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Gynecologic cancer prevention in Lynch syndrome/hereditary nonpolyposis colorectal cancer families.
Obstet Gynecol. 2007 Jul; 110(1):18-25.OG

Abstract

OBJECTIVE

Women from Lynch syndrome/hereditary nonpolyposis colorectal cancer (Lynch/HNPCC) families have an increased lifetime risk of developing endometrial and ovarian cancer. This study models a comparison of management strategies for women who carry a Lynch/HNPCC mutation.

METHODS

A decision analytic model with three arms was designed to compare annual gynecologic examinations with annual screening (ultrasonography, endometrial biopsy, CA 125) and with hysterectomy with bilateral salpingo-oophorectomy at age 30 years The existing literature was searched for studies on the accuracy of endometrial and ovarian cancer screening using endometrial biopsy, transvaginal ultrasonography, and serum CA 125. The Surveillance, Epidemiology and End Results database from 1988 to 2001 was used to estimate cancer mortality outcomes.

RESULTS

In the surgical arm, 0.0056% of women were diagnosed with ovarian cancer and 0.0060% of women with endometrial cancer. These numbers increased to 3.7% and 18.4% in women being screened, and 8.3% and 48.7% in women undergoing annual examinations, respectively. Surgical management led to the longest expected survival time at 79.98 years, followed by screening at 79.31 years, and annual examinations at 77.41 years. If starting at age 30 and discounting life years at 3%, surgery still leads to the greatest expected life years. When comparing prophylactic surgery with the screening option, one would need to perform 75 surgeries to save one woman's entire life. For cancer prevention, however, only 28 and 6 prophylactic surgeries would need to be performed to prevent one case of ovarian and endometrial cancer, respectively.

CONCLUSION

Risk-reducing hysterectomy and bilateral salpingo-oophorectomy may be considered in women with Lynch/HNPCC to prevent gynecologic cancers and their associated morbidities.

Authors+Show Affiliations

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA. Lee-may.Chen@ucsfmedctr.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17601891

Citation

Chen, Lee-may, et al. "Gynecologic Cancer Prevention in Lynch Syndrome/hereditary Nonpolyposis Colorectal Cancer Families." Obstetrics and Gynecology, vol. 110, no. 1, 2007, pp. 18-25.
Chen LM, Yang KY, Little SE, et al. Gynecologic cancer prevention in Lynch syndrome/hereditary nonpolyposis colorectal cancer families. Obstet Gynecol. 2007;110(1):18-25.
Chen, L. M., Yang, K. Y., Little, S. E., Cheung, M. K., & Caughey, A. B. (2007). Gynecologic cancer prevention in Lynch syndrome/hereditary nonpolyposis colorectal cancer families. Obstetrics and Gynecology, 110(1), 18-25.
Chen LM, et al. Gynecologic Cancer Prevention in Lynch Syndrome/hereditary Nonpolyposis Colorectal Cancer Families. Obstet Gynecol. 2007;110(1):18-25. PubMed PMID: 17601891.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gynecologic cancer prevention in Lynch syndrome/hereditary nonpolyposis colorectal cancer families. AU - Chen,Lee-may, AU - Yang,Kathleen Y, AU - Little,Sarah E, AU - Cheung,Michael K, AU - Caughey,Aaron B, PY - 2007/7/3/pubmed PY - 2007/8/1/medline PY - 2007/7/3/entrez SP - 18 EP - 25 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 110 IS - 1 N2 - OBJECTIVE: Women from Lynch syndrome/hereditary nonpolyposis colorectal cancer (Lynch/HNPCC) families have an increased lifetime risk of developing endometrial and ovarian cancer. This study models a comparison of management strategies for women who carry a Lynch/HNPCC mutation. METHODS: A decision analytic model with three arms was designed to compare annual gynecologic examinations with annual screening (ultrasonography, endometrial biopsy, CA 125) and with hysterectomy with bilateral salpingo-oophorectomy at age 30 years The existing literature was searched for studies on the accuracy of endometrial and ovarian cancer screening using endometrial biopsy, transvaginal ultrasonography, and serum CA 125. The Surveillance, Epidemiology and End Results database from 1988 to 2001 was used to estimate cancer mortality outcomes. RESULTS: In the surgical arm, 0.0056% of women were diagnosed with ovarian cancer and 0.0060% of women with endometrial cancer. These numbers increased to 3.7% and 18.4% in women being screened, and 8.3% and 48.7% in women undergoing annual examinations, respectively. Surgical management led to the longest expected survival time at 79.98 years, followed by screening at 79.31 years, and annual examinations at 77.41 years. If starting at age 30 and discounting life years at 3%, surgery still leads to the greatest expected life years. When comparing prophylactic surgery with the screening option, one would need to perform 75 surgeries to save one woman's entire life. For cancer prevention, however, only 28 and 6 prophylactic surgeries would need to be performed to prevent one case of ovarian and endometrial cancer, respectively. CONCLUSION: Risk-reducing hysterectomy and bilateral salpingo-oophorectomy may be considered in women with Lynch/HNPCC to prevent gynecologic cancers and their associated morbidities. SN - 0029-7844 UR - https://www.unboundmedicine.com/medline/citation/17601891/Gynecologic_cancer_prevention_in_Lynch_syndrome/hereditary_nonpolyposis_colorectal_cancer_families_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=17601891.ui DB - PRIME DP - Unbound Medicine ER -