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Introduction:The characterization of BRCA1 and BRCA2 gene mutations as high risk factors in familial breast cancer served as paradigm for the assessment of other more common but less penetrant genes as potential genetic risk factors for sporadic breast cancer. The ATM gene is such a candidate, since AT homozygous patients have (among other symptoms) a cancer phenotype and their cells exhibit excessive radiosensitivity. Moreover, AT heterozygote carriers, which occur at a significant prevalence in the general population, show an intermediate in vitro radiosensitivity, although clinically they are free of AT symptoms. Three epidemiological studies, before the ATM gene was cloned had estimated a relative risk of breast cancer in AT heterozygotes of 3.9 (1-4). However, once the ATM gene was cloned, direct mutational analysis on cumulatively over 500 patients failed to support the hypothesis that a mutant ATM allele plays a role in carcinogenesis and that ATM is a suppressor gene (5-7). Also, in the few cancers which harbored a mutant allele (somatically or constitutionally), no selection pressure exists against the retained wild type allele. Moreover, ATM mutations also failed to correlate with complications in those breast cancer patients with complications after radiotherapy (8,9). Clearly, these studies show that diagnostic or occupational exposure to ionizing radiation is not enough to increase the relative risk significantly. LOH analysis in the 1 lq23 region does find a roughly 40% frequency of LOH in the region that includes but does not focus on the ATM locus, thereby leaving it unclear whether the true deletional target is ATM or another unknown suppressor gene(s) thought to reside at this locus.The overall picture that emerges from cytogenetic and mutational studies on over 1,200 breast cancers over the past 1 1/2 years is comprehensive and can be summarized as follows. ATM heterozygosity is not a significant genetic determinant in unselected sporadic breast cancer (10-18). All stu...