Studies on inherited cancers: outcomes and challenges of 25 years

Research on the dominantly inherited cancer-susceptibility syndromes over the past 25 years has defined the genetic basis of most of these diseases, usually through linkage analysis on families carrying the disease, and identification and analysis of the genes responsible. At present, almost all of these genes have been cloned and, in most cases, the findings have lent full support to Knudson's original hypothesis: germline carriers of mutations in cancer susceptibility genes are predisposed to developing cancer, the resultant tumours contain aberrations in the remaining copy of that gene, and these genes often play a pivotal role in the genesis of the equivalent sporadic cancers, whereby two somatic events result in the disruption of both copies of the gene. This perspective highlight some of the issues that have been raised by these studies, and points to a few of the areas of future research that might help to resolve them.     

Alterations in eighteen-carbon saturated, monounsaturated and polyunsaturated fatty acid peroxisomal oxidation in mouse brain during development and aging

PURPOSE/OBJECTIVES: To provide an update on the breast cancer genes BRCA1 and BRCA2 and to review available primary preventive options. DATA SOURCES: Published articles, abstracts, and clinical experience. DATA SYNTHESIS: While genetic testing will help identify a cadre of women at high risk for breast cancer development, it also will raise many psychosocial and ethical issues, including if and when to be tested and what patients and healthcare professional should do with the information. CONCLUSIONS: The only currently available putative form of primary prevention is prophylactic mastectomy. Diet and the use of tamoxifen remain areas for future research. IMPLICATIONS FOR NURSING PRACTICE: Nurses can play an important role in educating patients who face difficult decisions surrounding genetic testing and primary prevention modalities. Nurses also can design and conduct much needed research in these areas.     

Genetic testing for cancer predisposition: behavioral science issues

The discovery of major cancer susceptibility genes is likely to create strong pressures for clinical testing from biotechnology companies, insurance carriers, the medical community, and the public. However, before genetic testing for cancer predisposition is made widely available, we must identify the optimum strategies to enhance informed decision making, minimize adverse psychologic consequences, and promote adherence to recommended surveillance. This report provides an overview of behavioral research in these areas and, on the basis of this literature, presents suggestions for developing effective and ethical genetic testing protocols.     

The role of ethnicity in cancer susceptibility gene polymorphisms: the example of CYP1A1

Individual susceptibility to cancer from environmental agents may be influenced by polymorphic metabolic genes such as CYP1A1. The CYP1A1 gene contains four major polymorphisms identified to date. A modern nomenclature system, used with other genes, is presented to clarify the identity of these polymorphisms. The various CYP1A1 alleles exhibit population frequencies that depend on ethnicity. The association of these alleles with cancer at several sites has also been found to depend on racial or ethnic origin of the study population. Statistical considerations, such as the need for large studies when the power to detect a rare polymorphism is low, and ethnic differences in genetic linkage disequilibrium are among possible reasons for ethnic-specific effects on cancer susceptibility related to metabolic gene polymorphisms. New efforts to determine population frequencies of such polymorphisms are essential for future research in this area.     

Lesions of the posterior insular cortex impair water maze performance in the rat

This special issue of Patient Education and Counseling on genetic education and counseling provides an overview of studies and findings in this field. It features a mixture of papers dealing with five different topics related to several psychosocial aspects of genetic education and counseling. Attention is paid to new issues in counseling for hereditary cancer and Huntington Disease. Articles are presented on information recall of counseled individuals, the use and impact of genetic services on counselees (acceptance of testing; knowledge of inherited cancer susceptibility; risks of genetically testing children). Also topics are addressed with respect to the counselor (neutral attitude; understandable language; information recall; satisfaction with the services provided by the genetic counselor). Furthermore, recommendations are discussed for screening practices for women with a family history of breast cancer, and in addition, the effectiveness of genetic counseling is addressed. In conclusion several suggestions for future research are given.     

No germline mutations in the dimerization domain of MXI1 in prostate cancer clusters. The CRC/BPG UK Familial Prostate Cancer Study Collaborators. Cancer Research Campaign/British Prostate Group

There is evidence that predisposition to cancer has a genetic component. Genetic models have suggested that there is at least one highly penetrant gene predisposing to this disease. The oncogene MXI1 on chromosome band 10q24-25 is mutated in a proportion of prostate tumours and loss of heterozygosity occurs at this site, suggesting the location of a tumour suppressor in this region. To investigate the possibility that MXI1 may be involved in inherited susceptibility to prostate cancer, we have sequenced the HLH and ZIP regions of the gene in 38 families with either three cases of prostate cancer or two affected siblings both diagnosed below the age of 67 years. These are the areas within which mutations have been described in some sporadic prostate cancers. No mutations were found in these two important coding regions and we therefore conclude that MXI1 does not make a major contribution to prostate cancer susceptibility.     

