Increasing evidence indicates that breast cancer pathogenesis is linked with DNA double-strand break (DSB) repair dysfunction. This conclusion is based on advances in the study of functions of breast cancer susceptibility genes such as BRCA1 and BRCA2, on the identification of breast cancer-associated changes regarding the genetics, expression, and localization of multiple DSB repair factors, and on observations indicating enhanced radiationinduced chromosomal damage in cells from predisposed individuals and sporadic breast cancer patients. In this pilot study, we describe a sensitive method for the analysis of DSB repair functions in mammary carcinomas. Using this method we firstly document alterations in pathway-specific DSB repair activities in primary cells originating from familial as well as sporadic breast cancer. In particular, we identified increases in the mutagenic nonhomologous end joining and single-strand annealing mechanisms in sporadic breast cancers with wild-type BRCA1 and BRCA2, and, thus, similar phenotypes to tumors with mutant alleles of BRCA1 and BRCA2. This suggests that detection of error-prone DSB repair activities may be useful to extend the limits of genotypic characterization of high-risk susceptibility genes. This method may, therefore, serve as a marker for breast cancer risk assessment and, even more importantly, for the prediction of responsiveness to targeted therapies such as to inhibitors of poly(ADP-ribose)polymerase (PARP1). ' 2008 Wiley-Liss, Inc.Key words: biomarker; breast cancer; DNA double-strand break repair; epithelial cell; prediction Germline loss-of-function mutations affecting one allele of the BRCA1, BRCA2, TP53, or PTEN genes predispose to breast cancer with high, i.e. up to 10-fold, risk. The more recently established susceptibility genes ATM, CHEK2, NBS1, RAD50, BRIP1, and PALB2 confer a 2-fold increase in breast cancer risk.1,2 Despite these advances in the identification of breast cancer susceptibility genes, no more than 30-50% of hereditary breast cancer can be explained by mutations in known genes.1,3 Still, current approaches to predict breast cancer risk primarily rely on genotyping single predisposing genes. 4 Thus, direct nucleotide sequencing has remained the gold standard technique for breast cancer risk assessment involving BRCA1 and BRCA2 mutations, even though mutations in the regulatory portion of the genes and large genomic rearrangements that produce deletions of whole exons escape this detection method. Moreover, roughly one third of the sequence alterations represent unclassified variants, i.e. missense mutations with unclear pathogenicity. Most importantly, lack of association between BRCA1 or BRCA2 (BRCA) gene alterations and breast cancer predisposition can be explained by the presence of mutations in known or as yet undiscovered genes that interact with the BRCA1 and/or BRCA2 pathway. Indeed the majority of familial cases are caused by one or more unknown high-penetrance susceptibility genes, and/or a combination of multiple low-penetra...