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NPJ Genom Med. 2018 Nov 15;3:30. doi: 10.1038/s41525-018-0070-7. eCollection 2018.

Clinical relevance of screening checklists for detecting cancer predisposition syndromes in Asian childhood tumours.

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1Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610 Singapore.
2SingHealth Duke-NUS Institute of Precision Medicine (PRISM), Singapore, 169856 Singapore.
3VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, Singapore, 229899 Singapore.
4Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, 229899 Singapore.
5Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, 229899 Singapore.
6Paediatric Hematology/Oncology Service, KK Women's and Children's Hospital, Singapore, 229899 Singapore.
7Department of Neurosurgery, National Neuroscience Institute, Singapore, 308433 Singapore.
8SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 308433 Singapore.
9Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, 169857 Singapore.
10Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232 Singapore.
11Institute of Molecular and Cellular Biology, ASTAR, Singapore, 138673 Singapore.
Contributed equally


Assessment of cancer predisposition syndromes (CPS) in childhood tumours is challenging to paediatric oncologists due to inconsistent recognizable clinical phenotypes and family histories, especially in cohorts with unknown prevalence of germline mutations. Screening checklists were developed to facilitate CPS detection in paediatric patients; however, their clinical value have yet been validated. Our study aims to assess the utility of clinical screening checklists validated by genetic sequencing in an Asian cohort of childhood tumours. We evaluated 102 patients under age 18 years recruited over a period of 31 months. Patient records were reviewed against two published checklists and germline mutations in 100 cancer-associated genes were profiled through a combination of whole-exome sequencing and multiplex ligation-dependent probe amplification on blood-derived genomic DNA. Pathogenic germline mutations were identified in ten (10%) patients across six known cancer predisposition genes: TP53, DICER1, NF1, FH, SDHD and VHL. Fifty-four (53%) patients screened positive on both checklists, including all ten pathogenic germline carriers. TP53 was most frequently mutated, affecting five children with adrenocortical carcinoma, sarcomas and diffuse astrocytoma. Disparity in prevalence of germline mutations across tumour types suggested variable genetic susceptibility and implied potential contribution of novel susceptibility genes. Only five (50%) children with pathogenic germline mutations had a family history of cancer. We conclude that CPS screening checklists are adequately sensitive to detect at-risk children and are relevant for clinical application. In addition, our study showed that 10% of Asian paediatric solid tumours have a heritable component, consistent with other populations.

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