Cancer risks by sex and variant type in PTEN Hamartoma Tumor Syndrome

Linda A J Hendricks, Nicoline Hoogerbrugge, Arjen R Mensenkamp, Joan Brunet, Roser Lleuger-Pujol, Hildegunn Høberg-Vetti, Marianne Tveit Haavind, Giovanni Innella, Daniela Turchetti, Stefan Aretz, Isabel Spier, Marc Tischkowitz, Arne Jahn, Thera P Links, Maran J W Olderode-Berends, Ana Blatnik, Edward M Leter, D Gareth Evans, Emma R Woodward, Verena Steinke-LangeVioletta C Anastasiadou, Chrystelle Colas, Marie-Charlotte Villy, Patrick R Benusiglio, Anna Gerasimenko, Valeria Barili, Maud Branchaud, Claude Houdayer, Bianca Tesi, M Omer Yazicioglu, Rachel S van der Post, Janneke H M Schuurs-Hoeijmakers, PTEN Study Group, Janet R Vos*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: PTEN Hamartoma Tumor Syndrome (PHTS) is a rare syndrome with a broad phenotypic spectrum, including increased risks of breast (BC, 67%-78% at age 60 years), endometrial (EC, 19%-28%), and thyroid cancer (TC, 6%-38%). Current risks are likely overestimated due to ascertainment bias. We aimed to provide more accurate and personalized cancer risks. Methods: This was a European, adult PHTS cohort study with data from medical files, registries, and/or questionnaires. Cancer risks and hazard ratios were assessed with Kaplan-Meier and Cox regression analyses, and standardized incidence ratios were calculated. Bias correction consisted of excluding cancer index cases and incident case analyses. Results: A total of 455 patients were included, including 50.5% index cases, 372 with prospective follow-up (median 6 years, interquartile range ¼ 3-10 years), and 159 of 281 females and 39 of 174 males with cancer. By age 60 years, PHTS-related cancer risk was higher in females (68.4% to 86.3%) than males (16.4% to 20.8%). Female BC risks ranged from 54.3% (95% confidence interval [CI] ¼ 43.0% to 66.4%) to 75.8% (95% CI ¼ 60.7% to 88.4%), with two- to threefold increased risks for PTEN truncating and approximately twofold for phosphatase domain variants. EC risks ranged from 6.4% (95% CI ¼ 2.1% to 18.6%) to 22.1% (95% CI ¼ 11.6% to 39.6%) and TC risks from 8.9% (95% CI ¼ 5.1% to 15.3%) to 20.5% (95% CI ¼ 11.3% to 35.4%). Colorectal cancer, renal cancer, and melanoma risks were each less than 10.0%. Conclusions: Females have a different BC risk depending on their PTEN germline variant. PHTS patients are predominantly at risk of BC (females), EC, and TC. This should be the main focus of surveillance. These lower, more unbiased and personalized risks provide guidance for optimized cancer risk management.

Original languageEnglish
Pages (from-to)93-103
Number of pages11
JournalJournal of the National Cancer Institute
Issue number1
Early online date28 Sept 2022
Publication statusPublished - 10 Jan 2023


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