Full Molecular Screening for Colon Cancer Patients of Familial/ Highly Inherited Germline Mutations in BRCA1 and BRCA2

doi:10.21203/rs.3.rs-745071/v1

Background: There is evidence of increasing number of early colon cancer cases among young people in many countries. The objective of this research is to assess the inherited germinal mutations in all BRCA2and BRCA1 coding areas in four consanguineous cases’ generations from a single Saudi family having occurrence of colon cancer.

Methods: This research examines a single Saudi family through four generations from Riyadh, Saudi Arabia. This family have diagnosed with colon cancer and inherited germline mutations in BRCA1 and BRCA2. The examination was conducted by DNA sequencing for the whole coding sections of BRCA1 and BRCA2. In addition, the colon samples were immunohistochemically and histologically analyzed utilizing BRCA1&2 antibodies and H&E staining, respectively.

Results: 21 scenarios at-risk consanguineous cases were mutations carried in the BRCA genes (2 BRCA2 and 4 BRCA1) and comprised of 3 affected consanguineous cases having malignant cancer of the colon. The BRCA nucleotide sequencing revealed a substantial mutations’ cases within the genes of BRCA1 (frameshift mutations situated within exon 11 and exon 2 while there were no such mutations within the BRCA2 genes). A novel replacement mutation within BRCA2 (exon 18) 139 C > A was obtained (45.83%) in females whereas it was (31.26%) in males. Immunohistochemical staining showed positive staining for BRCA1 and BRCA2.

Conclusion: The key reason that led to colon cancer incidences among them is highly inherited mutations of germline in BRCA2 and BRCA1 through repeated endogamy between consanguineous cases who carry these mutations.

Epigenetics & Genomics

Molecular Screening

Colon Cancer

Familial Inherited

Germline Mutations

BRCA1&2

Colon cancer (CC) can be regarded as a heterogeneous illness, which includes at least 3 major forms: colitis-associated, hereditary, and sporadic CC. Hereditary cancer of the colon accounts for roughly 10–15% of all colon cancers [1].

BRCA2 and BRCA1 genes act as caretaker genes that maintain genome integrity, and tumor suppressor’s genes [3, 5]. The occurrence rate of BRCA2 and BRCA1 gene mutations can vary in various populations [2, 4] that leads to5-10% of colon and breast cancer [3]. The gene of BRCA1 is found on chromosomes 17 and entails 24 exons as well as 1,863 various amino acids coding, whereas the BRCA2’s gene is found on chromosome 13 which still encompasses 27 exons codes for amino acids (3,418) [6]. More than 700 BRCA1’s mutations and more than 600 BRCA2’s mutations are reported in the coding regions [7]. Estimations indicate that several patients with BRCA2 and BRCA1 genes inherited mutations are susceptible to 3-fold increased colon, breast, and pancreatic risk [8, 15]. In addition, conventional histopathology, molecular analysis, and immunohistochemistry can give the whole information regarding any cancer type [9–12]. The highly favorable methods for identifying sequences include heteroduplex analysis (HA) and single-strand conformation polymorphism (SSCP) analysis for they are sensitive and simple in detection of germinal mutations [13].

Patients of familial colon cancer (CC) having germline BRCA2 and BRCA1 mutations, form adenomas in the colonic mucosa. During the process, they normally obtain germline mutations within the BRCA2 and BRCA1 genes [7, 8]. Consequently, the cellular mechanism associated with these inherited genes’ changes normally occurs with tissue changes for both breast and colon tumorigenesis [4, 14, 15].

Although, BRCA1/2 have been studied extensively, data obtained from Saudi Arabia is still insufficient. Thus, this study aims at determining germinal mutations of BRCA2 and BRCA1 whole coding areas for highly/familial inherited mutations indicating incidence of colon cancer for consanguineous cases among the four generations from a Saudi Arabian single. Besides, the study aims to assess the other related cofactors, which increased incidences of colon cancer among these consanguineous cases with family history of other cancer types.

2.1 Ethics Statement and Human Participants

The current research had the approval of the Deanship of Scientific Research for Princess Nourah Bint Abdulrahman University. This study was approved by national regulation committee of ethics, KACST, KSA (study number H-01-R059, IRB LOG number 20-0287). Additionally, the written acquainted permissions have been obtained from the participating patients prior to obtaining their samples

2.2 Case Selection and Samples Collection

Theis research data was made up of 24 consanguineous cases of affected carriers and patients from a single Saudi family (for four generations) from Riyadh, Saudi Arabia. From 24 relatives, three samples of biopsies were obtained from relatives affected by malignant cancer of the colon in 2020 (August) at the King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia.

