title: Optimal selection of individuals for BRCA mutation testing: a comparison of available methods.
abstract: OBJECTIVE
  Several methods have been described that estimate the likelihood that a family history of cancer is a result of a mutation in the BRCA1 or BRCA2 genes. We examined the performance of six different methods with the aim of identifying an optimal strategy for selecting individuals for mutation testing in clinical practice.
  
  
  METHODS
  Two hundred fifty-seven families who had completed BRCA1 and BRCA2 mutation screening were assessed by six models representing the major methodologies used to assess the likelihood of a pathogenic mutation. The performance of each method as a selection criterion was compared with the result of mutation testing to produce sensitivity, specificity, and receiver operating curve data. The impact of incorporating breast cancer pathology data in the assessment was also analyzed.
  
  
  RESULTS
  The highest accuracy was achieved by the Bayesian probabilistic model (BRCAPRO). The formal probabilistic methods were significantly more accurate than clinical scoring methods. The methods were further improved by the incorporation of information on breast cancer pathology (tumor grade and estrogen receptor/progesterone receptor status). The resulting combined probability figure was highly accurate when selecting individuals for BRCA1 testing. Some BRCA2 mutation carriers were missed by all of the models examined.
  
  
  CONCLUSIONS
  Formal probabilistic models provide significantly greater accuracy in the selection of families for gene testing than the use of clinical criteria or scoring methods. The accuracy is further enhanced by incorporating information on the pathology of breast cancers occurring in the families.
authors.affiliation: Familial Cancer Centre, Murdoch Children's Research Institute, Melbourne, Australia. paul.james@anat.ox.ac.uk
authors.forename: Paul A
authors.initials: PA
authors.lastname: James
authors.forename: Rebecca
authors.initials: R
authors.lastname: Doherty
authors.forename: Marion
authors.initials: M
authors.lastname: Harris
authors.forename: Bickol N
authors.initials: BN
authors.lastname: Mukesh
authors.forename: Alvin
authors.initials: A
authors.lastname: Milner
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Young
authors.forename: Clare
authors.initials: C
authors.lastname: Scott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000235:genetics*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics*; D018579:Patient Selection; D010375:Pedigree; D012372:ROC Curve; D012307:Risk Factors