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Open Access Research article

Polymorphisms in thymidylate synthase gene and susceptibility to breast cancer in a Chinese population: a case-control analysis

Xiangjun Zhai13, Jun Gao12, Zhibin Hu12, Jinhai Tang4, Jianwei Qin4, Shui Wang5, Xuechen Wang6, Guangfu Jin2, Jiyong Liu2, Wenshen Chen2, Feng Chen2, Xinru Wang12, Qingyi Wei7 and Hongbing Shen12*

Author Affiliations

1 Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 210029, China

2 Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China

3 Jiangsu Centers for Diseases Prevention and Control, Nanjing 210009, China

4 Department of General Surgery, Jiangsu Cancer Hospital, Nanjing 210009, China

5 Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

6 Department of General Surgery, Nanjing Gulou Hospital, Nanjing210009, China

7 Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA

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BMC Cancer 2006, 6:138  doi:10.1186/1471-2407-6-138

Published: 25 May 2006



Accumulative evidence suggests that low folate intake is associated with increased risk of breast cancer. Polymorphisms in genes involved in folate metabolism may influence DNA methylation, nucleotide synthesis, and thus individual susceptibility to cancer. Thymidylate synthase (TYMS) is a key enzyme that participates in folate metabolism and catalyzes the conversion of dUMP to dTMP in the process of DNA synthesis. Two potentially functional polymorphisms [a 28-bp tandem repeat in the TYMS 5'-untranslated enhanced region (TSER) and a 6-bp deletion/insertion in the TYMS 3'-untranslated region (TS 3'-UTR)] were suggested to be correlated with alteration of thymidylate synthase expression and associated with cancer risk.


To test the hypothesis that polymorphisms of the TYMS gene are associated with risk of breast cancer, we genotyped these two polymorphisms in a case-control study of 432 incident cases with invasive breast cancer and 473 cancer-free controls in a Chinese population.


We found that the distribution of TS3'-UTR (1494del6) genotype frequencies were significantly different between the cases and controls (P = 0.026). Compared with the TS3'-UTR del6/del6 wild-type genotype, a significantly reduced risk was associated with the ins6/ins6 homozygous variant genotype (adjusted OR = 0.58, 95% CI = 0.35–0.97) but not the del6/ins6 genotype (OR = 1.09, 95% CI = 0.82–1.46). Furthermore, breast cancer risks associated with the TS3'-UTR del6/del6 genotype were more evident in older women, postmenopausal subjects, individuals with a younger age at first-live birth and individuals with an older age at menarche. However, there was no evidence for an association between the TSER polymorphism and breast cancer risks.


These findings suggest that the TS3'-UTR del6 polymorphism may play a role in the etiology of breast cancer. Further larger population-based studies as well as functional evaluation of the variants are warranted to confirm our findings.