The benchmark demographic profiles entailed all the participating consanguineous cases that is summarised in (Table 1). TNM’s classifications of malignant cancer of the colon for the participating consanguineous cases affected patients showing malignant cancer of the colon are l shown in (Table 2).

Table 1. Benchmark demographic profiles showing clinical characteristics for the participating consanguineous cases in four generations together with their consanguineous cases mutated couples

Cases #	Age at diagnosis (years)	Gender	Family history with other types of cancer	Diagnosed with colon cancer	*BRCA1* *& BRCA2* mutations**	Smoking history	Chronic colitis history	Obesity (BMI ≥ 25 kg)
1	79	M	unknown	YES	YES	-	-	-
2	76	F	-	-	YES	-	-	YES
3	59	M	YES – breast	-	YES	YES	YES	-
4	55	F	YES – pancreatic & breast	-	YES	-	-	YES
5	55	M	YES – breast	-	YES	-	-	-
6	53	F	YES – breast	-	YES	-	YES	YES
7	51	M	YES – breast	-	YES	YES	YES	-
8	48	F	YES – breast	-	YES	-	-	YES
9	46	F	YES – breast	-	YES	-	-	-
10	39	M	YES – breast	-	YES	-	YES	-
11	38	F	YES – pancreatic & breast	-	YES	-	YES	-
12	36	F	YES – breast	-	YES	YES	-	YES
13	34	F	YES – breast	YES	YES	-	YES	YES
14	31	M	YES – breast	-	YES	-	-	-
15	30	M	YES – breast	-	YES	YES	-	YES
16	28	F	YES – breast	-	YES	-	-	-
17	24	F	YES – breast	-	YES	-	-	-
18	17	F	YES – breast	YES	YES	-	YES	YES
19	14	M	YES – breast	-	YES	-	-	-
20	12	F	YES – breast	-	-	-	-	-
21	10	F	YES – breast	-	YES	-	-	-
22	7	M	YES – breast	-	YES	-	-	-
23	6	F	YES – breast	-	-	-	-	-
24	6	F	YES – breast	-	-	-	-	-
Total			22/24	3/24	21/24	4/24	7/24	8/24

Table 2. Pathological characteristics (TNM classifications) for the participating consanguineous cases having malignant cancer of the colon.

Stage (TNM Classification)	Number of Patients (%)
T1 - Tumor affects the submucosa (1-2 cm)	2
T2 - Tumor affects the muscularis propria (5 cm)	1
Total	3

DNA Extraction

Samples of blood were obtained from all the consanguineous cases affected carriers and patients from a single Saudi family (for four generations). Then, DNA was collected using the Qiagen DNA isolation kit (Cat No./ID: 69506, Quigen, Hilden, Germany) using the instructions of the manufacturer. The sample concentration and quality DNA ratio were assessed by use of the NanoDrop Spectrophotometer system (Thermo Scientific, USA).

Targeted Capture Sequencing of BRCA2 /BRCA1 Mutations

Exon coding sequences for the BRCA2 BRCA1 genes were put under heteroduplex analysis, according to the description by [16] or the single-stranded conformation analysis, according to the description by [17].

PCR and Sanger Sequencing for Detection of BRCA2/ BRAC1 Mutations

The whole coding sections of BRCA2 and BRCA1 used the conventional Sanger sequencing technique. The primer 3 program was used for designing the primers of all the coding exons for BRCA2 and BRCA1 genes. The primers’ sequences for BRCA2 and BRCA1 are shown in Table 3 b& a respectively. The nucleoFast ® 96 PCR Clean-up kit purified PCR products, according to the instructions of the manufacturer.

The reactions of sequencing were done utilising the BigDye ® Terminator v1.1 Cycle Sequencing kit in every PCR product (purified). The sequencing reaction products were purified utilising the MontageTM SEQ96 Sequencing Reaction kit, that followed by some electrophoresis by Applied Biosystems 3130 Genetic Analyzer, which is similar to the previous study [18].

