Journal of Community Genetics

, Volume 2, Issue 2, pp 53–69 | Cite as

Genetic testing for familial/hereditary breast cancer—comparison of guidelines and recommendations from the UK, France, the Netherlands and Germany

  • Dorothea GadzickiEmail author
  • D. Gareth Evans
  • Hilary Harris
  • Claire Julian-Reynier
  • Irmgard Nippert
  • Jörg Schmidtke
  • Aad Tibben
  • Christi J. van Asperen
  • Brigitte Schlegelberger


In this review, the national guidelines and recommendations for genetic testing for familial/hereditary breast cancer from the UK, France, the Netherlands and Germany were evaluated as to the inclusion criteria for genetic testing. In all four countries, access to genetic testing relies basically on the family history of breast and ovarian cancer. Similarities are obvious for most selection criteria. All four guidelines recommend embedding genetic testing within a framework of genetic counselling, and all agree to perform genetic testing first in an affected person. However, there are differences regarding the thresholds based on certain familial constellations, detailed description of selection criteria, the degree of relatedness between affected individuals and the counsellee, the age of diagnosis, the individual history of early onset breast cancer, bilateral breast cancer, the tumour morphology or the access to intensified surveillance. These differences and open questions not covered by the guidelines, e.g. on how to deal with phenocopies, unclassified variants, genetic variants in newly identified breast cancer susceptibility genes or with family constellations not fitting the criteria, are discussed. New evidence is usually slowly integrated into the guidelines. An exchange process towards the harmonization of the guidelines will ensure high quality health care across Europe.


Hereditary breast cancer BRCA1 and BRCA2 Genetic testing Inclusion criteria European comparison 



The authors gratefully acknowledge Gillian Teicke for her support in preparing the manuscript. This work was supported by the German Bundesministerium für Bildung und Forschung (BMBF, Federal Ministry of Education and Research), contract number 01GP0617. Prof. Evans is supported by the NIHR Biomedical Research Centre in Manchester.


  1. Ahrens P, Kreipe HH (2009) BRCA1- and BRCA2- associated breast carcinomas. Pathologe 30 Suppl 2:207–209PubMedCrossRefGoogle Scholar
  2. Albert US für die Mitglieder der Planungsgruppe und Leiter der Arbeitsgruppen Konzentrierte Aktion Brustkrebs-Früherkennung in Deutschland (2008) Stufe-3-Leitlinie Brustkrebs-Früherkennung in Deutschland. W. Zuckschwerdt Verlag, GermeringGoogle Scholar
  3. Albert U, Altland H, Duda V, Engel J, Geraedts M, Heywang-Köbrunner S, Hölzel D, Kalbheim E, Koller M, König K, Kreienberg R, Kühn T, Lebeau A, Nass-Griegoleit I, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz-Wendtland R, Wagner U, Kopp I (2009) 2008 update of the guideline: early detection of breast cancer in Germany. J Cancer Res Clin Oncol 135:339–354PubMedCrossRefGoogle Scholar
  4. Amir E, Freedman OC, Seruga B, Evans DG (2010) Assessing women at high risk of breast cancer: a review of risk assessment models. J Natl Cancer Inst 102:680–691PubMedCrossRefGoogle Scholar
  5. Andrieu N, Arveux P, Bonadona V, Bonaïti-Pellié C, Buechner B, Delpech M, Jolly D, Julian-Reynier C, Luporsi E, Noguès C, Nowak F, Olschwang S, Orsi F, Pujol P, Saurin JC, Sinilnikova O, Stoppa-Lyonnet D, Thépot F (2009) Synthèse du rapport sur l'estimation des besoins de la population pour les 10 années à venir en termes d'accès aux consultations et aux tests d'oncogénétique. Available at
