Perceptions of Cancer Risks and Predictors of Colon and Endometrial Cancer Screening in Women Undergoing Genetic Testing for Lynch Syndrome

• Published in: Journal of clinical oncology Vol. 26; no. 6; pp. 948 - 954
• Main Authors: Hadley, Donald W., Jenkins, Jean F., Steinberg, Seth M., Liewehr, David, Moller, Stephanie, Martin, Jean C., Calzone, Kathleen A., Soballe, Peter W., Kirsch, Ilan R.
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 20.02.2008; Lippincott Williams & Wilkins
• Subjects: Adult; Age Factors; Aged; Analysis of Variance; Biological and medical sciences; Colonic Neoplasms - epidemiology; Colonic Neoplasms - etiology; Colonoscopy; Colorectal Neoplasms, Hereditary Nonpolyposis - genetics; Endometrial Neoplasms - epidemiology; Endometrial Neoplasms - etiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Genetic Counseling; Genetic Testing; Heterozygote; Humans; Income; Medical sciences; Middle Aged; Mutation; Predictive Value of Tests; Risk Assessment; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Human; Hereditary nonpolyposis colorectal cancer; Endometrium cancer; Rectal disease; Malignant tumor; Medical screening; Epidemiology; Genetic disease; Female genital diseases; Colonic disease; Colon cancer; Cancerology; Risk factor; Uterine diseases; Digestive diseases; Intestinal disease; Adult; Female; Genetics; Perception; Predictive factor; Woman; Cancer; Lynch syndrome
• ISSN: 0732-183X; 1527-7755; 1527-7755
• DOI: 10.1200/JCO.2007.13.0575

Lynch syndrome poses multiple cancer risks, yet attention has focused on screening for colorectal cancer. Estimated risks for endometrial cancer equal risks for colorectal cancer. This study (1) evaluated women's perceived risks for cancers, (2) compared endometrial cancer screening and colonoscopy, and (3) identified predictors of screening before and after genetic testing. Sixty-five adult women at 50% risk for carrying a cancer-predisposing mutation, without a history of endometrial cancer or hysterectomy, participated in genetic counseling and received unequivocal genetic test results for Lynch syndrome. Participants completed questionnaires before and after receipt of genetic results. Pretest, perceived risks for colon cancer were significantly higher than for extracolonic cancers (P < .0001). Use of colonoscopy was significantly higher (P = .006) than endometrial cancer screening. Post-test, carriers demonstrated a significant (P < .0001) increase in their perceived risk for extracolonic cancers and increased both colonoscopy (P = .79) and endometrial cancer screening (P = .11). Mutation status, age, perceived likelihood of carrying a mutation, and communication of test results to their physician independently predicted cancer screening at follow-up. Women in families with Lynch syndrome are less aware of their risks for extracolonic cancers and undergo endometrial cancer screening significantly less often than colonoscopy before genetic counseling. Given the significantly increased risks for endometrial and ovarian cancers and the mortality associated with ovarian cancer, additional efforts to inform families of cancer risks and screening recommendations seem prudent. Physicians play a critical role in ensuring appropriate cancer screening in women with Lynch syndrome.