Table 3. BRCA2 and BRCA1 PCR primers

a) BRCA1 Primers Sequence

Exon 2	Forward	5'-GAAGTTGTCATTTTATAAACCTTT-3'	315 bp
	Reverse	5'-TGTCTTTTCTTCCCTAGTATGT-3'
Exon 5	Forward	5'-GCTCTTCGCGTTGAAGAAGT-3'	400 bp
	Revers e	5'-GAAGTCTTTTGGCACGGTTT-3'
Exon 8	Forward	5'-CAGCTTGACACAGGTTTGGA-3'	499 bp
	Reverse	5'-TTTCTGGATGCCTCTCAGCT-3'
Exon 11	Forward	5'-GAGGACAAAGCAGCGGATAC-3'	359 bp
	Reverse	5'- GCTGTAATGAGCTGGCATGA-3'
Exon 18	Forward	5'- GGGAGAAGCCAGAATTGACA-3'	354 bp
	Reverse	5'- CTCGCTTTGGACCTTGGTG -3'
Exon23	Forward	5'- TTCAGGGGGCTAGAAATCTG-3'	289 bp
	Reverse	5'- AAGCTCATTCTTGGGGTCCT -3'
Exon24	Forward	5'- TTCAGGGGGCTAGAAATCTG-3'	289 bp
	Reverse	5'- GGGGTATCAGGTAGGTGTCC-3'

b) BRCA2 Primers Sequence

Exon 2	Forward	5'- AGCGTGAGGGGACAGATTTG-3'	519 bp
	Reverse	5'-GTGGACAGGAAACATCATCTGC -3'	519 bp
Exon 9	Forward	5'- AGGAGCTGAGGTGGATCCTG -3'	980 bp
	Reverse	5'- TCAGAATTGTCCCAAAAGAGCT -3'	980 bp
Exon 9	Forward	5'- GTTCAGCCCAGTTTGAAGCA -3'	980 bp
	Reverse	5'- TGACACTTGGGTTGCTTGTT -3'	980 bp
Exon 14	Forward	5'- TGTCCCGAAAATGAGGAAATGG -3'	925 bp
	Reverse	5'- TGTGAAACTGAAAAGACTCTGCA -3'	925 bp
Exon 18	Forward	5'- GGTGGATGGCTCATACCCTC -3'	809 bp
	Reverse	5'-TTTGCTGCTTCCTTTTCTTCC-3'	809 bp
Exon 23	Forward	5'- GAAGAATGCAGCAGACCCAG -3'	751 bp
	Reverse	5'- TGTCTCTTGAAAGTGGCCCT-3'	751 bp

Quantitative Genome Analysis

Sequence data was confirmed visually using the snap gene viewer (SGV). BRCA2 (accession number: NP_000050.2) and GenBank BRCA1 human sequences(accession number: NP_009225.1) were referenced to the NCBI Reference Sequences Database.

Pedigree Analysis

History of colon cancer including particular factors: carriers of BRCA2 and BRCA1 gene mutations, age-of-onset, tumors type, endogamy, other history of cancer, cause and date of death was determined for all the descendants of traceable ancestors for the patients having colon cancer. Cancer incidence and pedigree data were registered on a database (computerized). The traceable consanguineous cases were the ones living between 2019- 2020.

Tissue and Histological Preparation

Tissue specimens consisted of small biopsies i.e., 7-10 mm in diameter and were obtained from consanguineous cases affected patients having malignant cancer of the colon. Later, tissue specimens underwent transfer to 10% formalin fixative (buffered). After processing of tissue in an automated tissue’s processor applying a schedule for 24 hours, blocks of paraffin were sectioned and made to attain sections of 3-5 µm for the conventional histopathology. Then, conventional histopathology applied the Hematoxylin and Eosin (H&E) technique, as described [19].

Immunohistochemical Stating for BRCA1&2

In accordance with the major aim of BRCA1&2 IHC expression of screening and confirming inherited germline’s mutations in order to examine BRCA1&2 deficiency linked to a number of biological mechanisms.