  6. Antoniou AC, Easton DF (2006) Risk prediction models for familial breast cancer. Future Oncol 2:257–274PubMedCrossRefGoogle Scholar
  7. Antoniou AC, Pharoah PPD, Smith P, Easton DF (2004) The BOADICEA model of genetic susceptibility to breast and ovarian cancer. Br J Cancer 91:1580–1590PubMedGoogle Scholar
  8. Antoniou AC, Hardy R, Walker L, Evans DG, Shenton A, Eeles R, Shanley S, Pichert G, Izatt L, Rose S, Douglas F, Eccles D, Morrison PJ, Scott J, Zimmern RL, Easton DF, Pharoah PD (2008) Predicting the likelihood of carrying a BRCA1 or BRCA2 mutation: validation of BOADICEA, BRCAPRO, IBIS, Myriad and the Manchester scoring system using data from UK genetics clinics. Med Genet 45:425–431CrossRefGoogle Scholar
  9. Antoniou AC, Wang X, Fredericksen ZS et al (2010a) A locus on 19p13 modifies risk of breast cancer in BRCA1 mutation carriers and is associated with hormone receptor-negative breast cancer in the general population. Nat Genet 42:885–892PubMedCrossRefGoogle Scholar
  10. Antoniou AC, Beesley J, McGuffog L et al (2010b) Common breast cancer susceptibility alleles and the risk of breast cancer for BRCA1 and BRCA2 mutation carriers: implications for risk prediction. Cancer Res 70:9742–9754PubMedCrossRefGoogle Scholar
  11. Audeh MW, Carmichael J, Penson RT, Friedlander M, Powell B, Bell-McGuinn KM, Scott C, Weitzel JN, Oaknin A, Loman N, Lu K, Schmutzler RK, Matulonis U, Wickens M, Tutt A (2010) Oral poly(ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer: a proof-of-concept trial. Lancet 376:245–251PubMedCrossRefGoogle Scholar
  12. Bonaïti-Pellié C, Andrieu N, Arveux P, Bonadona V, Buecher B, Delpech M, Jolly D, Julian-Reynier C, Luporsi E, Noguès C, Nowak F, Olschwang S, Orsi F, Pujol P, Saurin JC, Sinilnikova O, Stoppa-Lyonnet D, Thépot F (2009) Cancer genetics: estimation of the needs of the population in France for the next 10 years. Bull Cancer 96:875–900PubMedGoogle Scholar
  13. Bryant HE, Schultz N, Thomas HD, Parker KM, Flower D, Lopez E, Kyle S, Meuth M, Curtin NJ, Helleday T (2005) Specific killing of BRCA2-deficient tumours with inhibitors of poly(ADP-ribose) polymerase. Nature 434:913–917PubMedCrossRefGoogle Scholar
  14. Bundesärztekammer K (1998) Richtlinien zur diagnostik der genetischen disposition für Krebserkrankungen. Dt Ärztebl 95:A1396–A1403, Google Scholar
  15. Chen S, Iversen ES, Friebel T, Finkelstein D, Weber BL, Eisen A, Peterson LE, Schildkraut JM, Isaacs C, Peshkin BN, Corio C, Leondaridis L, Tomlinson G, Dutson D, Kerber R, Amos CI, Strong LC, Berry DA, Euhus DM, Parmigiani G (2006) Characterization of BRCA1 and BRCA2 mutations in a large United States sample. J Clin Oncol 24:863–871PubMedCrossRefGoogle Scholar
  16. Claus EB, Risch N, Thompson WD (1994) Autosomal dominant inheritance of early-onset breast cancer. Implications for risk prediction. Cancer 73:643–651PubMedCrossRefGoogle Scholar
  17. Collaborative Group on Hormonal Factors in Breast Cancer (2001) Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58, 209 women with breast cancer and 101, 986 women without the disease. Lancet 358:1389–1399CrossRefGoogle Scholar
  18. Commission of the European Communities (2004) 2nd progress report and future orientations on life sciences and biotechnology. Available at
  19. Commission of the European Communities (2008) Directive of the European Parliament and of the Council on the application of patients' rights in cross-border healthcare. Available at
