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Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome.
N Engl J Med 2006; 354(3):261-9NEJM

Abstract

BACKGROUND

Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have a 40 to 60 percent lifetime risk of endometrial cancer and a 10 to 12 percent lifetime risk of ovarian cancer. The benefit of prophylactic gynecologic surgery for women with this syndrome has been uncertain. We designed this study to determine the reduction in the risk of gynecologic cancers associated with prophylactic hysterectomy and bilateral salpingo-oophorectomy in women with the Lynch syndrome.

METHODS

Three hundred fifteen women with documented germ-line mutations associated with the Lynch syndrome were identified. Women who had undergone prophylactic hysterectomy (61 women) and women who had undergone prophylactic bilateral salpingo-oophorectomy (47 women) were matched with mutation-positive women who had not undergone the procedure in question (210 women for the analysis of endometrial cancer and 223 for the analysis of ovarian cancer). Women who had undergone prophylactic surgery and their matched controls were followed from the date of the surgery until the occurrence of cancer or until the data were censored at the time of the last follow-up visit.

RESULTS

There were no occurrences of endometrial, ovarian, or primary peritoneal cancer among the women who had undergone prophylactic surgery. Endometrial cancer was diagnosed in 69 women in the control group (33 percent), for an incidence density of 0.045 per woman-year, yielding a prevented fraction (the proportion of potential new cancers prevented) of 100 percent (95 percent confidence interval, 90 to 100 percent). Ovarian cancer was diagnosed in 12 women in the control group (5 percent), for an incidence density of 0.005 per woman-year, yielding a prevented fraction of 100 percent (95 percent confidence interval, -62 to 100 percent).

CONCLUSIONS

These findings suggest that prophylactic hysterectomy with bilateral salpingo-oophorectomy is an effective strategy for preventing endometrial and ovarian cancer in women with the Lynch syndrome.

Authors+Show Affiliations

Department of Gynecologic Oncology, the University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1439, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

16421367

Citation

Schmeler, Kathleen M., et al. "Prophylactic Surgery to Reduce the Risk of Gynecologic Cancers in the Lynch Syndrome." The New England Journal of Medicine, vol. 354, no. 3, 2006, pp. 261-9.
Schmeler KM, Lynch HT, Chen LM, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med. 2006;354(3):261-9.
Schmeler, K. M., Lynch, H. T., Chen, L. M., Munsell, M. F., Soliman, P. T., Clark, M. B., ... Lu, K. H. (2006). Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. The New England Journal of Medicine, 354(3), pp. 261-9.
Schmeler KM, et al. Prophylactic Surgery to Reduce the Risk of Gynecologic Cancers in the Lynch Syndrome. N Engl J Med. 2006 Jan 19;354(3):261-9. PubMed PMID: 16421367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. AU - Schmeler,Kathleen M, AU - Lynch,Henry T, AU - Chen,Lee-may, AU - Munsell,Mark F, AU - Soliman,Pamela T, AU - Clark,Mary Beth, AU - Daniels,Molly S, AU - White,Kristin G, AU - Boyd-Rogers,Stephanie G, AU - Conrad,Peggy G, AU - Yang,Kathleen Y, AU - Rubin,Mary M, AU - Sun,Charlotte C, AU - Slomovitz,Brian M, AU - Gershenson,David M, AU - Lu,Karen H, PY - 2006/1/20/pubmed PY - 2006/1/25/medline PY - 2006/1/20/entrez SP - 261 EP - 9 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 354 IS - 3 N2 - BACKGROUND: Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have a 40 to 60 percent lifetime risk of endometrial cancer and a 10 to 12 percent lifetime risk of ovarian cancer. The benefit of prophylactic gynecologic surgery for women with this syndrome has been uncertain. We designed this study to determine the reduction in the risk of gynecologic cancers associated with prophylactic hysterectomy and bilateral salpingo-oophorectomy in women with the Lynch syndrome. METHODS: Three hundred fifteen women with documented germ-line mutations associated with the Lynch syndrome were identified. Women who had undergone prophylactic hysterectomy (61 women) and women who had undergone prophylactic bilateral salpingo-oophorectomy (47 women) were matched with mutation-positive women who had not undergone the procedure in question (210 women for the analysis of endometrial cancer and 223 for the analysis of ovarian cancer). Women who had undergone prophylactic surgery and their matched controls were followed from the date of the surgery until the occurrence of cancer or until the data were censored at the time of the last follow-up visit. RESULTS: There were no occurrences of endometrial, ovarian, or primary peritoneal cancer among the women who had undergone prophylactic surgery. Endometrial cancer was diagnosed in 69 women in the control group (33 percent), for an incidence density of 0.045 per woman-year, yielding a prevented fraction (the proportion of potential new cancers prevented) of 100 percent (95 percent confidence interval, 90 to 100 percent). Ovarian cancer was diagnosed in 12 women in the control group (5 percent), for an incidence density of 0.005 per woman-year, yielding a prevented fraction of 100 percent (95 percent confidence interval, -62 to 100 percent). CONCLUSIONS: These findings suggest that prophylactic hysterectomy with bilateral salpingo-oophorectomy is an effective strategy for preventing endometrial and ovarian cancer in women with the Lynch syndrome. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/16421367/Prophylactic_surgery_to_reduce_the_risk_of_gynecologic_cancers_in_the_Lynch_syndrome_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa052627?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -