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Perceptions of cancer risks and predictors of colon and endometrial cancer screening in women undergoing genetic testing for Lynch syndrome.

Abstract

PURPOSE

Lynch syndrome poses multiple cancer risks, yet attention has focused on screening for colorectal cancer. Estimated risks for endometrial cancer equal risks for colorectal cancer. This study (1) evaluated women's perceived risks for cancers, (2) compared endometrial cancer screening and colonoscopy, and (3) identified predictors of screening before and after genetic testing.

PATIENTS AND METHODS

Sixty-five adult women at 50% risk for carrying a cancer-predisposing mutation, without a history of endometrial cancer or hysterectomy, participated in genetic counseling and received unequivocal genetic test results for Lynch syndrome. Participants completed questionnaires before and after receipt of genetic results.

RESULTS

Pretest, perceived risks for colon cancer were significantly higher than for extracolonic cancers (P < .0001). Use of colonoscopy was significantly higher (P = .006) than endometrial cancer screening. Post-test, carriers demonstrated a significant (P < .0001) increase in their perceived risk for extracolonic cancers and increased both colonoscopy (P = .79) and endometrial cancer screening (P = .11). Mutation status, age, perceived likelihood of carrying a mutation, and communication of test results to their physician independently predicted cancer screening at follow-up.

CONCLUSION

Women in families with Lynch syndrome are less aware of their risks for extracolonic cancers and undergo endometrial cancer screening significantly less often than colonoscopy before genetic counseling. Given the significantly increased risks for endometrial and ovarian cancers and the mortality associated with ovarian cancer, additional efforts to inform families of cancer risks and screening recommendations seem prudent. Physicians play a critical role in ensuring appropriate cancer screening in women with Lynch syndrome.

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  • Authors+Show Affiliations

    ,

    Social & Behavioral Research Branch, National Institutes of Health, 31 Center Drive, MSC 2073, Building 31, Room B1B37F, Bethesda, MD 20892-2073, USA. dhadley@mail.nih.gov

    , , , , , , ,

    Source

    MeSH

    Adult
    Age Factors
    Aged
    Analysis of Variance
    Colonic Neoplasms
    Colonoscopy
    Colorectal Neoplasms, Hereditary Nonpolyposis
    Endometrial Neoplasms
    Female
    Genetic Counseling
    Genetic Testing
    Heterozygote
    Humans
    Income
    Middle Aged
    Mutation
    Predictive Value of Tests
    Risk Assessment
    Risk Factors

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    18281669

    Citation

    Hadley, Donald W., et al. "Perceptions of Cancer Risks and Predictors of Colon and Endometrial Cancer Screening in Women Undergoing Genetic Testing for Lynch Syndrome." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 26, no. 6, 2008, pp. 948-54.
    Hadley DW, Jenkins JF, Steinberg SM, et al. Perceptions of cancer risks and predictors of colon and endometrial cancer screening in women undergoing genetic testing for Lynch syndrome. J Clin Oncol. 2008;26(6):948-54.
    Hadley, D. W., Jenkins, J. F., Steinberg, S. M., Liewehr, D., Moller, S., Martin, J. C., ... Kirsch, I. R. (2008). Perceptions of cancer risks and predictors of colon and endometrial cancer screening in women undergoing genetic testing for Lynch syndrome. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 26(6), pp. 948-54. doi:10.1200/JCO.2007.13.0575.
    Hadley DW, et al. Perceptions of Cancer Risks and Predictors of Colon and Endometrial Cancer Screening in Women Undergoing Genetic Testing for Lynch Syndrome. J Clin Oncol. 2008 Feb 20;26(6):948-54. PubMed PMID: 18281669.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Perceptions of cancer risks and predictors of colon and endometrial cancer screening in women undergoing genetic testing for Lynch syndrome. AU - Hadley,Donald W, AU - Jenkins,Jean F, AU - Steinberg,Seth M, AU - Liewehr,David, AU - Moller,Stephanie, AU - Martin,Jean C, AU - Calzone,Kathleen A, AU - Soballe,Peter W, AU - Kirsch,Ilan R, PY - 2008/2/19/pubmed PY - 2008/2/29/medline PY - 2008/2/19/entrez SP - 948 EP - 54 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 26 IS - 6 N2 - PURPOSE: Lynch syndrome poses multiple cancer risks, yet attention has focused on screening for colorectal cancer. Estimated risks for endometrial cancer equal risks for colorectal cancer. This study (1) evaluated women's perceived risks for cancers, (2) compared endometrial cancer screening and colonoscopy, and (3) identified predictors of screening before and after genetic testing. PATIENTS AND METHODS: Sixty-five adult women at 50% risk for carrying a cancer-predisposing mutation, without a history of endometrial cancer or hysterectomy, participated in genetic counseling and received unequivocal genetic test results for Lynch syndrome. Participants completed questionnaires before and after receipt of genetic results. RESULTS: Pretest, perceived risks for colon cancer were significantly higher than for extracolonic cancers (P < .0001). Use of colonoscopy was significantly higher (P = .006) than endometrial cancer screening. Post-test, carriers demonstrated a significant (P < .0001) increase in their perceived risk for extracolonic cancers and increased both colonoscopy (P = .79) and endometrial cancer screening (P = .11). Mutation status, age, perceived likelihood of carrying a mutation, and communication of test results to their physician independently predicted cancer screening at follow-up. CONCLUSION: Women in families with Lynch syndrome are less aware of their risks for extracolonic cancers and undergo endometrial cancer screening significantly less often than colonoscopy before genetic counseling. Given the significantly increased risks for endometrial and ovarian cancers and the mortality associated with ovarian cancer, additional efforts to inform families of cancer risks and screening recommendations seem prudent. Physicians play a critical role in ensuring appropriate cancer screening in women with Lynch syndrome. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/18281669/Perceptions_of_cancer_risks_and_predictors_of_colon_and_endometrial_cancer_screening_in_women_undergoing_genetic_testing_for_Lynch_syndrome_ L2 - http://ascopubs.org/doi/full/10.1200/JCO.2007.13.0575?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -