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Lower Cancer Incidence in Amsterdam-I Criteria Families Without Mismatch Repair Deficiency
Familial Colorectal Cancer Type X
Noralane M. Lindor, MD;
Kari Rabe, MS;
Gloria M. Petersen, PhD;
Robert Haile, PhD;
Graham Casey, PhD;
John Baron, MD;
Steve Gallinger, MD;
Bharati Bapat, PhD;
Melyssa Aronson, MSc, CGC;
John Hopper, PhD;
Jeremy Jass, MD;
Loic LeMarchand, MD, PhD;
John Grove, PhD;
John Potter, MD, PhD;
Polly Newcomb, PhD;
Jonathan P. Terdiman, MD;
Peggy Conrad, MS;
Gabriella Moslein, MD;
Richard Goldberg, MD;
Argyrios Ziogas, PhD;
Hoda Anton-Culver, PhD;
Mariza de Andrade, PhD;
Kim Siegmund, PhD;
Stephen N. Thibodeau, PhD;
Lisa A. Boardman, MD;
Daniela Seminara, PhD, MPH
JAMA. 2005;293:1979-1985.
Context Approximately 60% of families that meet the Amsterdam-I criteria (AC-I) for hereditary nonpolyposis colorectal cancer (HNPCC) have a hereditary abnormality in a DNA mismatch repair (MMR) gene. Cancer incidence in AC-I families with MMR gene mutations is reported to be very high, but cancer incidence for individuals in AC-I families with no evidence of an MMR defect is unknown.
Objective To determine if cancer risks in AC-I families with no apparent deficiency in DNA MMR are different from cancer risks in AC-I families with DNA MMR abnormalities.
Design, Setting, and Participants Identification (1997-2001) of 161 AC-I pedigrees from multiple population- and clinic-based sources in North America and Germany, with families grouped into those with (group A) or without (group B) MMR deficiency by tumor testing. A total of 3422 relatives were included in the analyses.
Main Outcome Measures Cancer incidence in groups A and B (excluding the 3 affected members used to define each pedigree as AC-I) and computed age- and sex-adjusted standardized incidence ratios (SIRs) using Surveillance, Epidemiology, and End Results data.
Results Group A families from both population- and clinic-based series showed increased incidence of the HNPCC-related cancers. Group B families showed increased incidence only for colorectal cancer (SIR, 2.3; 95% confidence interval, 1.7-3.0) and to a lesser extent than group A (SIR, 6.1; 95% confidence interval, 5.2-7.2) (P<.001).
Conclusions Families who fulfill AC-I criteria but who have no evidence of a DNA MMR defect do not share the same cancer incidence as families with HNPCC-Lynch syndrome (ie, hereditary MMR deficiency). Relatives in such families have a lower incidence of colorectal cancer than those in families with HNPCC-Lynch syndrome, and incidence may not be increased for other cancers. These families should not be described or counseled as having HNPCC-Lynch syndrome. To facilitate distinguishing these entities, the designation of "familial colorectal cancer type X" is suggested to describe this type of familial aggregation of colorectal cancer.
Author Affiliations: Departments of Medical Genetics (Dr Lindor), Health Sciences Research (Ms Rabe and Drs Petersen and de Andrade), and Laboratory Medicine (Dr Thibodeau), and Division of Gastroenterology (Dr Boardman), Mayo Clinic, Rochester, Minn; University of Southern California, Los Angeles (Drs Haile and Siegmund); Cleveland Clinic, Cleveland, Ohio (Dr Casey); Dartmouth Medical School, Hanover, NH (Dr Baron); Mount Sinai Hospital, University of Toronto, Toronto, Ontario (Drs Gallinger and Bapat and Ms Aronson); University of Melbourne, Melbourne, Australia (Dr Hopper); McGill University, Montreal, Quebec (Dr Jass); University of Hawaii Cancer Research Center, Honolulu (Drs LeMarchand and Grove); Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Wash (Drs Potter and Newcomb); Department of Cancer Biology, University of San Francisco, San Francisco, Calif (Dr Terdiman and Ms Conrad); Department of Surgery, Heinrich Heine University, Düsseldorf, Germany (Dr Moslein); University of North Carolina, Chapel Hill (Dr Goldberg); University of California, Irvine (Drs Ziogas and Anton-Culver); and Division of Cancer Control and Population Sciences, Clinical and Genetic Epidemiology Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (Dr Seminara).
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