Multigene assessment of genetic risk for women for two or more breast cancers

Jeffrey N. Weitzel, John Kidd, Ryan Bernhisel, Susan Shehayeb, Paul Frankel, Kathleen R. Blazer, Diana Turco, Bita Nehoray, Kim McGreevy, Kira Svirsky, Krystal Brown, Anna Gardiner, Mary Daly, Elisha Hughes, Shelly Cummings, Jennifer Saam, Thomas P. Slavin

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose: The prevalence, penetrance, and spectrum of pathogenic variants that predispose women to two or more breast cancers is largely unknown. Methods: We queried clinical and genetic data from women with one or more breast cancer diagnosis who received multigene panel testing between 2013 and 2018. Clinical data were obtained from provider-completed test request forms. For each gene on the panel, a multivariable logistic regression model was constructed to test for association with risk of multiple breast cancer diagnoses. Models accounted for age of diagnosis, personal and family cancer history, and ancestry. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: This study included 98,979 patients: 88,759 (89.7%) with a single breast cancer and 10,220 (10.3%) with ≥ 2 breast cancers. Of women with two or more breast cancers, 13.2% had a pathogenic variant in a cancer predisposition gene compared to 9.4% with a single breast cancer. BRCA1, BRCA2, CDH1, CHEK2, MSH6, PALB2, PTEN, and TP53 were significantly associated with two or more breast cancers, with ORs ranging from 1.35 for CHEK2 to 3.80 for PTEN. Overall, pathogenic variants in all breast cancer risk genes combined were associated with both metachronous (OR 1.65, 95% CI 1.53–1.79, p = 7.2 × 10–33) and synchronous (OR 1.33, 95% CI 1.19–1.50, p = 2.4 × 10–6) breast cancers. Conclusions: This study demonstrated that several high and moderate penetrance breast cancer susceptibility genes are associated with ≥ 2 breast cancers, affirming the association of two or more breast cancers with diverse genetic etiologies.

Original languageEnglish
Pages (from-to)759-768
Number of pages10
JournalBreast Cancer Research and Treatment
Issue number3
StatePublished - Jul 2021


  • BRCA1
  • BRCA2
  • Breast cancer
  • Hereditary breast cancer
  • Multiple breast cancers
  • Second breast cancer


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