| Title: |
Uptake of hysterectomy and bilateral salpingooophorectomy in carriers of pathogenic mismatch repair variants: a Prospective Lynch Syndrome Database report |
| Authors: |
Seppala, TT; Dominguez-Valentin, M; Crosbie, EJ; Engel, C; Aretz, S; Macrae, F; Winship, I; Capella, G; Thomas, H; Hovig, E; Nielsen, M; Sijmons, RH; Bertario, L; Bonanni, B; Tibiletti, MG; Cavestro, GM; Mints, M; Gluck, N; Katz, L; Heinimann, K; Vaccaro, CA; Green, K; Lalloo, F; Hill, J; Schmiegel, W; Vangala, D; Perne, C; Strauss, HG; Tecklenburg, J; Holinski-Feder, E; Steinke-Lange, V; Mecklin, JP; Plazzer, JP; Pineda, M; Navarro, M; Vida, JB; Kariv, R; Rosner, G; Pinero, TA; Pavicic, W; Kalfayan, P; Ten Broeke, SW; Jenkins, MA; Sunde, L; Bernstein, I; Burn, J; Greenblatt, M; Cappel, WHDTN; Della Valle, A; Lopez-Koestner, F; Alvarez, K; Buttner, R; Gorgens, H; Morak, M; Holzapfel, S; Huneburg, R; Doeberitz, MV; Loeffler, M; Redler, S; Weitz, J; Pylvanainen, K; Renkonen-Sinisalo, L; Lepisto, A; Hopper, JL; Win, AK; Lindor, NM; Gallinger, S; Marchand, LL; Newcomb, PA; Figueiredo, JC; Thibodeau, SN; Therkildsen, C; Wadt, KAW; Mourits, MJE; Ketabi, Z; Denton, OG; Rodland, EA; Vasen, H; Neffa, F; Esperon, P; Tjandra, D; Moslein, G; Rokkones, E; Sampson, JR; Evans, DG; Moller, P |
| Contributors: |
ATG - Applied Tumor Genomics; HUS Abdominal Center; Clinicum; II kirurgian klinikka; Department of Surgery; Doctoral Programme in Clinical Research |
| Publisher Information: |
Elsevier Ltd. |
| Publication Year: |
2021 |
| Collection: |
Helsingfors Universitet: HELDA – Helsingin yliopiston digitaalinen arkisto |
| Subject Terms: |
Lynch syndrome; Endometrial cancer; Ovarian cancer; Risk-reducing surgery; Hysterectomy; Oophorectomy; MLH1; MSH2; MSH6; PMS2; COLON-CANCER; SURGERY; COLECTOMY; WOMEN; anesthesiology; intensive care; radiology |
| Description: |
Purpose: This study aimed to report the uptake of hysterectomy and/or bilateral salpingo-oophorectomy (BSO) to prevent gynaecological cancers (risk-reducing surgery [RRS]) in carriers of pathogenic MMR (path_MMR) variants. Methods: The Prospective Lynch Syndrome Database (PLSD) was used to investigate RRS by a cross-sectional study in 2292 female path_MMR carriers aged 30-69 years. Results: Overall, 144, 79, and 517 carriers underwent risk-reducing hysterectomy, BSO, or both combined, respectively. Two-thirds of procedures before 50 years of age were combined hysterectomy and BSO, and 81% of all procedures included BSO. Risk-reducing hysterectomy was performed before age 50 years in 28%, 25%, 15%, and 9%, and BSO in 26%, 25%, 14% and 13% of path_MLH1, path_MSH2, path_MSH6, and path_PMS2 carriers, respectively. Before 50 years of age, 107 of 188 (57%) BSO and 126 of 204 (62%) hysterectomies were performed in women without any prior cancer, and only 5% (20/392) were performed simultaneously with colorectal cancer (CRC) surgery. Conclusion: Uptake of RRS before 50 years of age was low, and RRS was rarely undertaken in association with surgical treatment of CRC. Uptake of RRS aligned poorly with gene-and age-associated risk estimates for endometrial or ovarian cancer that were published recently from PLSD and did not correspond well with current clinical guidelines. The reasons should be clarified. Decision-making on opting for or against RRS and its timing should be better aligned with predicted risk and mortality for endometrial and ovarian cancer in Lynch syn-drome to improve outcomes. (C) 2021 The Author(s). Published by Elsevier Ltd. ; Peer reviewed |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
RIS: urn:24639478853965089D368C64FDB8B0DD; https://hdl.handle.net/10138/337489; 000645079600016 |
| Availability: |
https://hdl.handle.net/10138/337489 |
| Rights: |
cc_by ; info:eu-repo/semantics/openAccess ; openAccess |
| Accession Number: |
edsbas.8007071A |
| Database: |
BASE |