Immunohistochemical researches were done in samples obtained from all the consanguineous cases subjects having colon cancer got from the blocks embedded with paraffin. Sections of 5 µm obtained from paraffin-embedded wax blocks then were put in slides (saline-glass) and later air-dried for a night at 37°C, deparaffinised in xylene, followed by rehydration in some graded alcohol (70 and 100%). The slides were then incubated in 3% methanol/ H₂O₂ for 10 minutes and washed by phosphate-buffered saline (PBS). Primary antibodies in the study for : anti-BRCA1 (MS110, mouse monoclonal, 1:200, Abcam, Cambridge, UK), anti-BRCA2 (MAB2476, mouse monoclonal, 1:500, R&D Systems, Inc. Minneapolis, MN, USA) were utilised at a diluted ration of 1:10, and then recorded as negative (absent or greatly reduced) in case the brown-like nuclear stain indicated <20% whereas nuclear staining of >20% was regarded as positive (American society of clinical oncology/college of American pathologist clinical practice guideline update 2013). Later, the sections were subjected to incubation for half a day in the primary antibodies BRCA2 and BRCA1 at 4°C washed using PBS. Consequently, a light microscope was used to examine for any immunostained sections.

Analysis of Statistics

The analytical examinations applied the SigmaStat programming adaptation 3.5 (Systat Software, San Jose, CA, USA). Later, the quantitative outcomes’ results were expressed in terms of, standard deviations and mean. P values < 0.05, were regarded as statically significant.

Deleterious BRCA2 and BRCA1 Gene mutations for All the Participating Consanguineous Cases

The age for the participating consanguineous cases patients having malignant cancer of the colon ranged between 17 – 79 years old. In this research, all the participating consanguineous cases had both genes’ inherited mutations.

Demetrious BRCA2 and BRCA1 genes were observed in 3/24(12.5%) consanguineous cases patients had colon cancer. Contrastingly, BRCA genes’ mutations were observed in 22/24(91.7%) consanguineous cases patients with a family history of breast cancer. Nevertheless, BRCA genes’ mutations were recorded in 21/24(87.5%) consanguineous carriers.

Besides, BRCA genes’ mutations were analysed as detailed in (Table 4). The BRCA1 gene had 4 mutations in exon 11 and 2, whereas in the BRCA2 gene, there were two mutations within exon 18. Besides, a substantial amount of BRCA1 gene’s mutations were the frameshift mutations situated within exon 11 and exon 2.

Overall, the occurrence of BRCA1 mutations in females and males was (11.06%) and (19.8%) respectively. Nevertheless, the BRCA2 mutation’s frequency among females and males was (31.8%) and (48.62%) respectively.

The BRCA genes’ mutations frequencies were analysed as indicated in (Figure 1) and SSCA’s movement in exon 2 (BRCA1) was recorded in consanguineous cases because of 185 del AG mutations (15.24%) in males and (29.16%) in females. Additionally, SSCA’s movement in exon 11 (BRCA1) was recorded for 3279 del C mutations (8.14%) in males and (12.91%) in females. Additionally, two mutations applying substitution in exon 11 for 2201 C >T (20.62%) in males and females and (11.35%) and for 2612 C >T (9.51%) in males and (16.7%) in females.

Contrastingly, the sequencing of nucleotide for BRCA2 and BRCA1 showed absence of frameshift mutations within BRCA2 gene, whereas two substituting mutations in the exon 18 indicated novel mutations 139 C > A (31.26%) in males and (45.83%) in females. Simultaneously, another substituting mutation for 8415 G >T (32.29%) in males and (51.42%) in females is the highly common germinal mutation analysed in this research (Figure 1 and Table 4).

Table 4. BRCA2 and BRCA1 inherited mutations for consanguineous cases for four Saudi family’s generations

Gene	Exon	Mutations	Mutation’s type	Reported earlier in other populations
*BRCA1*	2	185 del AG	Deletion	Yes
	11	2201 C >T	Substitution	Yes
	11	2612 C >T	Substitution	Yes
	11	3279 del C	Deletion	Yes
*BRCA2*	18	139 C > A	Substitution	Yes (it was reported in our previous study) [15]
*BRCA2*	18	8415 G >T	Substitution	Yes

Pedigree Analysis and Cancer Risk Estimations for All the Consanguineous Cases within Four Generations of the Saudi’s Family

Only a single Saudi’s family met the HNPCC’s criteria. Tracing of pedigree for the BRCA germline genes’ mutations showed 24 consanguineous cases in four generations for the Saudi’s family associated to an index case through common ancestry.