Genetic and biochemical screening for endocrine disease: II. Ethical issues

The ability to test for specific genes conferring susceptibility to a variety of diseases has profound ethical implications for the way in which we care for patients. Legislators and health care insurers are scrambling to address the aspects of genetic screening that they believe fall within their purview. Critical to the development of appropriate societal regulations regarding genetic screening is a fundamental understanding of the ethical issues involved. A review of those concerns and the areas in which they interface with legal and insurance issues is the topic of this paper.     

Genes, Race, and Psychology in the Genome Era: An Introduction.

The mapping of the human genome has reawakened interest in the topic of race and genetics, especially the use of genetic technology to examine racial differences in complex outcomes such as health and intelligence. Advances in genomic research challenge psychology to address the myriad conceptual, methodological, and analytical issues associated with research on genetics and race. In addition, the field needs to understand the numerous social, ethical, legal, clinical, and policy implications of research in this arena. Addressing these issues should not only benefit psychology but could also serve to guide such thought in other fields, including molecular biology. The purpose of this special issue is to begin a discussion of this issue of race and genetics within the field of psychology. Several scholars who work in the fields of genetics, race, or related areas were invited to write (or had previously submitted) articles sharing their perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive rehabilitation of chronic alcohol abusers

Gene-based therapies for cancer in clinical trials include strategies that involve augmentation of immunotherapeutic and chemotherapeutic approaches. These strategies include ex vivo and in vivo cytokine gene transfer, drug sensitization with genes for prodrug delivery, and the use of drug-resistance genes for bone marrow protection from high-dose chemotherapy. Inactivation of oncogene expression and gene replacement for tumor suppressor genes are among the strategies for targeting the underlying genetic lesions in the cancer cell. A review of clinical trial results to date, primarily in patients with very advanced cancers refractory to conventional treatments, indicates that these treatments can mediate tumor regression with acceptably low toxicity. Vector development remains a critical area for future research. Important areas for future research include modifying viral vectors to reduce toxicity and immunogenicity, increasing the transduction efficiency of nonviral vectors, enhancing vector targeting and specificity, regulating gene expression, and identifying synergies between gene-based agents and other cancer therapeutics.     

Effect of the mass media in promoting calls to the Cancer Information Service

The Cancer Information Service is a toll-free telephone inquiry service that provides information about cancer and related resources to the public, patients and their families, and health-care providers. The service was created in 1975 to provide rapid access to the latest information about cancer, to address specific population needs, and to bridge gaps between cancer research and application. This article reviews a variety of ways in which the mass media have been used to promote calls to the Cancer Information Service. Conclusions are drawn about the usefulness of media promotion in the past, and recommendations are suggested for future media promotion of the service.     

Androgen receptor and mating-induced fos immunoreactivity are co-localized in limbic and midbrain neurons that project to the male rat medial preoptic area

The repair of DNA damage protects the genome of the cell from the insults of cancer causing agents. This was originally demonstrated in individuals with the rare genetic disease, xeroderma pigmentosum, the prototype of cancer genes, and subsequently in the relationship of mismatch repair to colon cancer. Recent studies suggest that individuals with less dramatic reductions in the capacity to repair DNA damage are observed at polymorphic frequency and these individuals have an increased susceptibility to several types of cancer. Screening of individuals for DNA sequence variation in the exons of 9 DNA repair genes has resulted in identification of 15 different polymorphic amino acid substitution variants. Although the studies to relate these variants to reduced DNA repair capacity and cancer status have not been completed, the available information is sufficient to suggest that DNA repair genes should be incorporated into molecular epidemiology and cancer susceptibility studies. The availability of molecular epidemiology data presents exciting opportunities for refinement of risk estimation models and identification of individuals at increased risk of disease, with resultant opportunities for effective surveillance and early intervention and treatment. The opportunities to acquire susceptibility data are associated with possible perils for establishment of regulations for permissible exposures to carcinogenic agents and also stigmatization of 'at risk' individuals that may result in decreased access to employment opportunities and health care.     

