Reasoning
The PALB2 VCEP requires case-control studies with p-value ≤.05 and either an odds ratio, hazard ratio, or relative risk ≥3 or a lower 95% confidence interval ≥1.5. The exact c.1592delT variant was evaluated in a Finnish case-control comparison: familial breast-cancer cases carried the variant in 3/113 (2.7%) versus 6/2,501 controls (0.2%), with reported p=0.005, OR=11.3, and 95% CI 1.8–57.8; the paper's abstract also describes significant enrichment versus ancestry-matched population controls. In the same paper's unselected breast-cancer analysis, the variant occurred in 18 additional cases and was significantly associated with breast cancer at 0.9% versus 0.2% in 2,051 controls, p=0.003, OR=3.94, 95% CI 1.5–12.1. The independent penetrance study of the exact variant estimated HR=6.1, 95% CI 2.2–17.2, p=0.01. Each reported comparison satisfies the VCEP rule; the familial case-control result alone satisfies both the p-value and effect-size requirements.
VCEP rule
Case-control studies; p-value ≤.05 **and** (Odds ratio, hazard ratio, or relative risk ≥3 **or** lower 95% CI ≥1.5).
Evidence considered
- ClinGen PALB2 VCEP CSPEC PS4 rule: case-control studies require p-value ≤.05 and (odds ratio, hazard ratio, or relative risk ≥3 or lower 95% CI ≥1.5).
- Erkko et al., Nature 2007, PMID:17287723, Table 1, row PALB2 c.1592delT: familial cases 3/113 (2.7%), controls 6/2,501 (0.2%), p=0.005, OR=11.3, 95% CI 1.8–57.8.
- Erkko et al., Nature 2007, unselected breast-cancer analysis: 0.9% of cases versus 0.2% of 2,051 controls, p=0.003, OR=3.94, 95% CI 1.5–12.1.
- Erkko et al., Clinical Cancer Research 2008, PMID:18628482, abstract/results: exact c.1592delT carriers had HR=6.1 for breast cancer, 95% CI 2.2–17.2, p=0.01; the study used modified segregation analyses of Finnish carrier families identified from unselected breast-cancer cases.
Sources