  20. de Sanjosé S, Léoné M, Bérez V, Izquierdo A, Font R, Brunet JM, Louat T, Vilardell L, Borras J, Viladiu P, Bosch FX, Lenoir GM, Sinilnikova OM (2003) Prevalence of BRCA1 and BRCA2 germline mutations in young breast cancer patients: a population-based study. Int J Cancer 106:588–593PubMedCrossRefGoogle Scholar
  21. Deutsche Gesellschaft für Humangenetik e.V. (2008) Indikationskriterien für genetische Diagnostik Bewertung der Validität und des klinischen Nutzens Indikationskriterien für die Krankheit: Familiärer Brust-/Eierstockkrebs [BRCA1/BRCA2]. Available at
  22. Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, Garber JE, Neuhausen SL, Matloff E, Eeles R, Pichert G, Van't Veer L, Tung N, Weitzel JN, Couch FJ, Rubinstein WS, Ganz PA, Daly MB, Olopade OI, Tomlinson G, Schildkraut J, Blum JL, Rebbeck TR (2010) Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 304:967–975PubMedCrossRefGoogle Scholar
  23. Evans DGR, Eccles DM, Rahman N, Young K, Bulman M, Amir E, Shenton A, Howell A, Lalloo F (2004) A new scoring system for the chances of identifying a BRCA1/2 mutation, outperforms existing models including BRCAPRO. J Med Genet 41:474–480PubMedCrossRefGoogle Scholar
  24. Evans DG, Lalloo F, Cramer A, Jones E, Knox F, Amir E, Howell A (2009) Addition of pathology and biomarker information significantly improves the performance of the Manchester scoring system for BRCA1 and BRCA2 testing. J Med Genet 46:811–817PubMedCrossRefGoogle Scholar
  25. European Commission, Directorate General, Directorate E Biotechnology, Agriculture and Food (2005) Survey on national legislation and activities in the field of genetic testing in EU Member States. Available at
  26. Farmer H, McCabe N, Lord CJ, Tutt ANJ, Johnson DA, Richardson TB, Santarosa M, Dillon KJ, Hickson I, Knights C, Martin NMB, Jackson SP, Smith GCM, Ashworth A (2005) Targeting the DNA repair defect in BRCA mutant cells as a therapeutic strategy. Nature 434:917–921PubMedCrossRefGoogle Scholar
  27. Fletcher O, Johnson N, dos Santos SI, Kilpivaara O, Aittomäki K, Blomqvist C, Nevanlinna H, Wasielewski M, Meijers-Heijerboer H, Broeks A, Schmidt MK, Van't Veer LJ, Bremer M, Dörk T, Chekmariova EV, Sokolenko AP, Imyanitov EN, Hamann U, Rashid MU, Brauch H, Justenhoven C, Ashworth A, Peto J (2009) Family history, genetic testing, and clinical risk prediction: pooled analysis of CHEK2*1100delC in 1,828 bilateral breast cancers and 7,030 controls. Cancer Epidemiol Biomark Prev 18:230–234CrossRefGoogle Scholar
  28. Foulkes WD (2008) Inherited susceptibility to common cancers. N Engl J Med 359:2143–2153PubMedCrossRefGoogle Scholar
  29. Gadzicki D, Schubert A, Fischer C, Milde S, Lehmann U, Steinemann D, Lück H, Kreipe H, Schlegelberger B (2009) Histopathological criteria and selection algorithms for BRCA1 genetic testing. Cancer Genet Cytogenet 189:105–111PubMedCrossRefGoogle Scholar
  30. Gendiagnostikgesetz (2009) German act on genetic diagnostics. Available at
  31. Goldgar DE, Easton DF, Deffenbaugh AM, Monteiro ANA, Tavtigian SV, Couch FJ (2004) Integrated evaluation of DNA sequence variants of unknown clinical significance: application to BRCA1 and BRCA2. Am J Hum Genet 75:535–544PubMedCrossRefGoogle Scholar
  32. Graeser MK, Engel C, Rhiem K, Gadzicki D, Bick U, Kast K, Froster UG, Schlehe B, Bechtold A, Arnold N, Preisler-Adams S, Nestle-Kraemling C, Zaino M, Loeffler M, Kiechle M, Meindl A, Varga D, Schmutzler RK (2009) Contralateral breast cancer risk in BRCA1 and BRCA2 mutation carriers. J Clin Oncol 27:5887–5892PubMedCrossRefGoogle Scholar