The contribution of pleiotropy to blood pressure and body-mass index variation: the Gubbio Study

Blood pressure (BP), body-mass index (BMI), and quantitative phenotypes thought to influence BP (e.g., lithium-sodium countertransport activity) were studied in 2,184 households comprising 5,376 people in Gubbio, Italy. Variance-components models were used to partition the variation of these phenotypes into components characterizing the effects of age-related, measured environmental, additive genetic, pleiotropic, unmeasured shared-household, and individual-specific (or random) factors. The goal of the investigation was to estimate the contribution of pleiotropy to variation in BP and BMI in population-based samples. Although our results suggest that numerous significant bivariate genetic correlations exist between BP and some of the traits investigated, they ultimately lead us to reject a prominent role for any individual bivariate pleiotropic system influencing the natural variation of BP. However, because we found evidence that many traits enter into small-impact pleiotropic relationships with BP, we cannot rule out the possibility that pleiotropic genes, when considered collectively, may contribute to BP variation at the population level. Similar results were obtained when BMI was taken as the primary variable of interest. We argue that the small but significant portion of BP variation explained by individual genes displaying bivariate pleiotropic effects is intuitive, in light of the relatively low heritabilities associated with quantitative cardiovascular phenotypes and the low phenotypic correlations between BP, BMI, and many other physiologically linked measures of cardiovascular function. Our results not only bear directly on both the nature of the multifactorial determinants of BP and the maintenance of BP variation in the population at large, but also emphasize the utility of variance-components models in epidemiologic and population genetics research. We discuss the implications of our results for genetic epidemiologists and medical researchers studying hypertension, as well as the limitations of our study and areas for future research.     

Long-term effects of amyloid enhancing factor: clinical and experimental implications

The aim of our study was to assess Polish women's attitudes and possible acceptance of genetic tests for breast cancer susceptibility. The research was carried out in 1995-1996 and enrolled 200 women of different age, education and professional status who were asked to answer the questions included in a questionnaire. We estimate the percentage of women presenting different attitudes towards breast cancer genetic testing: 77% of women accepted genetic tests for breast cancer (BRCA) and 48% of women accepted informing their close relatives of the genetic tests results.     

Are genetic factors important in the aetiology of leukoaraiosis? Results from a memory clinic population

Although cumulative evidence suggests that a genetic predisposition plays a major role in development of systemic lupus erythematosus (SLE) and/or lupus nephritis (LN), the susceptibility genes are mostly unknown. The difficulty in identifying susceptibility genes is due in part to multiple genes with variable genetic effects and the diverse genetic backgrounds of human populations. In human SLE, genes of early components of complements as well as many polymorphic genes (including the MHC class II and class III, FcgammaR, mannose-binding protein, IL-6, Bcl-2, and IL-10 genes) have been associated with SLE or LN by population-based case-control or within-case studies. The contribution of some of these disease-associated genes to the presence or absence of clinical manifestations has been further tested in mice with targeted disruption of the specific candidate gene. In addition to SLE susceptibility genes, there may be a separate set of nephropathy susceptibility genes predisposing to LN as suggested by the familial clustering of end-stage renal disease in African-Americans with LN. The availability of densely mapped genetic markers spanning the entire genome has enabled the identification of chromosomal regions linked to disease susceptibility genes without prior knowledge of the gene function. Our group has used known murine lupus susceptibility loci as a guide, and conducted linkage analysis of genetic markers located within a specific, possibly syntenic human chromosomal region. Evidence for linkage of a chromosome 1q41-42 region was observed in SLE-affected sib pairs from multiple ethnic groups. More recently, several groups have reported results of genome scans of SLE-affected sib pairs or pedigrees. These exciting recent developments in delineating the genetic basis of SLE or LN are summarized in this review.     

Genetic dissection of murine susceptibilities to liver and lung tumors based on the two-stage concept of carcinogenesis

Inbred mouse strains exhibit strain-specific susceptibilities to spontaneous and induced tumors, indicating that the individual risks for neoplastic development are largely under genetic control. Recent advances in linkage analysis have made it routine to chromosomally map the mouse genes responsible for the strain variations in tumor susceptibility using segregating crosses. It is also possible to characterize their biological functions using the positional information. These types of studies are still severely hampered for human cases due to the remarkable genetic heterogeneity and impossibility of experimental crosses. In this article, previous work on genetic susceptibility to mouse liver and lung tumors is reviewed in view of the classical two-stage concept of carcinogenesis. According to this central concept, the tumor susceptibility genes should affect either the first stage, 'initiation', or the second stage, 'promotion', or both. At least some genes seem to be specifically involved in initiation or promotion, in line with the fact that initiation and promotion are due, to a certain extent, to independent mechanisms. This notion should be also applicable to human carcinogenesis and may provide important clues for prevention of initiation and promotion in populations with a genetic predisposition for cancer development.     

