The impact of variant classification on the clinical management of hereditary cancer syndromes

Abstract

Purpose

The reclassification of genetic variants poses a significant challenge for laboratories and clinicians. Variant review has resulted in the reclassification of variants of unknown significance as well as the reclassification of previously established pathogenic and likely pathogenic variants. These reclassifications have the potential to alter the clinical management of patients with hereditary cancer syndromes.

Methods

Results were reviewed for 1694 patients seen for hereditary cancer evaluation between August 2012 and May 2017 to determine the frequency and types of variant reclassification. Patients with reclassifications with high potential for impact were monitored for alterations in organ surveillance, prophylactic surgery, and cascade testing.

Results

One hundred forty-two variants were reclassified representing 124/1694 (7.3%) patients; 11.3% of reclassifications (16/142) had a high potential for clinical impact with 94% (15/16) altering clinical management of patients with 56% (9/16) changing multiple areas of management.

Conclusion

While reclassifications are rare, the impact on clinical management is profound. In many cases, patients with downgraded pathogenic/likely pathogenic variants had years of unnecessary organ surveillance and underwent unneeded surgical intervention. In addition, cascade testing misidentified those at risk for developing cancers, thereby altering the management across generations. The frequency and types of alterations to clinical management highlight the need for timely variant reclassification.

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Acknowledgements

We thank the genetic counselors, advanced practice nurses, and the patients and their families who were seen at the Vanderbilt Hereditary Cancer Clinic at Vanderbilt-Ingram Cancer Center for participating in this study. G.L.W. is supported through the Vanderbilt-Ingram Cancer Center (VICC).

Author information

Correspondence to Scott A. Turner PhD.

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DISCLOSURE

The authors declare no conflicts of interest.

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Turner, S.A., Rao, S.K., Morgan, R.H. et al. The impact of variant classification on the clinical management of hereditary cancer syndromes. Genet Med 21, 426–430 (2019). https://doi.org/10.1038/s41436-018-0063-z

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Keywords

  • Hereditary cancer syndrome
  • Hereditary cancer clinic
  • Variant reclassification,
  • Clinical impact

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