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Anticipating disaster: the genetics of familial pancreatic cancer
  1. M M Lerch
  1. Correspondence to:
    Professor M M Lerch
    Department of Gastroenterology, Endocrinology and Nutrition, Ernst-Moritz-Arndt-Universität Greifswald, Friedrich Loeffler Str 23A, D-17484 Greifswald, Germany; lerch{at}uni-greifswald.de

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To be born into a family with familial pancreatic cancer, an inheritable, autosomal dominant disorder, has various implications for an individual’s life—and none is fortunate. The prospects just turned even darker because of “anticipation”, the phenomenon that successive generations are affected by an inheritable disorder at a progressively earlier age. An up to date study shows that “anticipation” is also operative in familial pancreatic cancer, meaning that affected children die approximately 10 years earlier than their affected parents

One of the definitions The Oxford English Dictionary offers for the word “anticipation” is: the action of looking forward to something. This is clearly the opposite of what individuals experience who have the misfortune of being born into a family that is burdened with the risk of an inheritable disorder. In genetics, “anticipation” describes the phenomenon that successive generations within a family are affected by an inherited disorder at either a progressively earlier age or with progressively greater severity. For example, if the malignant melanoma that affected your father at the age of 50 years was one of the inheritable variety, you have a good chance as a daughter or a son of this patient to develop malignant melanoma at the age of 30–35 years,1 provided you have inherited the gene that places you at risk. Genetic “anticipation” therefore implies, indeed, nothing to look forward to. When the respective inheritable disorder is not one for which the offspring of an affected founder can be tested because no genetic assay is yet available or when a cure for this disorder is neither available nor within sight, “anticipation” feels like rolling dice with the devil …

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