Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: A systematic review

Noralane M. Lindor, Gloria M. Petersen, Donald W. Hadley, Anita Y. Kinney, Susan Miesfeldt, Karen H. Lu, Patrick Lynch, Wylie Burke, Nancy Press

    Research output: Contribution to journalReview article

    508 Scopus citations

    Abstract

    Context: About 2% of all colorectal cancer occurs in the context of the autosomal dominantly inherited Lynch syndrome, which is due to mutations in mismatch repair genes. Potential risk-reducing interventions are recommended for individuals known to have these mutations. Objectives: To review cancer risks and data on screening efficacy in the context of Lynch syndrome (hereditary nonpolyposis colorectal cancer) and to provide recommendations for clinical management for affected families, based on available evidence and expert opinion. Data Sources and Study Selection: A systematic literature search using PubMed and the Cochrane Database of Systematic Reviews, reference list review of retrieved articles, manual searches of relevant articles, and direct communication with other researchers in the field. Search terms included hereditary non-polyposis colon cancer, Lynch syndrome, microsatellite instability, mismatch repair genes, and terms related to the biology of Lynch syndrome. Only peer-reviewed, full-text, English-language articles concerning human subjects published between January 1, 1996, and February 2006 were included. The US Preventive Services Task Force's 2-tier system was adapted to describe the quality of evidence and to assign strength to the recommendations for each guideline. Evidence Synthesis: The evidence supports colonoscopic surveillance for individuals with Lynch syndrome, although the optimal age at initiation and frequency of examinations is unresolved. Colonoscopy is recommended every 1 to 2 years starting at ages 20 to 25 years (age 30 years for those with MSH6 mutations), or 10 years younger than the youngest age of the person diagnosed in the family. While fully acknowledging absence of demonstrated efficacy, the following are also recommended annually: endometrial sampling and transvaginal ultrasound of the uterus and ovaries (ages 30-35 years); urinalysis with cytology (ages 25-35 years); history, examination, review of systems, education and genetic counseling regarding Lynch syndrome (age 21 years). Regular colonoscopy was favored for at-risk persons without colorectal neoplasia. For individuals who will undergo surgical resection of a colon cancer, subtotal colectomy is favored. Evidence supports the efficacy of prophylactic hysterectomy and oophorectomy. Conclusions: The past 10 years have seen major advances in the understanding of Lynch syndrome. Current recommendations regarding cancer screening and prevention require careful consultation between clinicians, clinical cancer genetic services, and well-informed patients.

    Original languageEnglish (US)
    Pages (from-to)1507-1517
    Number of pages11
    JournalJournal of the American Medical Association
    Volume296
    Issue number12
    DOIs
    StatePublished - Sep 27 2006

    ASJC Scopus subject areas

    • Medicine(all)

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    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. Journal of the American Medical Association, 296(12), 1507-1517. https://doi.org/10.1001/jama.296.12.1507