Cancer and Your Genes

Other Cancers Seen in Families with RAD51D Mutations

Two days ago, we discussed a recent study by Dr. Nazneen Rahman and colleagues which clearly demonstrated that inherited mutations in a gene called RAD51D result in a substantial elevation in risk for ovarian cancer.  Some families with mutations in the study also had some other cancer types in the family tree.  So, does this mean that the other cancer types in these families are also due to the RAD51D mutations?

In short, the answer is that we don't know.  Ovarian cancer risk was the only one that Dr. Rahman and her colleagues could pin down as being associated with RAD51D mutations with any statistical confidence.  For the others, future studies can address the specific question; however, they may be challenging and require extremely large sample sizes in order to have the statistical power to answer the question.

Here are the other cancer types that were seen in the eight families with inactivating RAD51D mutations in the study:

Breast Cancer

•  Seen in 8 out of 8 families (not surprising given that the families were included in the study because they had both ovarian and breast cancer)
• There were 13 breast cancer cases total in these 8 families
• Two of the breast cancer cases were bilateral
• Seven of the 13 cases were found to have inactivating RAD51D mutations (the other 6 were not tested)
• In contrast to ovarian cancer, the association of RAD51D mutations with breast cancer was not statistically significant (Relative Risk = 1.32 with 95% confidence intervals from 0.59 - 2.96)

Colorectal Cancer

•  Seen in 5 out of 8 families (keep in mind that some of these extended families are quite large and that colorectal cancer is common)
• There were 8 total colorectal cancer cases in the 5 families
• None of the affected individuals were tested for the presence of mutations in this study

Lung Cancer

•  Seen in 1 individual in 1 out of 8 families (keep in mind that some of these extended families are quite large and that lung cancer is common)
• The individual with lung cancer was not tested for the presence of the familial RAD51D mutation in this study

Non-Hodgkin Lymphoma

•  Seen in 1 individual in 1 out of 8 families
• The individual with NHL was not tested for the presence of the familial RAD51D mutation

Pancreatic Cancer

•  Seen in 2 individuals total from 2 out of 8 families
• The 2 individuals with pancreatic cancer were not tested for the familial RAD51D mutation

Prostate Cancer

• A total of 2 cases were seen in 1 out of the 8 families
• The 2 individuals with prostate cancer were not tested for the familial RAD51D mutation

It's very important to keep in mind that seeing these cancers in these families could just be due to chance or to the fact that the families were more likely to come to the researchers' attention because of the other cancers (particularly breast cancer).  Thus, we can't say anything about whether RAD51D mutations may lead to elevated risk for any cancer other than ovarian cancer based on this study.  Nevertheless, it will be important in the future to keep an eye on this. 

Bottom Line Implications

1. Mutations in the RAD51D gene lead to ovarian cancer risk in some families in which the familial ovarian cancer risk is not explained by mutations in BRCA1/2

2. Although several other cancer types (including breast cancer) were seen in the families with mutations, there was no statistically significant evidence from this study implicating RAD51D mutations in risk for any of the other cancer types. 

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Selected References

Loveday C, Turnbull C, Ramsay E, et al.  Germline mutations in RAD51D confer susceptibility to ovarian cancer.  Nature Genetics 2011 (Published online August 7 2011)

RAD51D - A New Hereditary Ovarian Cancer Gene With Important Implications

The last couple of decades have brought significant advances in our ability to estimate ovarian cancer risk and, in some cases, prevent it - largely due to the discovery of the impact of mutations in the BRCA1 and BRCA2 genes on risk.  However, progress for women with a significant family history of ovarian cancer in families where BRCA1/2 mutations have been ruled out has been painstakingly slow.

Recently, physicians and scientists discovered that mutations in a gene called RAD51C account for hereditary breast and ovarian cancer risk in a modest number of families with a compelling family history of these cancers, but no mutations in the BRCA1 and BRCA2 genes.

In a new study published online at Nature Genetics today, scientists led by Dr. Nazneen Rahman at The Institute of Cancer Research (Sutton, UK), have clearly shown that inherited mutations in another gene called RAD51D appear to be the cause of ovarian cancer risk in some families that do not have mutations in the BRCA1 or BRCA2 genes.

