BRCA Database Submission Form

Please fill out this form to submit new BRCA sequence variations to the database. This form should also be used to update clinical information or to phenotype of variants already in the database. Submissions will be reviewed before they are added to the database and the submitter may be contacted for clarification or additional information. For this reason, valid contact information is required to make a submission. If you have any questions or concerns about the submission process, please contact Rong Mao (rong.mao@aruplab.com) at ARUP Laboratories. If you have multiple mutations to submit, you can also contact us about an efficient transfer of this data into the database.

Required Fields *


Note: Please describe your variant according to current recommendations by the HGVS, especially for mutations causing truncation or changing the normal protein reading frame. Additional information can be added into the comments section.

Gene *
Location * Example: Exon11
Nucleotide Change * Example: c.197C>T, c.564+36A>G (no spaces)
Other description Example: Exon 3 is deleted (free text)
Protein Change * Example: p.T440M (no spaces)
Clinical Significance Please describe any supporting evidence for your classification (benign, mutation, uncertain) such as laboratory results, clinical presentations of the disease, family history, functional study results, etc.

Family History*
* observed in *

Immunohistochemistry Results
ER Status:
PR Status:
HER2:
Histological Type:
Grade: *
Comments Additional information you wish to submit to database curator and/or displayed in the database.
# of times seen Observations in separate families or not previously reported.
Publication Information Please include reference only if accepted or published in a peer reviewed journal.
Contributors Please let us know if you wish your name or institution to appear on the database next to the variation submitted (for unpublished variants only).

Contact Information


Contact Name*
Institution Name*
Address
City
State
Country
Postal Code
Please include country code if you are outside of the US. Phone number will only be used if additional information is needed during the submission process.
Please provide a fax number if you are outside the US.
In order to prevent spam, please enter the solution to the arithmetic problem found in the image to the left of the input field.