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The gynecological surveillance of women with Lynch syndrome in Sweden.
Gynecol Oncol 2015; 138(3):717-22GO

Abstract

OBJECTIVE

Women with Lynch syndrome (LS) have up to a 60% lifetime risk of endometrial cancer (EC) and up to a 24% risk of ovarian cancer (OC). Gynecological surveillance is recommended, but the benefit and how it should be performed remain unclear. The purpose of this study was to assess diagnostic modalities for gynecological screening of LS patients in Sweden and clinical outcome.

METHODS

A retrospective nationwide study of 170 women with molecularly confirmed LS. Data including gynecological LS screening history, biopsy results (if any), genetic records, number of screening visits, results from screening including transvaginal ultrasound (TVUS), endometrial biopsy (EB), blood test for tumor marker cancer antigen (CA) 125, prophylactic surgery including age at procedure, and setting from which screening data were obtained from medical records.

RESULTS

A total of 117 women were eligible for gynecological screening and of these, 86 patients attended screening visits. Of these, 41 underwent prophylactic hysterectomy and/or bilateral salpingo-oophorectomy. Two patients (4.9%) were diagnosed with EC and two (4.9%) with precancerous lesions in conjunction with prophylactic surgery. Total incidence of gynecological cancer in the surveillance group (45 women) was 20% EC, 4% OC. Five patients had endometrial cancer or complex hyperplasia with atypia (n=2) detected by endometrial biopsy. Four additional cases were detected due to interval bleeding. Both cases of ovarian cancer were detected by transvaginal ultrasound in patients with ovarian cysts under surveillance. The youngest woman with endometrial cancer was diagnosed at 35 years of age, before she was aware of her diagnosis of Lynch syndrome.

CONCLUSIONS

Gynecological surveillance of women with Lynch syndrome may lead to earlier detection of precancerous lesions, which might have some impact on the morbidity from endometrial cancer although further studies are needed to prove this. Prophylactic hysterectomy with or without bilateral salpingo-oophorectomy reduces the cancer incidence. A practical approach to surveillance in Lynch syndrome women would be to offer annual surveillance beginning at age 30 years including probably both TVUS and EB in order to increase diagnostic yield with prospective data registry for follow-up studies. Prophylactic surgery could be performed at a suitable age after childbearing to obtain a balance between reducing the risk of cancer and minimizing long-term complications from premature menopause.

Authors+Show Affiliations

Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Solna, S-171 76 Stockholm, Sweden.Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Solna, S-171 76 Stockholm, Sweden.Department of Clinical Genetics, Skåne University Hospital, 21428 Malmo-Lund, Sweden.Department of Clinical Pathology and Clinical Genetics, Faculty of Health Sciences, Linköping University, County Council of Östergötland, 581 85 Linköping, Sweden; Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, County Council of Östergötland, 581 85 Linköping, Sweden.Department of Clinical Genetics, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.Department of Clinical Genetics, Akademiska Hospital, Uppsala University, 75185 Uppsala, Sweden.Department of Clinical Genetics, Karolinska Institutet, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, 171 76 Stockholm, Sweden.Department of Clinical Genetics, Karolinska Institutet, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, 171 76 Stockholm, Sweden.Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Solna, S-171 76 Stockholm, Sweden. Electronic address: miriam.mints@ki.se.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26177554

Citation

Tzortzatos, Gerasimos, et al. "The Gynecological Surveillance of Women With Lynch Syndrome in Sweden." Gynecologic Oncology, vol. 138, no. 3, 2015, pp. 717-22.
Tzortzatos G, Andersson E, Soller M, et al. The gynecological surveillance of women with Lynch syndrome in Sweden. Gynecol Oncol. 2015;138(3):717-22.
Tzortzatos, G., Andersson, E., Soller, M., Askmalm, M. S., Zagoras, T., Georgii-Hemming, P., ... Mints, M. (2015). The gynecological surveillance of women with Lynch syndrome in Sweden. Gynecologic Oncology, 138(3), pp. 717-22. doi:10.1016/j.ygyno.2015.07.016.
Tzortzatos G, et al. The Gynecological Surveillance of Women With Lynch Syndrome in Sweden. Gynecol Oncol. 2015;138(3):717-22. PubMed PMID: 26177554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The gynecological surveillance of women with Lynch syndrome in Sweden. AU - Tzortzatos,Gerasimos, AU - Andersson,Emil, AU - Soller,Maria, AU - Askmalm,Marie Stenmark, AU - Zagoras,Theofanis, AU - Georgii-Hemming,Patrik, AU - Lindblom,Annika, AU - Tham,Emma, AU - Mints,Miriam, Y1 - 2015/07/12/ PY - 2015/05/16/received PY - 2015/07/09/revised PY - 2015/07/10/accepted PY - 2015/7/16/entrez PY - 2015/7/16/pubmed PY - 2016/2/2/medline KW - Endometrial cancer KW - Lynch syndrome KW - Ovarian cancer KW - Screening SP - 717 EP - 22 JF - Gynecologic oncology JO - Gynecol. Oncol. VL - 138 IS - 3 N2 - OBJECTIVE: Women with Lynch syndrome (LS) have up to a 60% lifetime risk of endometrial cancer (EC) and up to a 24% risk of ovarian cancer (OC). Gynecological surveillance is recommended, but the benefit and how it should be performed remain unclear. The purpose of this study was to assess diagnostic modalities for gynecological screening of LS patients in Sweden and clinical outcome. METHODS: A retrospective nationwide study of 170 women with molecularly confirmed LS. Data including gynecological LS screening history, biopsy results (if any), genetic records, number of screening visits, results from screening including transvaginal ultrasound (TVUS), endometrial biopsy (EB), blood test for tumor marker cancer antigen (CA) 125, prophylactic surgery including age at procedure, and setting from which screening data were obtained from medical records. RESULTS: A total of 117 women were eligible for gynecological screening and of these, 86 patients attended screening visits. Of these, 41 underwent prophylactic hysterectomy and/or bilateral salpingo-oophorectomy. Two patients (4.9%) were diagnosed with EC and two (4.9%) with precancerous lesions in conjunction with prophylactic surgery. Total incidence of gynecological cancer in the surveillance group (45 women) was 20% EC, 4% OC. Five patients had endometrial cancer or complex hyperplasia with atypia (n=2) detected by endometrial biopsy. Four additional cases were detected due to interval bleeding. Both cases of ovarian cancer were detected by transvaginal ultrasound in patients with ovarian cysts under surveillance. The youngest woman with endometrial cancer was diagnosed at 35 years of age, before she was aware of her diagnosis of Lynch syndrome. CONCLUSIONS: Gynecological surveillance of women with Lynch syndrome may lead to earlier detection of precancerous lesions, which might have some impact on the morbidity from endometrial cancer although further studies are needed to prove this. Prophylactic hysterectomy with or without bilateral salpingo-oophorectomy reduces the cancer incidence. A practical approach to surveillance in Lynch syndrome women would be to offer annual surveillance beginning at age 30 years including probably both TVUS and EB in order to increase diagnostic yield with prospective data registry for follow-up studies. Prophylactic surgery could be performed at a suitable age after childbearing to obtain a balance between reducing the risk of cancer and minimizing long-term complications from premature menopause. SN - 1095-6859 UR - https://www.unboundmedicine.com/medline/citation/26177554/The_gynecological_surveillance_of_women_with_Lynch_syndrome_in_Sweden_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-8258(15)30078-0 DB - PRIME DP - Unbound Medicine ER -