In this episode of PaperCast Base by Base, we explore how the Hereditary Breast, Ovarian, and Pancreatic Cancer Variant Curation Expert Panel (HBOP VCEP) developed gene-specific ACMG/AMP guidelines for the interpretation of PALB2 germline sequence variants, a key gene in hereditary cancer syndromes.
Study Highlights:
The HBOP VCEP assembled an international team of experts to refine the 2015 ACMG/AMP framework specifically for PALB2, a tumor suppressor gene involved in homologous recombination repair. They systematically reviewed 28 evidence codes, advising against the use of 13, limiting six, and tailoring nine to account for PALB2-specific biology. These specifications were validated through the curation of 39 pilot variants, achieving 84% concordance with ClinVar entries and leading to the reclassification of several variants of uncertain significance. The work emphasized the rarity of pathogenic missense variation in PALB2, focusing instead on loss-of-function mechanisms and evidence-based population frequency cutoffs.
Conclusion:
These conservative, PALB2-specific guidelines enhance the accuracy and consistency of variant classification, improving genetic counseling and risk management for individuals with PALB2-related cancer predisposition.
Reference:
Richardson, M.E., Bishop, M.F.H., Holdren, M.A., de la Hoya, M., Spurdle, A.B., Tavtigian, S.V., Brannan, T., Young, C.C., Zec, L., Hiraki, S., Turnbull, C., Tischkowitz, M., Bernstein, K.A., Masson, J.-Y., McNulty, S.M., Pesaran, T., Monteiro, A.N., Walker, L.C., Foulkes, W.D., & Couch, F.J. (2025). Specifications of the ACMG/AMP variant curation guidelines for the analysis of germline PALB2 sequence variants. *The American Journal of Human Genetics*, 112(10), 1–15. https://doi.org/10.1016/j.ajhg.2025.08.020