  33. Gulden C, Olopade OI (2010) Risk assessment and genetic testing for ovarian cancer. AJR Am J Roentgenol 194:309–310PubMedCrossRefGoogle Scholar
  34. Jacobi CE, de Book GH, Siegerink B, van Asperen CJ (2009) Differences and similarities in breast cancer risk assessment models in clinical practice: which model to choose? Breast Cancer Res Treat 115:381–390PubMedCrossRefGoogle Scholar
  35. Julian-Reynier C, Chabal F, Frebourg T, Lemery D, Noguès C, Puech F, Stoppa-Lyonnet D (2009) Professionals assess the acceptability of preimplantation genetic diagnosis and prenatal diagnosis for managing inherited predisposition to cancer. J Clin Oncol 27:4475–4480PubMedCrossRefGoogle Scholar
  36. King M, Marks JH, Mandell JB (2003) Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 302:643–646PubMedCrossRefGoogle Scholar
  37. Kwon JS, Gutierrez-Barrera AM, Young D, Sun CC, Daniels MS, Lu KH, Arun B (2010) Expanding the criteria for BRCA mutation testing in breast cancer survivors. J Clin Oncol 28:4214–4220PubMedCrossRefGoogle Scholar
  38. Kreienberg R, Kopp I, Albert U, Bartsch HH, Beckmann MW, Berg D, Bick U, du Bois A, Budach W, Dunst J, Engel J, Ernst B, Geraedts M, Henscher U, Holzel D, Jackisch C, Konig K, Kreipe H, Kuhn T, Lebeau A, Leinung S, Link H, Luck HJ, Madjar H, Maiwald A, Maiwald G, Marschner N, Marx M, von Minckwitz G, Nas-Griegoleit I, Possinger K, Reiter A, Sauerbrei W, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz KD, Souchon R, Thomssen C, Untch M, Wagner U, Weis J, Zemmler T (2008) Interdisziplinare S3-leitlinie fur die diagnostik, Therapie und Nachsorge des Mammakarzinoms. W. Zuckschwerdt Verlag, GermeringGoogle Scholar
  39. Lakhani SR, van de Vijver MJ, Jacquemier J, Anderson TJ, Osin PP, McGuffog L, Easton DF (2002) The pathology of familial breast cancer: predictive value of immunohistochemical markers estrogen receptor, progesterone receptor, HER-2, and p53 in patients with mutations in BRCA1 and BRCA2. J Clin Oncol 20:2310–2318PubMedCrossRefGoogle Scholar
  40. Larsson N, Borg A, Hodgson S, Sinilnikova O, Loman N, McDevitt T, Müller-Reible C, Kristoffersson U (2007) European Molecular Genetics Quality Network (EMQN) best practice guidelines for molecular genetics analysis in hereditary breast/ovarian cancer. Available at
  41. Leach MO, Boggis CRM, Dixon AK, Easton DF, Eeles RA, Evans DGR, Gilbert FJ, Griebsch I, Hoff RJC, Kessar P, Lakhani SR, Moss SM, Nerurkar A, Padhani AR, Pointon LJ, Thompson D, Warren RML (2005) Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 365:1769–1778PubMedCrossRefGoogle Scholar
  42. Legido-Quigley H, McKee M, Walshe K, Suñol R, Nolte E, Klazinga N (2008) How can quality of health care be safeguarded across European Union? BMJ 336:920–923PubMedCrossRefGoogle Scholar
  43. Lidereau R, Eisinger F, Champème MH, Noguès C, Bièche I, Birnbaum D, Pallud C, Jacquemier J, Sobol H (2000) Major improvement in the efficacy of BRCA1 mutation screening using morphoclinical features of breast cancer. Cancer Res 60:1206–1210PubMedGoogle Scholar
  44. Liede A, Karlan BY, Narod SA (2004) Cancer risks for male carriers of germline mutations in BRCA1 or BRCA2: a review of the literature. J Clin Oncol 22:735–742PubMedCrossRefGoogle Scholar
  45. Meindl A (2002) Comprehensive analysis of 989 patients with breast or ovarian cancer provides BRCA1 and BRCA2 mutation profiles and frequencies for the German population. Int J Cancer 97:472–480PubMedCrossRefGoogle Scholar