If you have a compelling family history of ovarian cancer that is not explained by a mutation in the BRCA1 or BRCA2 gene, a mutation in the RAD51D gene could be the explanation.

RAD51D is an Ovarian Cancer Susceptibility Gene

Years of study of familial breast and ovarian cancer have shown that several genes involved in a cellular DNA repair pathway called "homologous recombination" are involved in cancer susceptibility.  For example, mutations in BRCA1, BRCA2, and RAD51C that can lead to Hereditary Breast and Ovarian Cancer risk can screw up DNA repair by homologous recombination within human cells.

It turns out that several other human genes code for proteins involved in homologous recombination within the cell, and it doesn't take a rocket scientist to guess that these genes might be involved in cancer risk too.  However, proving it is much easier said than done.

 Dr. Rahman and her colleagues were able to pull this off, however, thanks to access to DNA from a very large number of families with multiple cases of breast and ovarian cancer who had given permission for research.  They ruled out BRCA1 or BRCA2 mutations as a cause in the families in the current study.

Because the RAD51D gene is quite similar to RAD51C (they are called "paralogs" of each other in scientific terms), Dr. Rahman and her colleagues decided to look for mutations in RAD51D in the families without BRCA1/2 mutations.  What they found clearly establishes RAD51D in the group of genes behind familial ovarian cancer:

1. They found what look to be important "inactivating" RAD51D mutations in individuals from 8 of 911 families (0.9%) with at least 1 family ovarian cancer case and at least 1 family breast cancer case.  (A mutation was found in 1 out of 1,060 control individuals from families without breast and ovarian cancer family history)
   
2. Families in which the family history of cancer was most suggestive of cancer were more likely to have a RAD51D mutation.  1.7% of families with two or more cases of ovarian cancer had a RAD51D mutation.  For families with three or more cases of ovarian cancer, 5.1% had a RAD51D mutation.
3. When they studied other individuals with cancer in the families in which an initial person was found to have a RAD51D mutations, five out of five individuals affected with ovarian or breast cancer were found to have the family mutation.  This is consistent with the cancer risk potentially being due to the RAD51D mutation throughout the family. 
   
4. Using a statistical technique called "modified segregation analysis," they were able to show that ovarian cancer risk for carriers of the RAD51D mutations was approximately 6.3-fold higher than average risk. 
   
5. Female RAD51D mutation carriers were estimated to have a lifetime risk of ovarian cancer of approximately 10% as compared to the typical woman's lifetime ovarian cancer risk of about 1.5%.
6. There were too few breast cancer cases in the families with RAD51D mutations to be able to say with statistical certainty that there is any relationship between RAD51D mutations and breast cancer risk.  Thus, for now, we can only say for sure that RAD51D mutations confer ovarian cancer risk.  Future studies may further address questions about whether RAD51D mutations might be associated with risk of breast or other cancers.
7. Given recent evidence suggesting that cancer patients with BRCA1 or BRCA2 mutations may benefit in some cases from treatment with the homologous recombination pathway-targeting PARP inhibitor class of drugs, they assessed whether there was evidence in vitro that PARP inhibitor olaparib (AstraZeneca) selectively killed cells with reduced RAD51D activity.  The answer was yes, suggesting that PARP inhibitors may be useful in the treatment of cancers in individuals with RAD51D mutations.

 

Bottom Line Implications

1. Mutations in the RAD51D gene are responsible for ovarian cancer susceptibility in some families in which the familial risk of ovarian cancer is not explained by mutations in BRCA1 or BRCA2.
2. Although this is very important progress, this only explains ovarian cancer risk in a small subset of families.
3. Future studies will investigate risk of other cancers in families in which ovarian cancer risk is due to RAD51D mutations.
4. Preliminary evidence from in vitro experiments suggests that future clinical studies should assess whether PARP inhibitors may be particularly effective in the treatment of cancer in individuals with RAD51D mutations.

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Was this helpful?  Would you like to be notified when we post other similar breast and ovarian cancer risk-related information?  Click here for our free newsletter updates!

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Selected References

Loveday C, Turnbull C, Ramsay E, et al.  Germline mutations in RAD51D confer susceptibility to ovarian cancer.  Nature Genetics 2011 (Published online August 7 2011)