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Nouvelles stratégies pour l’étude des facteurs génétiques impliqués dans le cancer du sein familial

Abstract : One of the most important risk factors for breast cancer (BC) is having a family history of BC. Around 20% of the familial BC risk is explained by rare mutations in the genes BRCA1 and BRCA2 (BRCA1/2). An additional 30% of the risk is accounted for mutations in other known genes, like ATM or TP53, and by common genetic variants, called single nucleotide polymorphism (SNPs), identified in population-based GWAS. Therefore, the majority of the familial forms of BC remains unexplained. Furthermore, there are large variations in the estimation of the BC lifetime risk for BRCA1/2 mutation carriers. It has been shown that some SNPs identified in the general population by GWAS (Genome Wide Association Studies) modified BC risk for BRCA1/2 mutation carriers. Therefore, little is known on how these SNPs interact with BRCA1/2 mutations since association studies have been performed within the population of BRCA1/2 mutation carriers so far.In the first part of this PhD project, I developed a novel strategy to analyze genetic factors by integrating simultaneously environmental and lifestyle factors. This strategy was used to analyze the data of GENESIS study composed of pairs of sisters affected by BC without BRCA1/2 mutation and controls from the general population. 5,000 BC cases and controls were genotyped for the 200,000 SNPs targeted by the iCOGS array. Groups of subjects was created according to their exposition profile reflecting expositions to radiation or reproductive factors. Analyses stratified on groups built according to their reproduction factors exposures did not highlighted specific variants. However, analyses stratified on groups reflecting the chest X—ray exposures showed potential specific SNPs for women who had never been exposed to chest X—ray, in genes XRCC4 and MAGI1, and for women highly exposed to X-ray exposures, in gene FGFR2, already known in the general population.The second aim was to identify and characterize genetic modifiers of BC risk for BRCA1/2 mutation carriers using data from the international consortia CIMBA (Consortium of Investigators of Modifiers of BRCA1/2) and BCAC (Breast Cancer Association Consortium). I developed a case-only GWAS analysis where we compare genotype frequencies between 60,212 unselected BC cases from the BCAC and 13,007 BC cases from CIMBA. We identified 4 novel variants associated with BC for BRCA1 mutation carriers and 4 for BRCA2 mutation carriers at P<10-8. MADD, SPI1 and EIF1 genes, already associated with BC biology, was predicted by the tool INQUISIT, to be target genes of the potential causal variants located in the locus 11p11.2 associated with BRCA1 status.These new SNPs could be used to improve polygenic risk scores (PRS). Studies considering the exposure profile should be implemented in larger population. The models could then evolve towards an adaptation of the PRS according to women’s exposure profiles and that throughout their life.
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Juliette Coignard. Nouvelles stratégies pour l’étude des facteurs génétiques impliqués dans le cancer du sein familial. Santé publique et épidémiologie. Université Paris Saclay (COmUE), 2019. Français. ⟨NNT : 2019SACLS426⟩. ⟨tel-03005974⟩

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