Allelic imbalance in familial and sporadic prostate cancer at the putative human prostate cancer susceptibility locus, HPC1. CRC/BPG UK Familial Prostate Cancer Study Collaborators. Cancer Research Campaign/British Prostate Group

A recent report has provided strong evidence for a major prostate cancer susceptibility locus (HPC1) on chromosome 1q24-25 (Smith et al, 1996). Most inherited cancer susceptibility genes function as tumour-suppressor genes (TSGs). Allelic loss or imbalance in tumour tissue is often the hallmark of a TSG. Studies of allelic loss have not previously implicated the chromosomal region 1q24-25 in prostate cancer. However, analysis of tumour DNA from cases in prostate cancer families has not been reported. In this study, we have evaluated DNA from tissue obtained from small families [3-5 affected members (n = 17)], sibling pairs (n = 15) and sporadic (n = 40) prostate tumours using the three markers from Smith et al (1996) that defined the maximum multipoint linkage lod score. Although widely spaced (12-50 cM), each marker showed evidence of allelic imbalance in only approximately 7.5% of informative tumours. There was no difference between the familial and sporadic cases. We conclude that the incidence of allelic imbalance at HPC1 is low in both sporadic tumours and small prostate cancer families. In this group of patients, HPC1 is unlikely to be acting as a TSG in the development of prostate cancer.     

The past, present, and future of the prevention of lung cancer

The article relates details of the history of research into the causal association of cigarette smoking and lung cancer on the basis of multidisciplinary studies that have explored the epidemiology, biology, chemistry, and biochemistry of tobacco carcinogenesis and research in behavioral sciences and health education that has sought to address one of our nation's foremost public health problems. Recalling past and present challenges and achievements in all of these areas, the author then outlines his vision for addressing this health problem in the future. This is laid out for various segments of the research community and for society as a whole, i.e., Cancer Centers and hospitals, epidemiologists, laboratory scientists, legislators, educators and behavioral scientists, and the media. It is proposed that for the current policy initiatives in tobacco-related cancer control to succeed, there needs to be a focus on preventing the initiation of tobacco use among children and adolescents. All segments of society can help to achieve this goal. In the nation's research planning, there needs to be a proper balance between basic and applied research, including research on and application of preventive principles, because cancer need not be an inevitable consequence of aging but is largely preventable.     

The future of genetic epidemiology

Genetic epidemiology is a hybrid discipline whose ultimate aim is to identify and to characterize population-level factors that contribute to disease. Genetic epidemiologists often pursue this aim through the design and implementation of studies that simultaneously invoke principles in population genetics, epidemiology, molecular biology and biostatistics. However, traditional (and much contemporary) research in genetic epidemiology has barely tapped the potential that these disciplines have to work together. It is our view that future genetic epidemiology inquiry will benefit greatly from stronger integration of these disciplines and is likely to converge on themes in fields as diverse as demography, classical population and evolutionary genetics, pharmacoepidemiology, and ecology. The ultimate focus of this research will be evolution and maintenance of disease within and across populations.     

Dissecting the genetics of type 1 diabetes: relevance for familial clustering and differences in incidence

A combination of genetic and environmental factors is most likely the cause of Type 1 diabetes. Results from twin data, familial clustering of the disease and difference in incidence according to ethnicity infer the presence of specific disease genes. The genetic component of Type 1 diabetes cannot be classified according to a classical model of inheritance but is due to an interaction between different genes and environmental factors. The major genes are within the HLA region that are responsible for 40% of the genetic susceptibility, although other genes are important (non-HLA genes). To date, more than 10 specific loci have been localized on different chromosomes. The gene involved has been characterized only for two of such loci, IDDM1 and IDDM2, while in the other cases the presence of some susceptibility genes can be envisaged and their identification represents the goal of genetic research in coming years. Fine mapping of the loci will certainly increase our understanding of the genetics of Type 1 diabetes; the limitation in detecting some of the remaining genes by linkage studies can be overcome by association studies. That is possible via the collection of a large number of affected families (over 1000) in homogeneous populations.