FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 354:261-269 January 19, 2006 Number 3 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Offit, K. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have a 40 to 60 percent lifetime risk of endometrial cancer and a 10 to 12 percent lifetime risk of ovarian cancer. The benefit of prophylactic gynecologic surgery for women with this syndrome has been uncertain. We designed this study to determine the reduction in the risk of gynecologic cancers associated with prophylactic hysterectomy and bilateral salpingo-oophorectomy in women with the Lynch syndrome.

Methods Three hundred fifteen women with documented germ-line mutations associated with the Lynch syndrome were identified. Women who had undergone prophylactic hysterectomy (61 women) and women who had undergone prophylactic bilateral salpingo-oophorectomy (47 women) were matched with mutation-positive women who had not undergone the procedure in question (210 women for the analysis of endometrial cancer and 223 for the analysis of ovarian cancer). Women who had undergone prophylactic surgery and their matched controls were followed from the date of the surgery until the occurrence of cancer or until the data were censored at the time of the last follow-up visit.

Results There were no occurrences of endometrial, ovarian, or primary peritoneal cancer among the women who had undergone prophylactic surgery. Endometrial cancer was diagnosed in 69 women in the control group (33 percent), for an incidence density of 0.045 per woman-year, yielding a prevented fraction (the proportion of potential new cancers prevented) of 100 percent (95 percent confidence interval, 90 to 100 percent). Ovarian cancer was diagnosed in 12 women in the control group (5 percent), for an incidence density of 0.005 per woman-year, yielding a prevented fraction of 100 percent (95 percent confidence interval, –62 to 100 percent).

Conclusions These findings suggest that prophylactic hysterectomy with bilateral salpingo-oophorectomy is an effective strategy for preventing endometrial and ovarian cancer in women with the Lynch syndrome.

Source Information

From the Departments of Gynecologic Oncology (K.M.S., P.T.S., K.G.W., S.G.B.-R., C.C.S., B.M.S., D.M.G., K.H.L.), Biostatistics and Applied Mathematics (M.F.M.), and Clinical Cancer Genetics (M.S.D.), the University of Texas M.D. Anderson Cancer Center, Houston; the Department of Preventive Medicine, Creighton University, Omaha, Nebr. (H.T.L., M.B.C.); and the Departments of Gynecologic Oncology (L.C., K.Y.Y., M.M.R.) and Medicine (P.G.C.), University of California at San Francisco, San Francisco.

Address reprint requests to Dr. Lu at the Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, P.O. Box 301439, Unit 1362, Houston, TX 77230-1439, or at khlu{at}mdanderson.org.

Full Text of this Article

This article has been cited by other articles:

