A patient with 17 primary tumours and a germ line mutation in TP53: Tumourinduction by adjuvant therapy?

We report the case history of a woman with a germ line mutation in the TP53 gene who developed 17 separate primary tumours. The incidence of new tumou rs rose steeply after adjuvant tamoxifen treatment for breast cancer and ad juvant vaginal vault radiotherapy for endometrial cancer. This increase cou ld be due to cumulative genetic damage from enivronmental agents and the fa ct that the patient lived to the relatively late age of 60 years, or to a h igh inherent deleterious somatic mutation rate, which could represent the i nability of cells from patients with TP53 mutations to repair therapy-induc ed genetic damage.