  46. Meindl A, Hellebrand H, Wiek C, Erven V, Wappenschmidt B, Niederacher D, Freund M, Lichtner P, Hartmann L, Schaal H, Ramser J, Honisch E, Kubisch C, Wichmann HE, Kast K, Deissler H, Engel C, Müller-Myhsok B, Neveling K, Kiechle M, Mathew CG, Schindler D, Schmutzler RK, Hanenberg H (2010) Germline mutations in breast and ovarian cancer pedigrees establish RAD51C as a human cancer susceptibility gene. Nat Genet 42:410–414PubMedCrossRefGoogle Scholar
  47. Metcalfe KA, Lynch HT, Ghadirian P, Tung N, Olivotto IA, Foulkes WD, Warner E, Olopade O, Eisen A, Weber B, McLennan J, Sun P, Narod SA (2005) The risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers. Gynecol Oncol 96:222–226PubMedCrossRefGoogle Scholar
  48. Metcalfe K, Lubinski J, Lynch HT, Ghadirian P, Foulkes WD, Kim-Sing C, Neuhausen S, Tung N, Rosen B, Gronwald J, Ainsworth P, Sweet K, Eisen A, Sun P, Narod SA, for the Hereditary Breast Cancer Clinical Study Group (2010) Family history of cancer and cancer risks in women with BRCA1 or BRCA2 mutations. J Natl Cancer Inst 102:1874–1878PubMedCrossRefGoogle Scholar
  49. Miki Y, Swensen J, Shattuck-Eidens D, Futreal PA, Harshman K, Tavtigian S, Liu Q, Cochran C, Bennett LM, Ding W (1994) A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 266:66–71PubMedCrossRefGoogle Scholar
  50. Morgan JE, Carr IM, Sheridan E, Chu CE, Hayward B, Camm N, Lindsay HA, Mattocks CJ, Markham AF, Bonthron DT, Taylor GR (2010) Genetic diagnosis of familial breast cancer using clonal sequencing. Hum Mutat 31:484–491PubMedCrossRefGoogle Scholar
  51. Narod SA (2010) Testing for CHEK2 in the cancer genetics clinic: ready for prime time? Clin Genet 78:1–7PubMedCrossRefGoogle Scholar
  52. Netherlands Foundation for the Detection of Hereditary Tumours (STOET) and the Dutch Society of Clinical Geneticists (VKGN) (2010) Erfelijke Tumoren: Richtlijnen voor Diagnostiek en Preventie”. Available at
  53. NICE (National Institute for Clinical Excellence) (2006) NICE guideline CG041: familial breast cancer. The classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care. National Institute for Clinical Excellence, London. Available at
  54. Nys H (2010) European regulatory issues related to quality in provision of genetic services. In: Kristoffersson U, Schmidtke J, Cassiman JJ (eds) Quality issues in clinical genetic services. Springer, Heidelberg, pp 41–48CrossRefGoogle Scholar
  55. Pierce LJ, Levin AM, Rebbeck TR, Ben-David MA, Friedman E, Solin LJ, Harris EE, Gaffney DK, Haffty BG, Dawson LA, Narod SA, Olivotto IA, Eisen A, Whelan TJ, Olopade OI, Isaacs C, Merajver SD, Wong JS, Garber JE, Weber BL (2006) Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer. J Clin Oncol 24:2437–2443PubMedCrossRefGoogle Scholar
  56. Ramus SJ, Kartsonaki C, Gayther SA et al (2011) Genetic variation at 9p22.2 and ovarian cancer risk for BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst 103:105–116PubMedCrossRefGoogle Scholar
  57. Ripperger T, Gadzicki D, Meindl A, Schlegelberger B (2009) Breast cancer susceptibility: current knowledge and implications for genetic counselling. Eur J Hum Genet 17:722–731PubMedCrossRefGoogle Scholar
  58. Schmutzler R, Schlegelberger B, Meindl A, Gerber W, Kiechle M (2003a) Beratung, Genetische Testung und Prävention von Frauen mit einer familiären Belastung für das Mamma- und Ovarialkarzinom. Medgen 15:385–395Google Scholar
  59. Schmutzler R, Schlegelberger B, Meindl A, Gerber W, Kiechle M (2003b) Counselling, genetic testing and prevention in women with hereditary breast- and ovarian cancer. Interdisciplinary recommendations of the consortium “hereditary breast- and ovarian cancer” of the German Cancer AiD. Zentralbl Gynäkol 125:494–506PubMedCrossRefGoogle Scholar