From the 24 consanguineous people, 21 cases consanguineous cases at-risk were marked with characterised mutations in the BRCA genes while dealing with extended pedigrees. Samples of blood were collected from members of the family in regard to incidences of colon cancer, their prior history of breast cancer and BRCA2 and BRCA1 screened nucleic acids for the identified mutations within the proband. For this study, the ration of relatives (9 males and 15 females) that were BRCA2 and BRCA1 genes’ mutations carriers (21 from 24, 87.5%) for the germline major genetic disorder with (P = 0.00). The summary of data of cancer occurrence within family members is recorded in Figure 2. The pedigree analysis entailing metachronous tumors had three colon cancers through the fourth, third, and first generations having family history for breast and pancreatic cancers. Besides, two cases recorded breast cancer, a deceased female diagnosed with cancer of the breast and the other had breast cancer in second generation for 5 affected consanguineous cases with colon and breast cancers in one family is four generations.

Figure 2 indicates the female patients affected by breast cancer and diagnosed at the age of 53 years, case #6 during the second generation. The proband is indicated as having the affected father (where colon cancer was diagnosed at the age of 79 years, in the first generation). In contrast, a female cousin (had colon cancer that was diagnosed at the age of 17 years, case #1 in the fourth generation), having a paternal aunt (who was diagnosed with colon cancer at the age of 34 years, case #3 in the third generation).

Histopathology

Histopathological parts were obtained from colon cancer patients who carried BRCA2 and BRCA1 germline mutations showed badly distinguished including substantial mitotic numbers as well as pleomorphism with lesser gland formation instances. Besides, there were irregular histological formations with high-level tumors’s grade. A level of proliferation disorganizations was present (Figure 3, b) and as compared to normal histological section of the colon (Figure 3, a).

Immunohistochemical Stating for BRCA2 and BRCA1

BRCA2 and BRCA1 expression was examined utilising immunohistochemistry (Figure 4). From the immunohistochemistry, there was strong intensities of staining with BRCA1 as well as moderate staining by BRCA2 antibodies within tumor tissues for patients of colon cancer. Overexpression of BRCA1 was markedly noted in all the three colon tumors’ samples. Nuclear staining showing over 20% reactions for positivity with the particular antibodies was classified as positive reactions (Figure 4). Besides, expression of BRCA2 was recorded in all the colon tumors’ samples as well. Furthermore, the procedure of antigen retrieval was calculated in accordance to the lastly recorded numerical H-scores for every case and gotten by multiplying the scores in respect of the classification as follows: over 50% (Strong), 20-40% (moderate), 1-20% (weak), and 0% (none).

The history of colorectal cancer can be associated with specific factors that include: age-of-onset, BRCA2 and BRCA1 gene mutations, other cancers’ history, endogamy, tumors type, cause and date of death in conjunction with other associated possible cofactors like: gender, obesity (BMI ≥ 25 kg), history of chronic colitis, and history of smoking were revealed for all the descendants of earliest traceable ancestors for patients having colorectal cancer. The main causes and co-factors received consideration in this research to examine the most impactful factors in the inheritance of germline mutations within BRCA2 and BRCA1 genes as well as the colon cancer incidence in four single family’s generations.

The BRCA2 and BRCA1 mutations can be regarded as the key factor that increased colon cancer distribution [20, 21] and tumorigenesis of breast [15, 22, 23, 26] at times of increased cells’ division mitotic numbers, and a reversal for the proliferating cells distribution [24, 25].

All the participating family members i.e., consanguineous cases affected patients as well as carriers) in this research are inherited mutations having a single novel mutation within the BRCA2 gene (139 C > A) within exon 18 that is the highly common germinal mutation analysed, which was recorded in the prior research [15]. According to findings be obtained from both genomes (Fig. 1, Table 4) as well as pedigree (Fig. 2), the analyses showed that all consanguineous cases show germline mutations BRCA2 and BRCA1 that were passed by repeated endogamy for a family with history of breast and pancreatic cancers, and thus leads to an increase in risk for colon [15, 18, 20], pancreatic [20, 21] as well as breast cancer [15, 22, 23]. On the other hand, one female family member showed germline mutations within BRCA2 and BRCA1 and married to a unrelative male with no such mutations. They have twin daughters with no germline mutations within BRCA2 and BRCA1.

Besides, colon tissues’ immunohistochemical data markedly indicated overexpression of BRCA1 while it positively stained for the BRCA2. These, findings were consistent with previous studies [27, 28] that showed that there is substantial relationship between expressions of BRCA1/2 and advanced stage of tumor as indicated in (Fig. 3, b and a).

