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Testing women with endometrial cancer to detect Lynch syndrome.
J Clin Oncol 2011; 29(16):2247-52JC

Abstract

PURPOSE

Women with endometrial cancer as a result of Lynch syndrome may not be identified as such by Amsterdam II criteria. We estimated the costs and benefits of different testing criteria to identify Lynch syndrome in women with endometrial cancer.

METHODS

We developed a Markov Monte Carlo simulation model to compare six criteria for Lynch syndrome testing for women with endometrial cancer: Amsterdam II criteria; age younger than 50 years with at least one first-degree relative having a Lynch-associated cancer at any age (FDR); immunohistochemistry (IHC) triage if age younger than 50 years; IHC triage if age younger than 60 years; IHC triage at any age if 1 FDR; and IHC triage of all endometrial cancers. Net health benefit was life expectancy, and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of new colorectal cancers associated with each strategy.

RESULTS

IHC triage of women with endometrial cancer having at least 1 FDR yielded a favorable ICER of $9,126 per year of life gained. This strategy would subject fewer cases to IHC but identify more mutation carriers than age thresholds of 50 or 60 years. IHC triage of all endometrial cancers could identify the most mutation carriers and prevent the most colorectal cancers but at considerable cost ($648,494 per year of life gained).

CONCLUSION

IHC triage of women with endometrial cancer at any age having at least 1 FDR with a Lynch-associated cancer is a cost-effective strategy for detecting Lynch syndrome.

Authors+Show Affiliations

University of British Columbia, Vancouver, British Columbia, Canada. jkwon@post.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21537049

Citation

Kwon, Janice S., et al. "Testing Women With Endometrial Cancer to Detect Lynch Syndrome." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 29, no. 16, 2011, pp. 2247-52.
Kwon JS, Scott JL, Gilks CB, et al. Testing women with endometrial cancer to detect Lynch syndrome. J Clin Oncol. 2011;29(16):2247-52.
Kwon, J. S., Scott, J. L., Gilks, C. B., Daniels, M. S., Sun, C. C., & Lu, K. H. (2011). Testing women with endometrial cancer to detect Lynch syndrome. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 29(16), pp. 2247-52. doi:10.1200/JCO.2010.32.9979.
Kwon JS, et al. Testing Women With Endometrial Cancer to Detect Lynch Syndrome. J Clin Oncol. 2011 Jun 1;29(16):2247-52. PubMed PMID: 21537049.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Testing women with endometrial cancer to detect Lynch syndrome. AU - Kwon,Janice S, AU - Scott,Jenna L, AU - Gilks,C Blake, AU - Daniels,Molly S, AU - Sun,Charlotte C, AU - Lu,Karen H, Y1 - 2011/05/02/ PY - 2011/5/4/entrez PY - 2011/5/4/pubmed PY - 2011/7/29/medline SP - 2247 EP - 52 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 29 IS - 16 N2 - PURPOSE: Women with endometrial cancer as a result of Lynch syndrome may not be identified as such by Amsterdam II criteria. We estimated the costs and benefits of different testing criteria to identify Lynch syndrome in women with endometrial cancer. METHODS: We developed a Markov Monte Carlo simulation model to compare six criteria for Lynch syndrome testing for women with endometrial cancer: Amsterdam II criteria; age younger than 50 years with at least one first-degree relative having a Lynch-associated cancer at any age (FDR); immunohistochemistry (IHC) triage if age younger than 50 years; IHC triage if age younger than 60 years; IHC triage at any age if 1 FDR; and IHC triage of all endometrial cancers. Net health benefit was life expectancy, and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of new colorectal cancers associated with each strategy. RESULTS: IHC triage of women with endometrial cancer having at least 1 FDR yielded a favorable ICER of $9,126 per year of life gained. This strategy would subject fewer cases to IHC but identify more mutation carriers than age thresholds of 50 or 60 years. IHC triage of all endometrial cancers could identify the most mutation carriers and prevent the most colorectal cancers but at considerable cost ($648,494 per year of life gained). CONCLUSION: IHC triage of women with endometrial cancer at any age having at least 1 FDR with a Lynch-associated cancer is a cost-effective strategy for detecting Lynch syndrome. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/21537049/full_citation L2 - http://ascopubs.org/doi/full/10.1200/JCO.2010.32.9979?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -