Estrogen receptor (ER)-negative tumors represent 20–30% of all breast cancers, with a higher proportion occurring in younger women and women of African ancestry. The etiology and clinical behavior of ER-negative tumors are different from those of tumors expressing ER (ER positive), including differences in genetic predisposition. To identify susceptibility loci specific to ER-negative disease, we combined in a meta-analysis 3 genome-wide association studies of 4,193 ER-negative breast cancer cases and 35,194 controls with a series of 40 follow-up studies (6,514 cases and 41,455 controls), genotyped using a custom Illumina array, iCOGS, developed by the Collaborative Oncological Gene-environment Study (COGS). SNPs at four loci, 1q32.1 (MDM4, P = 2.1 × 10−12 and LGR6, P = 1.4 × 10−8), 2p24.1 (P = 4.6 × 10−8) and 16q12.2 (FTO, P = 4.0 × 10−8), were associated with ER-negative but not ER-positive breast cancer (P > 0.05). These findings provide further evidence for distinct etiological pathways associated with invasive ER-positive and ER-negative breast cancers.

Breast cancer is the most common cancer among women. Common variants at 27 loci have been identified as associated with susceptibility to breast cancer, and these account for ∼9% of the familial risk of the disease. We report here a meta-analysis of 9 genome-wide association studies, including 10,052 breast cancer cases and 12,575 controls of European ancestry, from which we selected 29,807 SNPs for further genotyping. These SNPs were genotyped in 45,290 cases and 41,880 controls of European ancestry from 41 studies in the Breast Cancer Association Consortium (BCAC). The SNPs were genotyped as part of a collaborative genotyping experiment involving four consortia (Collaborative Oncological Gene-environment Study, COGS) and used a custom Illumina iSelect genotyping array, iCOGS, comprising more than 200,000 SNPs. We identified SNPs at 41 new breast cancer susceptibility loci at genome-wide significance (P < 5 × 10−8). Further analyses suggest that more than 1,000 additional loci are involved in breast cancer susceptibility.

Various common genetic susceptibility loci have been identified for breast cancer; however, it is unclear how they combine with lifestyle/environmental risk factors to influence risk. We undertook an international collaborative study to assess gene-environment interaction for risk of breast cancer. Data from 24 studies of the Breast Cancer Association Consortium were pooled. Using up to 34,793 invasive breast cancers and 41,099 controls, we examined whether the relative risks associated with 23 single nucleotide polymorphisms were modified by 10 established environmental risk factors (age at menarche, parity, breastfeeding, body mass index, height, oral contraceptive use, menopausal hormone therapy use, alcohol consumption, cigarette smoking, physical activity) in women of European ancestry. We used logistic regression models stratified by study and adjusted for age and performed likelihood ratio tests to assess gene–environment interactions. All statistical tests were two-sided. We replicated previously reported potential interactions between LSP1-rs3817198 and parity (Pinteraction = 2.4×10−6) and between CASP8-rs17468277 and alcohol consumption (Pinteraction = 3.1×10−4). Overall, the per-allele odds ratio (95% confidence interval) for LSP1-rs3817198 was 1.08 (1.01–1.16) in nulliparous women and ranged from 1.03 (0.96–1.10) in parous women with one birth to 1.26 (1.16–1.37) in women with at least four births. For CASP8-rs17468277, the per-allele OR was 0.91 (0.85–0.98) in those with an alcohol intake of <20 g/day and 1.45 (1.14–1.85) in those who drank ≥20 g/day. Additionally, interaction was found between 1p11.2-rs11249433 and ever being parous (Pinteraction = 5.3×10−5), with a per-allele OR of 1.14 (1.11–1.17) in parous women and 0.98 (0.92–1.05) in nulliparous women. These data provide first strong evidence that the risk of breast cancer associated with some common genetic variants may vary with environmental risk factors.

