1-2-year Surveillance Intervals Reduce Risk of Colorectal Cancer in Families with Lynch Syndrome

Gastroenterology. 2010 Mar 2. [Epub ahead of print]

1-2-year Surveillance Intervals Reduce Risk of Colorectal Cancer in Families with Lynch Syndrome.
Vasen HF, Abdirahman M, Brohet R, Langers AM, Kleibeuker JH, van Kouwen M, Koornstra JJ, Boot H, Cats A, Dekker E, Sanduleanu S, Poley JW, Hardwick JC, Cappel WH, Jong AE, Tan TG, Jacobs M, Mohamed FA, de Boer SY, van de Meeberg PC, Verhulst ML, Salemans JM, van Bentem N, Westerveld BD, Vecht J, Nagengast FM.

The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden; Department of Gastroenterology and Hepatology, Leiden University Medical Center.

BACKGROUND & AIMS:: 2%-4% of all cases of colorectal cancer (CRC) are associated with Lynch syndrome. Dominant clustering of CRC (non-Lynch Syndrome) accounts for 1%-3% of the cases. Because carcinogenesis is accelerated in Lynch Syndrome, an intensive colonoscopic surveillance program has been recommended since 1995. The aim of the study was to evaluate the effectiveness of this program. METHODS:: The study included 205 Lynch Syndrome families with identified mutations in one of the mismatch repair genes (745 mutation carriers). We also analyzed data from non-Lynch Syndrome families (46 families, 244 relatives). Patients were observed from January 1, 1995 until January 1, 2009. Endpoints of the study were CRC or date of the last colonoscopy. RESULTS:: After a mean follow up of 7.2 years, 33 patients developed CRC under surveillance. The cumulative risk of CRC was 6% after the 10-year follow-up period. The risk of CRC was higher in carriers older than 40 years and in carriers of MLH1 and MSH2-mutations. After a mean follow-up of 7.0 years, 6 cases of CRC were detected among non-Lynch Syndrome families. The risk of CRC was significantly higher among families with Lynch Syndrome, compared to those without. CONCLUSIONS:: With surveillance intervals of 1-2 years, members of families with Lynch Syndrome have a lower risk of developing CRC than with surveillance intervals of 2-3 years. Because of the low risk of CRC in non-Lynch Syndrome families, a less-intensive surveillance protocol can be recommended. Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

PMID: 20206180 [PubMed - as supplied by publisher]

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