• Matthews, K. S., Estes, J. M., Conner, M. G., Manne, U., Whitworth, J. M., Huh, W. K., Alvarez, R. D., Straughn, J. M. Jr, Barnes, M. N., Rocconi, R. P. (2008). Lynch Syndrome in Women Less Than 50 Years of Age With Endometrial Cancer. Obstet Gynecol 111: 1161-1166 [Abstract] [Full Text]  
• Clendenning, M., Baze, M. E., Sun, S., Walsh, K., Liyanarachchi, S., Fix, D., Schunemann, V., Comeras, I., Deacon, M., Lynch, J. F., Gong, G., Thomas, B. C., Thibodeau, S. N., Lynch, H. T., Hampel, H., de la Chapelle, A. (2008). Origins and Prevalence of the American Founder Mutation of MSH2. Cancer Res. 68: 2145-2153 [Abstract] [Full Text]  
• Walsh, M. D., Cummings, M. C., Buchanan, D. D., Dambacher, W. M., Arnold, S., McKeone, D., Byrnes, R., Barker, M. A., Leggett, B. A., Gattas, M., Jass, J. R., Spurdle, A. B., Young, J., Obermair, A. (2008). Molecular, Pathologic, and Clinical Features of Early-Onset Endometrial Cancer: Identifying Presumptive Lynch Syndrome Patients. Clin. Cancer Res. 14: 1692-1700 [Abstract] [Full Text]  
• Sorosky, J. I. (2008). Endometrial Cancer. Obstet Gynecol 111: 436-447 [Abstract] [Full Text]  
• Schnipper, L. E. (2007). Update in Oncology. ANN INTERN MED 147: 775-782 [Full Text]  
• Kauff, N. D. (2007). How Should Women With Early-Onset Endometrial Cancer Be Evaluated for Lynch Syndrome?. JCO 25: 5143-5146 [Full Text]  
• South, S. A., Hutton, M., Farrell, C., Mhawech-Fauceglia, P., Rodabaugh, K. J. (2007). Uterine Carcinosarcoma Associated With Hereditary Nonpolyposis Colorectal Cancer. Obstet Gynecol 110: 543-545 [Abstract] [Full Text]  
• Chen, L.-m., Yang, K. Y., Little, S. E., Cheung, M. K., Caughey, A. B. (2007). Gynecologic Cancer Prevention in Lynch Syndrome/Hereditary Nonpolyposis Colorectal Cancer Families. Obstet Gynecol 110: 18-25 [Abstract] [Full Text]  
• Karlan, B. Y., Berchuck, A., Mutch, D. (2007). The Role of Genetic Testing for Cancer Susceptibility in Gynecologic Practice. Obstet Gynecol 110: 155-167 [Abstract] [Full Text]  
• Vasen, H F A, Moslein, G, Alonso, A, Bernstein, I, Bertario, L, Blanco, I, Burn, J, Capella, G, Engel, C, Frayling, I, Friedl, W, Hes, F J, Hodgson, S, Mecklin, J-P, Moller, P, Nagengast, F, Parc, Y, Renkonen-Sinisalo, L, Sampson, J R, Stormorken, A, Wijnen, J (2007). Guidelines for the clinical management of Lynch syndrome (hereditary non-polyposis cancer). J. Med. Genet. 44: 353-362 [Abstract] [Full Text]  
• Seiden, M. V., Patel, D., O'Neill, M. J., Oliva, E. (2007). Case 13-2007 -- A 46-Year-Old Woman with Gynecologic and Intestinal Cancers. NEJM 356: 1760-1769 [Full Text]  
• Ganz, P. A. (2006). Monitoring the Physical Health of Cancer Survivors: A Survivorship-Focused Medical History. JCO 24: 5105-5111 [Abstract] [Full Text]  
• Guillem, J. G., Wood, W. C., Moley, J. F., Berchuck, A., Karlan, B. Y., Mutch, D. G., Gagel, R. F., Weitzel, J., Morrow, M., Weber, B. L., Giardiello, F., Rodriguez-Bigas, M. A., Church, J., Gruber, S., Offit, K. (2006). ASCO/SSO Review of Current Role of Risk-Reducing Surgery in Common Hereditary Cancer Syndromes. JCO 24: 4642-4660 [Abstract] [Full Text]  
• Guillem, J. G., Wood, W. C., Moley, J. F., Berchuck, A., Karlan, B. Y., Mutch, D. G., Gagel, R. F., Weitzel, J., Morrow, M., Weber, B. L., Giardiello, F., Rodriguez-Bigas, M. A., Church, J., Gruber, S., Offit, K. (2006). ASCO/SSO Review of Current Role of Risk-Reducing Surgery in Common Hereditary Cancer Syndromes. Ann. Surg. Oncol. 13: 1296-1321 [Abstract] [Full Text]  
• Chen, S., Wang, W., Lee, S., Nafa, K., Lee, J., Romans, K., Watson, P., Gruber, S. B., Euhus, D., Kinzler, K. W., Jass, J., Gallinger, S., Lindor, N. M., Casey, G., Ellis, N., Giardiello, F. M., Offit, K., Parmigiani, G., for the Colon Cancer Family Registry, (2006). Prediction of germline mutations and cancer risk in the Lynch syndrome.. JAMA 296: 1479-1487 [Abstract] [Full Text]  
• Lindor, N. M., Petersen, G. M., Hadley, D. W., Kinney, A. Y., Miesfeldt, S., Lu, K. H., Lynch, P., Burke, W., Press, N. (2006). Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: a systematic review.. JAMA 296: 1507-1517 [Abstract] [Full Text]  
• (2006). Lynch Syndrome: Reducing Gynecologic Cancer Risk. JWatch Women's Health 2006: 3-3 [Full Text]  
• (2006). Prophylactic Surgery Prevents Gynecologic Cancers in Women with Lynch Syndrome. JWatch Gastroenterology 2006: 9-9 [Full Text]  
• Offit, K., Kauff, N. D. (2006). Reducing the Risk of Gynecologic Cancer in the Lynch Syndrome. NEJM 354: 293-295 [Full Text]