A nonsense mutation (E1978X) in the ATM gene is associated with breast cancer.

Blood relatives of patients with ataxia-telangiectasia (A-T) have an increased risk to develop breast cancer. Allelic heterogeneity has made it difficult to confirm the role of ATM, the gene mutated in A-T, for breast cancer susceptibility in the general population. We now report that a nonsense mutation, p.E1978X (c.5932G>T), is both a classical A-T mutation and a breast cancer susceptibility allele in Eastern European populations. In a case-control study from Belarus, the E1978X mutation was identified in 10/1,891 Byelorussian breast cancer cases (0.5%) compared with 1/1,019 population controls [odds ratio (OR): 5.4; 95% confidence interval (95% CI), 0.7-42.4, P = 0.1]. A second case-control study from Russia identified the E1978X mutation in two Russian and one Ukrainian cases out of 611 breast cancer patients but not in any Russian or Ukrainian controls (P = 0.1). In a third case-control study from Poland, E1978X was observed in 7/3,910 Polish breast cancer cases (0.2%) compared with 1/2,010 cancer-free population controls (OR: 3.6; 95% CI: 0.4-29.3, P = 0.4). In the combined analysis, E1978X was significantly associated with breast cancer (Mantel-Haenszel OR: 5.6, 95% CI: 1.3-21.4, P = 0.01). Taken together, this study provides first evidence for the association of a common A-T causing mutation with breast cancer in Eastern European founder populations.

ATM gene mutations in former uranium miners of SDAG Wismut: a pilot study.

Ataxia-telangiectasia is an autosomal recessive disease characterized by neurological and immunological symptoms, radiosensitivity and cancer predisposition. Heterozygous carriers of an ataxia-telangiectasia gene mutation are predisposed to epithelial cancers. We initiated a study to elucidate the frequency and clinical relevance of ATM gene mutations in former uranium miners exposed to high levels of radiation from radon and its decay products. Former uranium miners with Schneeberg lung cancer (n=48), former uranium miners suffering from silicosis (n=60) and uranium miners without occupational lung disorders (n=102) were investigated for nine mutations in the ATM gene. One gastric and one prostate cancer occurred in the group of miners without occupational lung diseases. Mutation analyses for S707P, IVS10-6Tright curved arrow G, 2250Gright curved arrow A, E1978X, R2443X, 3801delG, S49C and D2625E-A2626P were performed using genomic DNA obtained from peripheral blood samples. Three ATM gene alterations (S707P, S49C or IVS10-6Tright curved arrow G) were observed. Of all cancer patients, 8.0% were heterozygous, but only 1.9% of the non-cancer controls were [OR=4.6; 95% confidence interval (CI), 0.8-26.8]. In this pilot study a major role of six ATM gene mutations could not be revealed for cancer predisposition in former uranium miners. The results leave the possibility of a moderate risk associated with more subtle ATM gene alterations.

Clinical radiosensitivity in breast cancer patients carrying pathogenic ATM gene mutations: no observation of increased radiation-induced acute or late effects.

BACKGROUND AND PURPOSE: Reports on increased late subcutaneous toxicity after radiation therapy (RT) in breast cancer patients carrying ATM gene mutations has raised concerns about RT as part of the management in these patients. The impact of ataxia-telangiectasia (A-T) heterozygosity on clinical radiosensitivity remains a matter of debate while clinical data are scarce. PATIENTS AND METHODS: Between September 1995 and December 2002 genomic DNA samples were collected from 1100 unselected breast cancer patients receiving adjuvant radiotherapy at our department. Using mutation-specific assays, we screened for frequent ATM gene mutations. Analysis of acute and late radiation-related toxicity for skin and subcutaneous normal tissue was performed in patients identified as A-T heterozygotes applying common toxicity criteria (CTC) and LENT/SOMA (late effects on normal tissue/subjective objective management analytic) scoring criteria, respectively. RESULTS: Eleven patients were identified to be heterozygous for a pathogenic ATM gene mutation. Ten patients had received at least one course of RT. Median follow-up after completion of radiotherapy was 5.1 years (range 1.7-7.2). There was no evidence of increased radiation-induced acute or late skin or subcutaneous reactions in patients treated with linac-based RT. One patient failed distantly and was subsequently irradiated at four different sites for bone and brain metastases. Local relapse occurred in the single patient who had declined adjuvant RT following breast conservative therapy. CONCLUSIONS: Our results do not provide evidence for a relative contraindication to adjuvant RT in A-T heterozygous breast cancer patients. Due to their increased cellular radiosensitivity, these patients may differentially benefit from RT and qualify for dose and volume reduction trials.