Lynch Syndrome - is breast cancer a feature?
© Catts et al; licensee BioMed Central Ltd. 2011
Published: 10 March 2011
The debate on whether or not breast cancer is in the tumor spectrum for Lynch syndrome produces a conundrum for healthcare providers. The classic tumor spectrum for Lynch Syndrome (LS) includes colon, endometrial, ovarian, stomach, small intestine, hepatobiliary, urinary tract and brain/central nervous system cancers. Muir-Torre Syndrome (MTS) is a variant of LS that is associated with additional skin lesions including sebaceous gland tumors and keratoacanthomas. MTS was observed in 28% of LS families when assessing for MTS skin lesions . It has also been reported that 10-14% of individuals with MTS present initially with breast cancer [2, 3]. An extensive study published in 2002 excluded breast cancer as part of the tumor spectrum associated with LS . However, more recently it was reported that DNA mismatch repair (MMR) gene deficiencies were identified in 51% of breast cancers arising in MMR mutation carriers . Another study reported a male with an MLH1 mutation who had both colon and breast cancer. The breast cancer exhibited somatic reduction to homozygosity for the MLH1 mutation . Here we report two unrelated families in which the proband has a germline MMR gene mutation and bilateral breast cancer, and one family in which the proband had ovarian and renal cancer and her daughter, maternal aunt and cousin had breast cancer at age 47, 59, and 48 respectively. This raises the question are these breast cancers associated with the MMR mutations or a breast cancer susceptibility gene and what testing should be offered?
Three families underwent genetic counseling and testing through the Familial Cancer Risk Assessment Program and were found to have mutations in an MMR gene. All three families were then offered BRCA1/BRCA2 testing based on a personal and/or family history suggestive of hereditary breast and ovarian cancer. Informed consent was obtained and the proband underwent BRCA1/BRCA2 testing.
All three probands underwent BRCA1/BRCA2 DNA sequencing and one proband had large rearrangement analysis performed. All three probands were negative for alterations in BRCA1/BRCA2 genes.
Our findings indicate that breast cancer is part of the spectrum of tumors in LS families in which the breast cancer segregates with the other LS associated tumors. Additional hereditary breast cancer gene testing may not be warranted in these circumstances. A future research goal is to perform IHC on the breast tumors from these families to determine if they show loss of expression of the MMR gene that is known to be altered.
- South C, Hampel H, Comeras I, Westman J, Frankel W, Chapelle A: The Frequency of Muir-Torre Syndrome Among Lynch Syndrome Families. Journal National Cancer Institute 2008, 100: 277–281.View ArticleGoogle Scholar
- Cohen P, Kohn S, Kurzrock R: Association of Sebaceous Gland Tumors and Internal Malignancy: The Muir Torre Syndrome. The American Journal of Medicine 1991, 90: 606–613.PubMedView ArticleGoogle Scholar
- Cohen P, Kohn S, Davis D, Kurzrock R: The Muir Torre Syndrome. Dermatologic Clinics 1995, 13: 79–89.PubMedGoogle Scholar
- Muller A, Edmonston TB, Corao DA, et al.: Exclusion of breast cancer as an integral tumor of hereditary nonpolyposis colorectal cancer. Cancer Research 2002, 62: 1014–1019.PubMedGoogle Scholar
- Walsh M, Buchman D, Cummings M, Pearson S, Arnold S, Clendenning M, Wlaters R, McKeone D, Spurdle A, Hopper J, Jenkins M, Phillips K, Suthers G, George J, Goldblatt J, Muir A, Tucker K, Pelzer E, Gattas M, Woodall S, Parry S, Macrae F, Haile R, Baron J, Potter J, Marchand L, Bapat B, Thibodeau S, Lindor N, McGucklin M, Young J: Lynch Syndrome- Associated breast cancer: Clinicopathologic Characteristics of a Case Series from the Colon Cancer Family Registry. Clinical Cancer Research 2010,16(7):2214–2224. 10.1158/1078-0432.CCR-09-3058PubMed CentralPubMedView ArticleGoogle Scholar
- Boyd J, Rhei E, Federici M, Borgen P, Watson P, Franklin B, Karr B, Lynch J, Lemon S, Lynch H: Male breast cancer in hereditary nonpolyposis colorectal cancer syndrome. Breast cancer research and treatment 1999, 53: 87–91. 10.1023/A:1006030116357PubMedView ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.