One to 2-Year Surveillance Intervals Reduce Risk of Colorectal Cancer in Families With Lynch Syndrome

Hans F. A. Vasen*, Mohamed Abdirahman, Richard Brohet, Alexandra M. J. Langers, Jan H. Kleibeuker, Mariette van Kouwen, Jan Jacob Koornstra, Henk Boot, Annemieke Cats, Evelien Dekker, Silvia Sanduleanu, Jan-Werner Poley, James C. H. Hardwick, Wouter H. de Vos tot Nederveen Cappel, Andrea E. van der Meulen-de Jong, T. Gie Tan, Maarten A. J. M. Jacobs, Faig Lall A. Mohamed, Sijbrand Y. de Boer, Paul C. van de MeebergMarie-Louise Verhulst, Jan M. Salemans, Nico Van Bentem, B. Dik Westerveld, Juda Vecht, Fokko M. Nagengast

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND & AIMS: Two percent to 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, 344 relatives). Patients were observed from January 1, 1995, until January 1, 2009. End points 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 with 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.

Original languageEnglish
Pages (from-to)2300-2306
Number of pages7
JournalGastroenterology
Volume138
Issue number7
DOIs
Publication statusPublished - Jun-2010

Keywords

  • Familial Colorectal Cancer Type X
  • Microsatellite Instability
  • Extracolonic Cancers
  • MMR-Gene Mutation Carriers
  • COLONOSCOPIC SURVEILLANCE
  • INDIVIDUALS
  • MANAGEMENT
  • CRITERIA
  • TUMORS
  • HNPCC

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