Benefit from extended surveillance interval on colorectal cancer risk in Lynch syndrome.

Lindberg LJ1, Rasmussen M1, Andersen KK2, Nilbert M1,2,3, Therkildsen C1.

Author information

1: The Danish HNPCC Register, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
2: The Danish Cancer Society Research Center, Copenhagen, Denmark.
3: Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden.

Abstract

AIM:

Although patients with Lynch syndrome have an increased risk of developing colorectal cancer, surveillance can reduce morbidity and mortality. Whether or not affected individuals benefit from lifetime surveillance depends on individual factors and patient adherence, and these may vary, complicating risk modeling. The aim of this study was to identify individual factors which influence patient adherence to surveillance programmes and if the length of extended surveillance interval influenced their risk of developing colorectal cancer.

METHOD:

Demographics and survival data was obtained from patients (n=1223) with Lynch syndrome, identified by interrogating the Danish hereditary non-polyposis colorectal cancer (HNPCC) register. This data was linked to patient surveillance interval data which had been divided in to three subsets ( <27 months: adherent to the recommended biennial program; >27 months: extended surveillance interval ; and no surveillance) to estimate the cumulative risks and hazard ratios (HR) for colorectal cancer RESULTS: One hundred and forty seven colorectal cancers (99 first; 48 metachronous) were identified in 1223 patients Factors associated with adherence to surveillance were female sex, previous history of cancer and age <75 yr. Cumulative incidence for colorectal cancer was 38% (95% CI 27-50%) for surveillance intervals <27 months, 48% (95% CI 29-67%) for intervals >27 months, and 72% (95% CI 61-83%) with no surveillance. Adjusted HRs were 0.22 for surveillance intervals <27 months and 0.32 for surveillance intervals >27 months. Extended surveillance intervals >27 months had a non-significant benefit with an HR of 1.51 (95% CI 0.83-2.75) compared to surveillance intervals <27 months.

CONCLUSION:

This study demonstrates that adherence to colonoscopic surveillance in Lynch syndrome varies with age, sex, and cancer history but that any surveillance is better than nothing.