BOOK REVIEW Cancer Causes and Control. Vol 8. 1997

Genetic Predisposition to CancerEeles RA, Ponder BAJ, Easton DF, Horwich A, eds.Chapman & Hall; London, UK. £60.ISBN 0412 565803.

Over a period of just a few years,molecular biologists and genetic epi-demiologists have worked together toidentify a number of genes that, in theirmutated form, give rise to hereditarypredisposition to common humanmalignancies (Table). These discoveriesoffer the potential of a significantimpact on public health research as wellas the practice of preventive medicine.In their timely volume, Eeles et al haveassembled a thorough and lucid reviewof the major syndromes of cancerpredisposition.

The volume begins with an overviewof the known syndromes of cancer pre-disposition and the methods of geneticepidemiology, including linkageanalysis. The positional cloning of theretinoblastoma, Wilms’ tumor, neuro-fibromatosis I, and familial adenomatouspolyposis coli (APC) genes are reviewed.Subsequent chapters present the rarersyndromes of genetic predisposition,including retinoblastoma, neuro-

fibromatosis, the Multiple EndocrineNeoplasias, Wilms’ tumor, and Li-Fraumeni syndrome. The perspectivetaken in these chapters varies. Thus, thechapter on retinoblastoma focuseslargely on the pivotal role of the RB1gene in cell cycle control, while thechapter on neurofibromatosis, for ex-ample, focuses more on the differentclinical presentations and managementissues for the two forms of thissyndrome. The chapter on the Li-Fraumeni syndrome emphasizes thechallenges of molecular diagnosis ofthis syndrome, which is characterizedby childhood sarcomas, breast cancerin affected women, and a variety ofother tumor types. Germline muta-tions of the p53 gene are documentedin only about half of the families re-viewed. Even when p53 mutations arefound, the medical screening options forheterozygotes are presented as of un-proven value.

The syndromes of chromosomefragility, including ataxia telangiectasia,xeroderma pigmentosum, and Fanconianemia are presented along with the‘Gorlin syndrome.’ The discussionfocuses on the clinical features of therare (1 in 300,000) patients homozy-

gous for mutations of the AT gene.(The gene, ATM was identified afterpublication of the book). Particularattention is paid to the specific featuresof a ‘low-radiosensitivity’ phenotypeof AT homozygotes. Mention also ismade of the controversy regarding thepossible increased risk of breast cancerin the one percent of the populationthat may be heterozygous for AT genemutations. A similar susceptibility tocancer has been postulated for heter-ozygotes of the gene associated withFanconi anemia, a disease that is evenrarer (1 in 350,000-400,000). Originalcalculations by Swift estimated thatone percent of cancer deaths couldoccur in individuals with FAC muta-tions. The basis for both of theseobservations is the increased chromo-somal instability, and sensitivity toradiation and/or chemical carcinogensin these disorders. Bloom syndrome,usually included in this group, is notmentioned. The gene associated withthe syndrome, BLM, (identified afterpublication of the volume) is a memberof the helicase family; its recentidentification has made possibleheterozygote detection.

A full discussion of Gorlin (nevoidbasal cell carcinoma) syndrome high-lights the myriad features of thisdisorder. The major tumors of thissyndrome, basal cell carcinomas, areamong the most common of the humanneoplasms, although Gorlin syndromeis quite rare (1 in 50,000). Like thechromosome fragility syndromes thataccompany it in this section of thebook, Gorlin syndrome patientsdemonstrate radiosensitivity; they mayform basal cell carcinomas in sites ofradiation therapy. The gene mutated inthis syndrome, also identified afterpublication of the volume, is a humanhomologue to the drosophila gene,PTH.

Of current interest to clinicians isthe section on the common cancers:breast, colon, prostate, lung, andmelanoma. Several chapters review theepidemiologic approach to the geneticsof these cancers. The basis for the now

Cancer Causes and Control, 1997, 8, pp. 109-110

© 1997 Rapid Science Publishers

Table 1 . Cancer predisposition syndromes and associated genes

Gene Syndrome

APC Familial adenomatous polyposisATM Ataxia telangiectasiaBLM Bloom syndromeBRCA1 Breast, OvarianBRCA2 Breast, OvarianCDKN2p16/CDK4 Hereditary melanomaFAC Fanconi anemiahMSH2 Hereditary non-polyposis colon cancerhMLH1 Hereditary non-polyposis colon cancerhPMS1 Hereditary non-polyposis colon cancerhPMS2 Hereditary non-polyposis colon cancerhPTC Nevoid basal cell carcinoma (Gorlin syndrome)p53 Li-Fraumeni syndromeRB1 Hereditary retinoblastomaRET Multiple Endocrine Neoplasia 2aVHL von Hippel-Lindau syndromeWT1 Wilms’ tumor syndromes

