Surgery Reduces Cancer Risk in Lynch Syndrome

Preventive surgery to remove the uterus and ovaries appears to greatly reduce the risk of developing endometrial or ovarian cancer among women with Lynch syndrome, a new study has reported.

Because women with Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC) mutations, are at increased risk of developing endometrial and ovarian cancers, the researchers examined the extent to which cancer risk can be decreased by prophylactic surgery. Specifically, female mutation carriers may benefit from the surgical removal of their uterus (hysterectomy) and/or fallopian tubes and ovaries (salpingo-oophorectomy) before endometrial or ovarian cancer are diagnosed.

The researchers assessed cancer risk in 315 women who had undergone both hysterectomy and bilateral salpingo-oophorectomy (BSO), hysterectomy alone, or had not had prophylactic surgery at all. The results showed that endometrial cancer developed in 33% of women without prophylactic hysterectomy and none of the women with prophylactic hysterectomy. Ovarian cancer developed in 5.5% of the women without prophylactic BSO and none of the women with prophylactic BSO. The results were published in the January 19, 2006, edition of the New England Journal of Medicine.

Given the median ages at which endometrial and ovarian cancers developed in the women without prophylactic surgery (46 years for endometrial cancer and 42 years for ovarian cancer), the researchers noted that it may be appropriate to consider prophylactic surgery after the age of 35, or once childbearing has been completed.

"Women with the Lynch syndrome have a 40-60% lifetime risk of endometrial cancer and a 10-12% lifetime risk of ovarian cancer,” wrote Kathleen M. Schmeler, M.D., from the University of Texas M.D. Anderson Cancer Center (Houston, TX, USA), and colleagues. "These findings suggest that prophylactic hysterectomy with BSO is an effective strategy for preventing endometrial and ovarian cancer in women with the Lynch syndrome.”

Lynch syndrome results from inherited mutations in genes involved in DNA mismatch repair. These mutations greatly increase the risk of developing colorectal cancer and also increase the risk of several other cancers. Overall, roughly 3-5% of all colorectal cancers are thought to result from HNPCC mutations.






Related Links:
University of Texas M.D. Anderson Cancer Center