• Test Code:
    1696
  • Department:
  • Test Synonyms:
    ATMBRCA1BRCA2BRIP1CDH1CHEK2EPCAMMLH1MSH2MSH6NBNNF1PALB2PMS2PTENRAD51CRAD51DSTK11TP53
  • CPT Code(s):
    81162
Background:

A woman’s lifetime risk of developing breast cancer is approximately 12%. Furthermore, a woman’s lifetime risk of developing ovarian cancer and uterine cancer is 1.3% and 2.7%, respectively. Most cases of breast and gynecological cancers develop sporadically; however, an estimated 5-10% of cases are due to a hereditary predisposition. Although most inherited cancer predisposition syndromes are inherited in an autosomal dominant fashion, some genes on this panel are associated with clinically distinct autosomal recessive conditions. 

This test analyzes 19 well-established genes associated with an increased lifetime risk of hereditary breast and gynecological (ovarian, uterine, fallopian tube, and peritoneal) cancer. Notably, the genes analyzed on this panel are associated with conditions that have published management guidelines and adherence to these guidelines may result in risk-reduction and early diagnosis, which can increase the chance of successful treatment and survival. 

Factors that may be associated with hereditary breast and gynecological cancer predisposition syndromes include: early-onset of breast, uterine, endometrial, colon, pancreatic, melanoma, sarcoma, or prostate cancer, male breast cancer, ovarian or fallopian tube cancer, multiple primary cancers in one individual, and multiple affected family members. 

Understanding the molecular etiology of such cancer incidence can help guide treatment and proper surveillance. Our next-generation sequencing test is designed to detect mutations in the coding regions of 19 genes associated with inherited breast and gynecological cancer predisposition syndromes. Our microarray test is designed to identify single-exon deletions and duplications in the same 19 inherited breast and gynecological cancer-associated genes. Combining deletion/duplication data analyzed by microarray with next-generation sequencing data will allow KDL to improve diagnostic yield and deliver more comprehensive results. 

The results from genetic tests can facilitate assessment of levels of risk for patients and lead to more efficient and appropriate medical management. It is recommended that this testing be accompanied by a complete family history and genetic counseling.  

Reasons for Referral:

  • Molecular confirmation of a clinical diagnosis of inherited breast and gynecological cancer.
  • To aid in decision-making for treatment and management of individuals with inherited breast and gynecological cancer.
  • Testing for individuals with a positive family history for inherited breast and gynecological cancer (targeted testing is available if familial mutation is known). 

Methodology:

Component 1: Next generation sequencing will analyze the exons or coding regions of 19 Inherited Breast/Gyn Cancer-associated genes using Illumina NextSeq 500/550 technology. Samples are prepared using hybridization probes to enrich exonic regions. Promoter, intronic, etc. regions are not assessed on our assay, but may contain variants that impact gene function.

Component 2: A customized CytoSure “exon-centric” array (Oxford Gene Technology) will be used to detect deletions and duplications. The targeted array has enhanced probes targeted to the exonic regions of 19 Inherited Breast/Gyn Cancer-associated genes. The arrays are run using Agilent SureScan technology.

The 19 Inherited Breast/Gyn Cancer-associated genes are listed below: ATM, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, EPCAM, MLH1, MSH2, MSH6, NBN, NF1, PALB2, PMS2, PTEN, RAD51C, RAD51D, STK11, TP53 

Specimen Requirements:

Blood: EDTA or ACD (Solution A or B):

  • Adult: 5 mL
  • Child: 5 mL
  • Infant: 2-3 mL 

    Saliva: 2 ORAgene™ Saliva Collection Kit(s) (OGR-500) used according to manufacturer instructions. Please contact KDL Client Services for a Saliva Collection Kit for patients that cannot provide a blood sample.

    Skin Fibroblast: Punch Biopsy (Cell cultures will be prepared at KDL and used for testing), or 2 T-25 confluent flasks 

    DNA: 10µg at a minimum of 60-100ng/µL (DNA must be extracted in a CLIA-certified laboratory or a laboratory meeting equivalent requirements as determined by the CAP and/or CMS)

    For routine testing of blood, saliva and buccal swabs, KDL does NOT accept samples from patients within two (2) weeks of a packed cell/platelet transfusion or within four (4) weeks of a whole blood transfusion. For extraordinary circumstances, where testing must be performed outside of the above windows, please contact our lab.

    A REQUISITION FORM MUST ACCOMPANY ALL SAMPLES. Please include detailed clinical information, including ethnicity, clinical history, and family history.  
  • Test Performed (Days):

    Weekly

    Turn Around Time:

    3 weeks

    Shipment Sensitivity Requirements:

    • Package and ship specimen to remain cold, but not frozen.
    • Ship via overnight express, using the FedEx priority overnight label provided.
    • Contact Client Services for shipping kits and instructions at (855) 535- 1522.  

    References:

    1. Petrucelli N, Daly MB, Pal T. BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer. 1998 Sep 4 [Updated 2016 Dec 15]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1247/. 
    2. Zhang B, Beeghly-Fadiel A, Long J, Zheng W. Genetic variants associated with breast-cancer risk: comprehensive research synopsis, meta-analysis, and epidemiological evidence. The Lancet Oncology. 2011;12(5):477-488. doi:10.1016/s1470-2045(11)70076-6. 

    Additional Info:

    The Knight Cancer Institute at Oregon Health & Science University is a pioneer in the field of precision cancer medicine. The institute's director, Brian Druker, M.D., helped prove it was possible to shut down just the cells that enable cancer to grow. This breakthrough has made once-fatal forms of the disease manageable and transformed how cancer is treated. The OHSU Knight Cancer Institute is the only National Cancer Institute-designated Cancer Center between Sacramento and Seattle – an honor earned only by the nation's top cancer centers. It is headquarters for one of the National Cancer Institute's largest research collaboratives, SWOG, in addition to offering the latest treatments and technologies as well as hundreds of research studies and clinical trials.

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