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4], whereas others, including the study by O’Shea et al., did not detect any mutation at all [1, 5]. At the time of writing, at our Institution the TP53 analysis has been performed in 197 patients, either from families fulfilling LFS/LFL criteria or BRCA-negative women affected with BrCa <31 years of age regardless of family history. The analysis was carried out through Sanger sequencing in all cases, in most cases genomic rearrangements were also investigated. Pathogenic mutations, classified according to the American College of Medical Genetics guidelines (ACMG) [6], were found in 8.6% (17/197) of probands, all of whom (5 males and 12 females) belong either to LFS (6) or LFL (11) families. Ten out of 12 women developed BrCa, with a median age at diagnosis of 30 years (range 20–55 years). As observed by O’Shea et al. in their cohort, also our low mutation detection rate (DR) may be explained by the inclusion of families with only cases of BrCa, since we mainly assess probands/families for hereditary breast cancer. When we considered only the 53 out of 197 probands affected with BrCa before 31 years of age, unselected for family history, the DR would be 9.4% (5/53), although noticeably each mutation carrier also showed a significant personal or family history (two classified as LFS, three as LFL) (Table 1). These data elicit a few considerations concerning the TP53 testing. Currently, the multi-gene testing panels for BrCa are widely used, both in clinics and research, and likely to include most of the TP53 analyses performed. These tests will largely be offered to patients who do not meet classic LFS or LFL testing criteria, albeit some of whom will be affected with BrCa <31 years. The few studies reporting the TP53 mutation prevalence in patients with early-onset BrCa are conflicting, some showing as in our case a very low DR in families not fulfilling LFS/LFL criteria, most of whom were also selected following a negative Dear Editor,

Increased access to TP53 analysis through breast cancer multi-gene panels: clinical considerations