In this current research, there are 4 variables that increased colon cancer’s incidence rates such as; age, gender, history of chronic colitis, obesity (BMI ≥ 25 kg) as well as smoking history.

For the gender, Wang et al., (2020) showed that it is imperative to incorporate gender as also a major factor during colon cancer’s treatment and diagnosis. Sex-specific tools of diagnosis could result to earlier colon cancer’s diagnosis in women and help in devising ways of increasing chemotherapy rate in women [26, 29].

In contrast, the age factor plays a crucial role in incidences of colon cancer. Besides, several studies have shown the importance of healthy lifestyles for teenage age people in reducing colon cancer for this age group [26]. Besides, this present study revealed similar rates for two associated factors including: obesity 8/24 (33.33%) and history of chronic colitis 7/24 (29.16%) that are related to healthy lifestyles [30], where several researches showed that taking unhealthy foods with hot spices and fast foods that have unhealthy nutritional values, meals without fresh fruits and vegetables could as well increase the incidences of the obesity and chronic colitis, particularly when there is a family cancer history [31, 32]. This could result to increased breast and colon cancers incidences at the younger age [26].

As shown in Table 4, history of smoking was recorded as 4/24(16.7%) while none of the smokers had colon cancer. Nonetheless, history of smoking was a consideration in this study to assess all the potential cofactors, which could increase breast and colon cancer incidence within a single family as it was previously reported [31, 33].

The study proposes that highly passed (through inheritance) germline mutations within BRCA2 and BRCA1 as well as increased breast and colon cancer recurrence over the four generations was due to repeated endogamy between consanguineous cases who carry germinal mutations within BRCA2 and BRCA1. Nevertheless, there are other factors that entail history of chronic colitis as well as obesity that could result to early-onset of colon cancer for young people as indicated in the consanguineous cases in e this family’s fourth generation.

A: Adenine (1 of 4 bases found in a DNA molecule)

BRCA1: Human gene stand for breast cancer 1 as reported by the HUGO Gene Nomenclature Committee

BRCA2: Human gene stand for breast cancer 2 as reported by the HUGO Gene Nomenclature Committee

C: Cytosine (1 of 4 bases found in a DNA molecule)

CC: Colon cancer

del: Deletion

DNA: Deoxyribonucleic acid OR a double-stranded RNA molecule

dx: The age at diagnosis

IHC: Immunohistochemistry

mm: Millimeter

µm: Micrometer

PBS: Phosphate buffered saline

SGV: Snap gene viewer

SSCA: Single-strand conformation analyses

T: Thymine (1 of 4 bases found in a DNA molecule)

Ethics approval and consent to participate

Written informed consent for participation were obtained from all the participants. Each participant & the patients’ parents (under the age of 18) agreed to participate in the present study. The study was approved by written letter from King Fahad Medical City according to ICH GCP H-01-R059 guidelines, IRB LOG number 20-0287, dated on August 27, 2020.

Consent for publication

Written informed consent for publication were obtained from all the participants. Each participant & the patients’ parents (under the age of 18) agreed to publish their clinical details, identifying images, genetic analyses & other personal details.

Availability of data and material

All relevant data are presented within the paper.

Competing interests

The authors declare that they have no competing interests.

Funding

This research was funded by the Deanship of Scientific Research at Princess Nourah Bint Abdulrahman University through the Fast-track Research Funding Program. The funder had no role in the study design, data collection and analysis, decision to publish, and manuscript preparation.

Authors’ Contributions

‘DA’ Participated in formal analysis, performed experimental works, investigation, methodology, resources, review, and editing, ‘TA’ Participated in conceptualization, formal analysis, investigation, methodology, review, and editing, ‘MA’ Participated in performed experimental works, data curation, methodology, resources, review, and editing, ‘DD’ Participated in methodology, resources, funding acquisition, review, and editing, ‘AAA’ Participated in formal analysis, methodology, software, ‘FA’ Participated in performed experimental works, Data curation, Methodology, Resources, review, and editing, ‘GA^’Participated in performed experimental works, investigation, methodology, resources, review, and editing, ‘WA’ Project administration, formal analysis, investigation, wrote the original draft and submitted the paper as a corresponding author. All authors read and approved the final manuscript.

Acknowledgements

Not applicable.

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Full Molecular Screening for Colon Cancer Patients of Familial/ Highly Inherited Germline Mutations in BRCA1 and BRCA2

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