  60. Smith A, Moran A, Boyd MC, Bulman M, Shenton A, Smith L, Iddenden I, Woodward E, Lalloo F, Rahman N, Maher ER, Evans DGR (2007) The trouble with phenocopies: are those testing negative for a family BRCA1/2 mutation really at population risk? J Med Genet 44:10–15PubMedCrossRefGoogle Scholar
  61. Turnbull C, Rahman N (2008) Genetic predisposition to breast cancer: past, present, and future. Annu Rev Genomics Hum Genet 9:321–345PubMedCrossRefGoogle Scholar
  62. Tutt A, Robson M, Garber JE, Domchek SM, Audeh MW, Weitzel JN, Friedlander M, Arun B, Loman N, Schmutzler RK, Wardley A, Mitchell G, Earl H, Wickens M, Carmichael J (2010) Oral poly(ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and advanced breast cancer: a proof-of-concept trial. Lancet 376:235–244PubMedCrossRefGoogle Scholar
  63. Tyrer J, Duffy SW, Cuzick J (2004) A breast cancer prediction model incorporating familial and personal risk factors. Stat Med 23:1111–1130PubMedCrossRefGoogle Scholar
  64. Van Asperen CJ, Menko FH, Meijers-Heijboer EJ, Oosterwijk JC (2005) Vereniging Klinische Genetica Nederland (VKGN)/Werkgroep Klinische Oncogenetica (WKO). Beleid in mamma- en/of ovariumcarcinoomfamilies. Richtlijn 2005/2006Google Scholar
  65. Walsh T, Lee MK, Casadei S, Thornton AM, Stray SM, Pennil C, Nord AS, Mandell JB, Swisher EM, King MC (2010) Detection of inherited mutations for breast and ovarian cancer using genomic capture and massively parallel sequencing. Proc Natl Acad Sci USA 107:12629–12633PubMedCrossRefGoogle Scholar
  66. Wooster R, Weber BL (2003) Breast and ovarian cancer. N Engl J Med 348:2339–2347PubMedCrossRefGoogle Scholar
  67. Wooster R, Bignell G, Lancaster J, Swift S, Seal S, Mangion J, Collins N, Gregory S, Gumbs C, Micklem G (1995) Identification of the breast cancer susceptibility gene BRCA2. Nature 378:789–792PubMedCrossRefGoogle Scholar
  68. Young SR, Pilarski RT, Donenberg T, Shapiro C, Hammond LS, Miller J, Brooks KA, Cohen S, Tenenholz B, Desai D, Zandvakili I, Royer R, Li S, Narod SA (2009) The prevalence of BRCA1 mutations among young women with triple-negative breast cancer. BMC Cancer 9:86PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Dorothea Gadzicki
    • 1
    Email author
  • D. Gareth Evans
    • 2
    • 3
  • Hilary Harris
    • 4
  • Claire Julian-Reynier
    • 5
  • Irmgard Nippert
    • 6
  • Jörg Schmidtke
    • 7
  • Aad Tibben
    • 8
    • 9
  • Christi J. van Asperen
    • 10
  • Brigitte Schlegelberger
    • 1
  1. 1.Institute of Cell and Molecular PathologyHannover Medical SchoolHannoverGermany
  2. 2.Medical Genetics Research Group and Regional Genetics ServiceUniversity of Manchester and Central Manchester Foundation Hospital NHS Trust, St. Mary’s HospitalManchesterUK
  3. 3.Genesis Prevention CentreUniversity Hospital of South Manchester & Wythenshawe Hospital NHS Foundation TrustManchesterUK
  4. 4.GenEd Coordinating CentreUniversity of ManchesterManchesterUK
  5. 5.U912, INSERM, IRD, Institut Paoli-Calmettes, Aix-Marseille UniversitéMarseilleFrance
  6. 6.Women’s Health ResearchMünster Medical SchoolMünsterGermany
  7. 7.Institute of Human GeneticsHannover Medical SchoolHannoverGermany
  8. 8.Centre of Human and Clinical GeneticsLeiden University Medical Centre (LUMC)LeidenThe Netherlands
  9. 9.Department of Clinical GeneticsErasmus MCRotterdamThe Netherlands
  10. 10.Center for Human and Clinical Genetics, Department of Clinical GeneticsLeiden University Medical Center (LUMC)LeidenThe Netherlands

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