Prophylactic surgery to reduce the risk of gynecologic cancers in the lynch syndrome

Kathleen M. Schmeler, Henry T. Lynch, Lee May Chen, Mark F. Munsell, Pamela T. Soliman, Mary Beth Clark, Molly S. Daniels, Kristin G. White, Stephanie G. Boyd-Rogers, Peggy G. Conrad, Kathleen Y. Yang, Mary M. Rubin, Charlotte C. Sun, Brian Slomovitz, David M. Gershenson, Karen H. Lu

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)261-269
Number of pages9
JournalNew England Journal of Medicine
Volume354
Issue number3
DOIs
StatePublished - Jan 19 2006
Externally publishedYes

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Hereditary Nonpolyposis Colorectal Neoplasms
Neoplasms
Endometrial Neoplasms
Ovarian Neoplasms
Ovariectomy
Hysterectomy
Confidence Intervals
Control Groups
Gynecologic Surgical Procedures
Germ-Line Mutation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Schmeler, K. M., Lynch, H. T., Chen, L. M., Munsell, M. F., Soliman, P. T., Clark, M. B., ... Lu, K. H. (2006). Prophylactic surgery to reduce the risk of gynecologic cancers in the lynch syndrome. New England Journal of Medicine, 354(3), 261-269. https://doi.org/10.1056/NEJMoa052627

Prophylactic surgery to reduce the risk of gynecologic cancers in the lynch syndrome. / Schmeler, Kathleen M.; Lynch, Henry T.; Chen, Lee May; Munsell, Mark F.; Soliman, Pamela T.; Clark, Mary Beth; Daniels, Molly S.; White, Kristin G.; Boyd-Rogers, Stephanie G.; Conrad, Peggy G.; Yang, Kathleen Y.; Rubin, Mary M.; Sun, Charlotte C.; Slomovitz, Brian; Gershenson, David M.; Lu, Karen H.

In: New England Journal of Medicine, Vol. 354, No. 3, 19.01.2006, p. 261-269.

Research output: Contribution to journalArticle

Schmeler, KM, Lynch, HT, Chen, LM, Munsell, MF, Soliman, PT, Clark, MB, Daniels, MS, White, KG, Boyd-Rogers, SG, Conrad, PG, Yang, KY, Rubin, MM, Sun, CC, Slomovitz, B, Gershenson, DM & Lu, KH 2006, 'Prophylactic surgery to reduce the risk of gynecologic cancers in the lynch syndrome', New England Journal of Medicine, vol. 354, no. 3, pp. 261-269. https://doi.org/10.1056/NEJMoa052627
Schmeler KM, Lynch HT, Chen LM, Munsell MF, Soliman PT, Clark MB et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the lynch syndrome. New England Journal of Medicine. 2006 Jan 19;354(3):261-269. https://doi.org/10.1056/NEJMoa052627
Schmeler, Kathleen M. ; Lynch, Henry T. ; Chen, Lee May ; Munsell, Mark F. ; Soliman, Pamela T. ; Clark, Mary Beth ; Daniels, Molly S. ; White, Kristin G. ; Boyd-Rogers, Stephanie G. ; Conrad, Peggy G. ; Yang, Kathleen Y. ; Rubin, Mary M. ; Sun, Charlotte C. ; Slomovitz, Brian ; Gershenson, David M. ; Lu, Karen H. / Prophylactic surgery to reduce the risk of gynecologic cancers in the lynch syndrome. In: New England Journal of Medicine. 2006 ; Vol. 354, No. 3. pp. 261-269.
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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.",
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AU - Schmeler, Kathleen M.

AU - Lynch, Henry T.

AU - Chen, Lee May

AU - Munsell, Mark F.

AU - Soliman, Pamela T.

AU - Clark, Mary Beth

AU - Daniels, Molly S.

AU - White, Kristin G.

AU - Boyd-Rogers, Stephanie G.

AU - Conrad, Peggy G.

AU - Yang, Kathleen Y.

AU - Rubin, Mary M.

AU - Sun, Charlotte C.

AU - Slomovitz, Brian

AU - Gershenson, David M.

AU - Lu, Karen H.

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N2 - 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.

AB - 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.

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