If genetic testing for breast and ovarian cancer predisposition is to become available within a public health care system there needs to be a rational and cost-effective approach to mutation analysis.
We have screened for BRCA1 mutations in 230 women with breast cancer, all from the Wessex region of southern England, in order to establish the parameters on which to base a cost-effective regional mutation analysis strategy.
Truncating mutations were detected in 10/155 (6.5%) consecutive cases selected only for diagnosis under the age of 40 (nine of these ten women had a strong family history of breast or ovarian cancer), 3/61 (4.9%) bilateral-breast cancer cases (all three mutations occurring among women for whom the first cancer was diagnosed under 40 years) and 8/30 (26.6%) breast cancer cases presenting to the genetics clinic (for whom a strong family history of breast and/or ovarian cancer was present).
Ten different mutations were detected in 17 families, but three of these accounted for 10/17 (59%) of the families.
The cost of screening the population for mutations in the entire BRCA 1 gene is unacceptably high.
However, the cost of screening a carefully selected patient cohort is low, the risk of misinterpretation much less and the potential clinical benefits clearer.
Mots-clés Pascal : Tumeur maligne, Glande mammaire, Femelle, Ovaire, Homme, Prédisposition, Epidémiologie, Dépistage, Marqueur génétique, Rapport coût bénéfice, Mutation, Glande mammaire pathologie, Appareil génital femelle pathologie, Ovaire pathologie, Gène BRCA1
Mots-clés Pascal anglais : Malignant tumor, Mammary gland, Female, Ovary, Human, Predisposition, Epidemiology, Medical screening, Genetic marker, Cost benefit ratio, Mutation, Mammary gland diseases, Female genital diseases, Ovarian diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0318138
Code Inist : 002B20E02. Création : 27/11/1998.