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Review | Clinician's Corner

Genetic Susceptibility to Cancer The Role of Polymorphisms in Candidate Genes

Linda M. Dong, MPH, PhD; John D. Potter, MD, PhD; Emily White, PhD; Cornelia M. Ulrich, PhD; Lon R. Cardon, PhD; Ulrike Peters, PhD, MPH
JAMA. 2008;299(20):2423-2436. doi:10.1001/jama.299.20.2423.
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Context Continuing advances in genotyping technologies and the inclusion of DNA collection in observational studies have resulted in an increasing number of genetic association studies.

Objective To evaluate the overall progress and contribution of candidate gene association studies to current understanding of the genetic susceptibility to cancer.

Data Sources We systematically examined the results of meta-analyses and pooled analyses for genetic polymorphisms and cancer risk published through March 2008.

Study Selection We identified 161 meta-analyses and pooled analyses, encompassing 18 cancer sites and 99 genes. Analyses had to meet the following criteria: include at least 500 cases, have cancer risk as outcome, not be focused on HLA antigen genetic markers, and be published in English.

Data Extraction Information on cancer site, gene name, variant, point estimate and 95% confidence interval (CI), allelic frequency, number of studies and cases, tests of study heterogeneity, and publication bias were extracted by 1 investigator and reviewed by other investigators.

Results These 161 analyses evaluated 344 gene-variant cancer associations and included on average 7.3 studies and 3551 cases (range, 508-19 729 cases) per investigated association. The summary odds ratio (OR) for 98 (28%) statistically significant associations (P value <.05) were further evaluated by estimating the false-positive report probability (FPRP) at a given prior probability and statistical power. At a prior probability level of 0.001 and statistical power to detect an OR of 1.5, 13 gene-variant cancer associations remained noteworthy (FPRP <0.2). Assuming a very low prior probability of 0.000001, similar to a probability assumed for a randomly selected single-nucleotide polymorphism in a genome-wide association study, and statistical power to detect an OR of 1.5, 4 associations were considered noteworthy as denoted by an FPRP value <0.2: GSTM1 null and bladder cancer (OR, 1.5; 95% CI, 1.3-1.6; P = 1.9 × 10−14), NAT2 slow acetylator and bladder cancer (OR, 1.46; 95% CI, 1.26-1.68; P = 2.5 × 10−7), MTHFR C677T and gastric cancer (OR, 1.52; 95% CI, 1.31-1.77; P = 4.9 × 10−8), and GSTM1 null and acute leukemia (OR, 1.20; 95% CI, 1.14-1.25; P = 8.6 × 10−15). When the OR used to determine statistical power was lowered to 1.2, 2 of the 4 noteworthy associations remained so: GSTM1 null with bladder cancer and acute leukemia.

Conclusion In this review of candidate gene association studies, nearly one-third of gene-variant cancer associations were statistically significant, with variants in genes encoding for metabolizing enzymes among the most consistent and highly significant associations.

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Figure 1. Selection of Studies
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Figure 2. Risk of Bladder, Breast, Colorectal, Esophageal, and Gastric Cancer and Glioma by Genetic Variants—Limited to Meta-analyses and Pooled Analyses With Significant Summary Risk Estimates
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CI indicates confidence interval.

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Figure 3. Risk of Head and Neck, Lung, Ovarian, Prostate, Skin, Upper Aerodigestive Tract, and Urothelial Cancer and Leukemia, Meningioma, and Non-Hodgkin Lymphoma by Genetic Variants—Limited to Meta-analyses and Pooled Analyses With Significant Summary Risk Estimates
Graphic Jump Location

CI indicates confidence interval.

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