IntroductionWe hypothesised that breast cancer risk for relatives of women with early-onset breast cancer could be predicted by tumour morphological features.MethodsWe studied female first-degree relatives of a population-based sample of 452 index cases with a first primary invasive breast cancer diagnosed before the age of 40 years. For the index cases, a standardised tumour morphology review had been conducted for all; estrogen (ER) and progesterone receptor (PR) status was available for 401 (89%), and 77 (17%) had a high-risk mutation in a breast cancer susceptibility gene or methylation of the BRCA1 promoter region in peripheral blood DNA. We calculated standardised incidence ratios (SIR) by comparing the number of mothers and sisters with breast cancer with the number expected based on Australian incidence rates specific for age and year of birth.ResultsUsing Cox proportional hazards modelling, absence of extensive sclerosis, extensive intraductal carcinoma, absence of acinar and glandular growth patterns, and the presence of trabecular and lobular growth patterns were independent predictors with between a 1.8- and 3.1-fold increased risk for relatives (all P <0.02). Excluding index cases with known genetic predisposition or BRCA1 promoter methylation, absence of extensive sclerosis, circumscribed growth, extensive intraductal carcinoma and lobular growth pattern were independent predictors with between a 2.0- and 3.3-fold increased risk for relatives (all P <0.02). Relatives of the 128 (34%) index cases with none of these four features were at population risk (SIR = 1.03, 95% CI = 0.57 to 1.85) while relatives of the 37 (10%) index cases with two or more features were at high risk (SIR = 5.18, 95% CI = 3.22 to 8.33).ConclusionsThis wide variation in risks for relatives based on tumour characteristics could be of clinical value, help discover new breast cancer susceptibility genes and be an advance on the current clinical practice of using ER and PR as pathology-based predictors of familial and possibly genetic risks.

We hypothesised that breast cancer risk for relatives of women with early-onset breast cancer could be predicted by tumour morphological features. We studied female first-degree relatives of a population-based sample of 452 index cases with a first primary invasive breast cancer diagnosed before the age of 40 years. For the index cases, a standardised tumour morphology review had been conducted for all; estrogen (ER) and progesterone receptor (PR) status was available for 401 (89%), and 77 (17%) had a high-risk mutation in a breast cancer susceptibility gene or methylation of the BRCA1 promoter region in peripheral blood DNA. We calculated standardised incidence ratios (SIR) by comparing the number of mothers and sisters with breast cancer with the number expected based on Australian incidence rates specific for age and year of birth. Using Cox proportional hazards modelling, absence of extensive sclerosis, extensive intraductal carcinoma, absence of acinar and glandular growth patterns, and the presence of trabecular and lobular growth patterns were independent predictors with between a 1.8- and 3.1-fold increased risk for relatives (all P <0.02). Excluding index cases with known genetic predisposition or BRCA1 promoter methylation, absence of extensive sclerosis, circumscribed growth, extensive intraductal carcinoma and lobular growth pattern were independent predictors with between a 2.0- and 3.3-fold increased risk for relatives (all P <0.02). Relatives of the 128 (34%) index cases with none of these four features were at population risk (SIR = 1.03, 95% CI = 0.57 to 1.85) while relatives of the 37 (10%) index cases with two or more features were at high risk (SIR = 5.18, 95% CI = 3.22 to 8.33). This wide variation in risks for relatives based on tumour characteristics could be of clinical value, help discover new breast cancer susceptibility genes and be an advance on the current clinical practice of using ER and PR as pathology-based predictors of familial and possibly genetic risks.

