist, those of high penetrance are likely to be of very low mutational frequency. Contention exists regarding the clinical utility of such genes.

Publication metadata

Author(s): Loveday C, Garrett A, Law P, Hanks S, Poyastro-Pearson E, Adlard JW, Barwell J, Berg J, Brady AF, Brewer C, Chapman C, Cook J, Davidson R, Donaldson A, Douglas F, Greenhalgh L, Henderson A, Izatt L, Kumar A, Lalloo F, Miedzybrodzka Z, Morrison PJ, Paterson J, Porteous M, Rogers MT, Walker L, Ardern-Jones A, Adlard J, Ahmed M, Attard G, Bailey K, Bancroft E, Bardsley C, Barton D, Bartlett M, Baxter L, Belk R, Bernhard B, Bishop T, Boyes L, Bradshaw N, Brant S, Brice G, Bromilow G, Brooks C, Bruce A, Bulman B, Burgess L, Campbell J, Canham N, Castle B, Cetnarskyj R, Claber O, Coates N, Cole T, Collins A, Coulson S, Crawford G, Cruger D, Cummings C, D'Mello L, Day L, Dell B, Dolling C, Dorkins H, Downing S, Drummond S, Dubras C, Dunlop J, Durrell S, Eccles D, Eddy C, Edwards M, Edwards E, Edwardson J, Eeles R, Ellis I, Elmslie F, Evans G, Gibbons B, Gardiner C, Ghali N, Giblin C, Gibson S, Goff S, Goodman S, Goudie D, Grier J, Gregory H, Halliday S, Hardy R, Hartigan C, Heaton T, Higgins C, Hodgson S, Homfray T, Horrigan D, Houghton C, Houlston RS, Hughes L, Hunt V, Irvine L, Jacobs C, James S, James M, Jeffers L, Jobson I, Jones W, Kennedy MJ, Kenwrick S, Kightley C, Kirk C, Kirk E, Kivuva E, Kohut K, Kosicka-Slawinska M, Kulkarni A, Lambord N, Langman C, Leonard P, Levene S, Locker S, Logan P, Longmuir M, Lucassen A, Lyus V, Magee A, Male A, Mansour S, McBride D, McCann E, McConnell V, McEntagart M, McKeown C, McLeish L, McLeod D, Melville A, Mercer L, Mercer C, Mitra A, Murday V, Murray A, Myhill K, Myring J, O'Hara E, Pearson P, Pichert G, Platt K, Pottinger C, Price S, Protheroe L, Pugh S, Quarrell O, Randhawa K, Riddick C, Robertson L, Robinson A, Roffey-Johnson V, Rogers M, Rose S, Rowe S, Schofield A, Rahman N, Saya S, Scott G, Scott J, Searle A, Shanley S, Sharif S, Shaw A, Shaw J, Shea-Simonds J, Side L, Sillibourne J, Simon K, Simpson S, Slater S, Smalley S, Smith K, Snadden L, Snape K, Soloway J, Stait Y, Stayner B, Steel M, Steel C, Stewart H, Stirling D, Thomas M, Thomas S, Tomkins S, Turner H, Vandersteen A, Wakeling E, Waldrup F, Watt C, Watts S, Webber A, Whyte C, Wiggins J, Williams E, Winchester L, Evans DG, Hanson H, Turnbull C

Publication type: Article

Publication status: Published

Journal: Annals of Oncology

Year: 2022

Volume: 33

Issue: 12

Pages: 1318-1327

Print publication date: 01/12/2022

Online publication date: 17/09/2022

Acceptance date: 02/04/2018

Date deposited: 23/11/2022

ISSN (print): 0923-7534

ISSN (electronic): 1569-8041

Publisher: Elsevier BV


DOI: 10.1016/j.annonc.2022.09.152


Altmetrics provided by Altmetric


Funder referenceFunder name
Cancer Research UK [grants numbers C8620/A8372, C8620/A8857]
NHS to the Institute of Cancer Research and Royal Marsden ras part of a joint entity referred to as the National Institute of Health Research Specialist Biomedical Research Centre for Cancer
the Institute of Cancer Research (no grant number)