Current and future role of genetic screening in gynecologic malignancies

Am J Obstet Gynecol. 2017 Nov;217(5):512-521. doi: 10.1016/j.ajog.2017.04.011. Epub 2017 Apr 12.

Abstract

The world of hereditary cancers has seen exponential growth in recent years. While hereditary breast and ovarian cancer and Lynch syndrome account for the majority of mutations encountered by gynecologists, newly identified deleterious genetic mutations continue to be unearthed with their associated risks of malignancies. However, these advances in genetic cancer predispositions then force practitioners and their patients to confront the uncertainties of these less commonly identified mutations and the fact that there is limited evidence to guide them in expected cancer risk and appropriate risk-reduction strategies. Given the speed of information, it is imperative to involve cancer genetics experts when counseling these patients. In addition, coordination of screening and care in conjunction with specialty high-risk clinics, if available, allows for patients to have centralized management for multiple cancer risks under the guidance of physicians with experience counseling these patients. The objective of this review is to present the current literature regarding genetic mutations associated with gynecologic malignancies as well to propose screening and risk-reduction options for these high-risk patients.

Keywords: BRCA; Lynch syndrome; cervical cancer; endometrial cancer; hereditary cancer; high risk; ovarian cancer; risk reduction; screening.

Publication types

  • Review

MeSH terms

  • AMP-Activated Protein Kinase Kinases
  • DNA Mismatch Repair / genetics
  • DNA Polymerase III / genetics
  • DNA-Binding Proteins / genetics
  • Epithelial Cell Adhesion Molecule / genetics
  • Fanconi Anemia Complementation Group Proteins / genetics
  • Female
  • Genes, BRCA1
  • Genes, BRCA2
  • Genetic Predisposition to Disease
  • Genetic Testing
  • Genital Neoplasms, Female / diagnosis*
  • Genital Neoplasms, Female / genetics
  • Hamartoma Syndrome, Multiple / diagnosis
  • Hamartoma Syndrome, Multiple / genetics
  • Hereditary Breast and Ovarian Cancer Syndrome / diagnosis
  • Hereditary Breast and Ovarian Cancer Syndrome / genetics
  • Humans
  • Li-Fraumeni Syndrome / diagnosis
  • Li-Fraumeni Syndrome / genetics
  • Lynch Syndrome II / diagnosis
  • Lynch Syndrome II / genetics
  • Mismatch Repair Endonuclease PMS2 / genetics
  • MutL Protein Homolog 1 / genetics
  • MutS Homolog 2 Protein / genetics
  • Neoplastic Syndromes, Hereditary / diagnosis*
  • Neoplastic Syndromes, Hereditary / genetics
  • PTEN Phosphohydrolase / genetics
  • Peutz-Jeghers Syndrome / diagnosis
  • Peutz-Jeghers Syndrome / genetics
  • Protein Serine-Threonine Kinases / genetics
  • RNA Helicases / genetics
  • Tumor Suppressor Protein p53 / genetics

Substances

  • DNA-Binding Proteins
  • EPCAM protein, human
  • Epithelial Cell Adhesion Molecule
  • Fanconi Anemia Complementation Group Proteins
  • G-T mismatch-binding protein
  • MLH1 protein, human
  • RAD51C protein, human
  • RAD51D protein, human
  • TP53 protein, human
  • Tumor Suppressor Protein p53
  • Protein Serine-Threonine Kinases
  • STK11 protein, human
  • AMP-Activated Protein Kinase Kinases
  • POLD1 protein, human
  • DNA Polymerase III
  • PTEN Phosphohydrolase
  • PTEN protein, human
  • PMS2 protein, human
  • MSH2 protein, human
  • Mismatch Repair Endonuclease PMS2
  • MutL Protein Homolog 1
  • MutS Homolog 2 Protein
  • BRIP1 protein, human
  • RNA Helicases