Cancer Causes and Control. Vol 8. 1997 109

‘classic’ linkage-derived risk estimatesof the BRCA1 gene, already included inpromotional materials for somecommercial DNA testing laboratories,is reviewed. This chapter discusses thehigh (more than 80 percent) risk forbreast cancer, variable (10 to 80percent) risk for ovarian cancer, andincreased (three- to fourfold) risk forcolon and prostate cancers for ‘genecarriers.’ This is followed by severalchapters on clinical strategies ofmanagement of the patient at ‘high risk’for breast cancer, including separatechapters on tamoxifen chemopreven-tion and prophylactic surgery.

Familial ovarian cancer is consideredseparately, since increased risk for thiscancer may be associated with breast-ovarian cancer syndrome, hereditarynon-polyposis colon cancer (HNPCC),or a possible ‘site specific’ syndrome.Compared with the breast cancerchapters, the discussion of the clinicalmanagement and genetics of hereditarycolon cancer syndromes is handled moresuccinctly. Although the molecularbasis for HNPCC was uncoveredinitially many months before thecloning of BRCA1, the reader is struck

by the relative paucity of genotype-phenotype and clinical correlationspresented for specific mutations ofhMSH2 and hMLH1 genes. This is byno means a defect in authorship of thisvolume. Rather, it is a reflection of thedifferent emphasis of research involv-ing the ascertainment and pooling ofgenotypic data for HNPCC and re-lated syndromes.

Thought-provoking chapters areincluded on the genetics of prostate andlung cancers, which will represent thenext set of major genetic predisposition‘discoveries.’ The book concludes withchapters on the genetics of melanoma,and general chapters on the cancerfamily clinic, risk perception, methodsof testing, and psychological andethical issues.

This excellent monograph demon-s t ra t e s some of the inev i t ab lelimitations of a multi-authored text,and also is understandably limited bythe rapid pace of discovery in this field.The focus on clinical and moleculargenetic aspects often shifts betweenchapters. For example, the comprehen-sive chapter on the Multiple EndocrineNeoplasia 2a syndrome does not delve

into the options following detection ofgermline mutations of the RET gene.Clinical series employing prophylacticthyroidectomy (e.g., reports by Wellsin North America and Lipps inEurope) are not cited, probably be-cause the results were unavailable at thetime the manuscript was being organ-ized. In general, the volume alsopresupposes some knowledge of cancergenetics. For example, such basic con-cepts as the ‘Knudson hypothesis’ arementioned briefly in the context of thediscussion of retinoblastoma inChapter 4.

These issues are relatively minor,however, and do not detract from thecomprehensive scope and scholarlynature of the effort. This book shouldserve as a useful reference for all thosewi t h an in t e r es t in the recentdiscoveries in cancer genetics and theirpractical applications.

Kenneth OffitDepartment of Human Genetics

Memorial Sloan-Kettering Cancer CenterNew York, NY, USA

CALENDAR OF MEETINGS Cancer Causes and Control. Vol 8. 1997

1997

20-22 FebruarySan Francisco, CA, USAMolecular Advances in Cancer Epidemiology and PreventionInformation: University of California, Office of Continuing Medical Education,1855 Folsom Street, MCB-630, Box 0742,San Francisco, CA 94143-0742, USA. Tel: (+1) 415 476 4251; Fax: (+1) 415 4760318; WWW: http://cme.ucsf.edu

20 MarchSan Francisco, CA, USAInternational DermatoEpidemiology Association (IDEA)Information: Dr M. Chren, Case Western Reserve University andCleveland Veterans Affairs Medical Center,Dermatology, 11-G (W), 10701 East Blvd.,Cleveland, OH 44106, USA. Tel: (+1) 216231 3475; Fax: (+1) 216 231 3476; email:mmc2@po.cwru.edu

14-18 SeptemberHamburg, GermanyECCO 9: The European Cancer ConferenceInformation: Federation of EuropeanCancer Societies (FECS), Avenue E.Mounier 83, B-1200 Brussels, Tel: (+32) 27750202; Fax: (+32) 2 7750200.

Book Review

110 Cancer Causes and Control. Vol 8. 1997