The first wave of cancer genome-wide association studies (GWAS) have revealed tens of independent loci marked by common variants of unknown or likely no functional significance that explain about 5-10% of familial risk for the particular disease. The approach taken to date has been conservative, and only a fraction of information has yet to be extracted from these expensive enterprises. For example, the Bonferroni procedure for selecting candidate phase II SNPs ignores many SNPs that happen to fail an extremely low p-value threshold. While this procedure does guarantee control of false positives, it seems counterintuitive to the purpose of phase I, which is to generate hypotheses based on promising candidates. Researchers have generally combined data from the discovery phase I and other phases and used ‘genome-wide thresholds’ based on assuming all SNPs are independent. Linkage disequilibrium (LD) makes it problematic to differentiate a real signal from highly correlated proxy signals. Most published GWAS do not examine SNP interactions due to: (a) the high computational complexity of computing pvalues for the interaction terms, and (b) the typically low power to detect significant interactions. It is plausible that more information should be extracted if: (i) higher order interactions are fitted, (ii) highly selected cases and controls are used in phase I, (iii) large replication studies are used, especially if involving existing GWAS data, (iv) the non-independence of SNPs is taken into account using, e.g. BEAGLE CALL or haplotype analyses, (v) focus is on candidate gene pathways, and/or functional SNPs, and (vi) rarer and more SNPs, such as is available from the Illumina 5M SNP chip, are used. We will illustrate these ideas using data from a GWAS of early-onset breast cancers, enriched for those with a family history, and a GWAS using extremes sample of extremes for mammographic density. We will also discuss the design of a large international breast cancer GWAS using the Illumina 5M SNP chip, phase I cases enriched for family history, population-based phase II cases and controls, population-based family study of candidate SNPs, and GxG analyses using ‘massively parallel’ super computing.

The first wave of cancer genome-wide association studies (GWAS) have revealed tens of independent loci marked by common variants of unknown or likely no functional significance that explain about 5-10% of familial risk for the particular disease. The approach taken to date has been conservative, and only a fraction of information has yet to be extracted from these expensive enterprises. For example, the Bonferroni procedure for selecting candidate phase II SNPs ignores many SNPs that happen to fail an extremely low p-value threshold. While this procedure does guarantee control of false positives, it seems counterintuitive to the purpose of phase I, which is to generate hypotheses based on promising candidates. Researchers have generally combined data from the discovery phase I and other phases and used ‘genome-wide thresholds’ based on assuming all SNPs are independent. Linkage disequilibrium (LD) makes it problematic to differentiate a real signal from highly correlated proxy signals. Most published GWAS do not examine SNP interactions due to: (a) the high computational complexity of computing pvalues for the interaction terms, and (b) the typically low power to detect significant interactions. It is plausible that more information should be extracted if: (i) higher order interactions are fitted, (ii) highly selected cases and controls are used in phase I, (iii) large replication studies are used, especially if involving existing GWAS data, (iv) the non-independence of SNPs is taken into account using, e.g. BEAGLE CALL or haplotype analyses, (v) focus is on candidate gene pathways, and/or functional SNPs, and (vi) rarer and more SNPs, such as is available from the Illumina 5M SNP chip, are used. We will illustrate these ideas using data from a GWAS of early-onset breast cancers, enriched for those with a family history, and a GWAS using extremes sample of extremes for mammographic density. We will also discuss the design of a large international breast cancer GWAS using the Illumina 5M SNP chip, phase I cases enriched for family history, population-based phase II cases and controls, population-based family study of candidate SNPs, and GxG analyses using ‘massively parallel’ super computing.

Breast cancer is the most common cancer among women. To date, 22 common breast cancer susceptibility loci have been identified accounting for ∼8% of the heritability of the disease. We attempted to replicate 72 promising associations from two independent genome-wide association studies (GWAS) in ∼70,000 cases and ∼68,000 controls from 41 case-control studies and 9 breast cancer GWAS. We identified three new breast cancer risk loci at 12p11 (rs10771399; P = 2.7 × 10−35), 12q24 (rs1292011; P = 4.3 × 10−19) and 21q21 (rs2823093; P = 1.1 × 10−12). rs10771399 was associated with similar relative risks for both estrogen receptor (ER)-negative and ER-positive breast cancer, whereas the other two loci were associated only with ER-positive disease. Two of the loci lie in regions that contain strong plausible candidate genes: PTHLH (12p11) has a crucial role in mammary gland development and the establishment of bone metastasis in breast cancer, and NRIP1 (21q21) encodes an ER cofactor and has a role in the regulation of breast cancer cell growth.