Breast cancer outcomes following predictive BRCA testing in Northern Ireland

Objectives: Since 1995, BRCA testing has identified 445 women in Northern Ireland who carry a pathogenic BRCA1/2 mutation, without breast cancer (bca) at testing. This study examined outcomes with reference to management, bca risk, and incidence following positive predictive testing. Methods: Patients were identified from the regional genetics database. Electronic clinical records were used to obtain management and outcome details. Median follow-up was to bca diagnosis, risk-reducing mastectomy (rrm), death, or last follow-up. Results: 169 women had a BRCA1 mutation, and 276 BRCA2. ■ BRCA1 cohort: Median follow-up post-testing was 3 years. 56 Women (33%) had rrm, and 12 are awaiting rrm (total 68, 40%) at a median age of 36 years. 12 Women (7%) developed bca, at a median of 2 years following testing. 4 Women were diagnosed with bcas incidentally at rrm. 7 Patients had bilateral mastectomies following a cancer diagnosis. 1 Woman developed bca following rrm (1.7%). Three deaths were reported: 1 breast cancer (1.7%), 1 ovarian cancer (1.7%), and 1 with no recorded breast/ovarian cancer diagnosis. ■ BRCA2 cohort: Median follow-up post-testing was 6 years. rrm was carried out in 75 women (27%), with 20 awaiting rrm (total 95, 35%); median age: 39 years. 16 Women developed bca (5.8%), at a median of 5 years from testing. 6 Women were diagnosed with cancer incidentally at rrm; 9 women had bilateral mastectomy following diagnosis, and 1 developed bca following rrm (1.3%). Five deaths were reported: 1 bca, 1 ovarian cancer, and 3 with no recorded breast/ovarian cancer diagnosis. Conclusions: The uptake of rrm following predictive BRCA testing in Northern Ireland is comparable with that reported elsewhere. The incidence of bca following rrm is low (<2%) in our cohort, with low breast and ovarian cancer–specific mortality following positive predictive testing.

Testing quasar unification: radiative transfer in clumpy winds

Various unification schemes interpret the complex phenomenology of quasars and luminous active galactic nuclei (AGN) in terms of a simple picture involving a central black hole, an accretion disc and an associated outflow. Here, we continue our tests of this paradigm by comparing quasar spectra to synthetic spectra of biconical disc wind models, produced with our state-of-the-art Monte Carlo radiative transfer code. Previously, we have shown that we could produce synthetic spectra resembling those of observed broad absorption line (BAL) quasars, but only if the X-ray luminosity was limited to 1043 erg s-1. Here, we introduce a simple treatment of clumping, and find that a filling factor of ˜0.01 moderates the ionization state sufficiently for BAL features to form in the rest-frame UV at more realistic X-ray luminosities. Our fiducial model shows good agreement with AGN X-ray properties and the wind produces strong line emission in, e.g., Lyα and C IV 1550 Å at low inclinations. At high inclinations, the spectra possess prominent LoBAL features. Despite these successes, we cannot reproduce all emission lines seen in quasar spectra with the correct equivalent-width ratios, and we find an angular dependence of emission line equivalent width despite the similarities in the observed emission line properties of BAL and non-BAL quasars. Overall, our work suggests that biconical winds can reproduce much of the qualitative behaviour expected from a unified model, but we cannot yet provide quantitative matches with quasar properties at all viewing angles. Whether disc winds can successfully unify quasars is therefore still an open question.

A comparison of three methods for detecting KRAS mutations in formalin-fixed colorectal cancer specimens.

BACKGROUND: KRAS mutation testing is required to select patients with metastatic colorectal cancer (CRC) to receive anti-epidermal growth factor receptor antibodies, but the optimal KRAS mutation test method is uncertain. METHODS: We conducted a two-site comparison of two commercial KRAS mutation kits - the cobas KRAS Mutation Test and the Qiagen therascreen KRAS Kit - and Sanger sequencing. A panel of 120 CRC specimens was tested with all three methods. The agreement between the cobas test and each of the other methods was assessed. Specimens with discordant results were subjected to quantitative massively parallel pyrosequencing (MPP). DNA blends were tested to determine detection rates at 5% mutant alleles. RESULTS: Reproducibility of the cobas test between sites was 98%. Six mutations were detected by cobas that were not detected by Sanger, and five were confirmed by MPP. The cobas test detected eight mutations which were not detected by the therascreen test, and seven were confirmed by MPP. Detection rates with 5% mutant DNA blends were 100% for the cobas and therascreen tests and 19% for Sanger. CONCLUSION: The cobas test was reproducible between sites, and detected several mutations that were not detected by the therascreen test or Sanger. Sanger sequencing had poor sensitivity for low levels of mutation.