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Preventive Surgery Suggested for syndromeWomen Disposed to Have Cancers Should Weigh the Option, Says a Creighton Expert Writing in a National Journal.

Posted on: Wednesday, 18 January 2006, 18:00 CST

By Nichole Aksamit

Women with the Lynch syndrome -- a genetic condition that predisposes them to colon and other cancers -- should at least think about having their uterus, ovaries and fallopian tubes surgically removed after childbearing to prevent endometrial and life- threatening ovarian cancers.

That's according to an article in Thursday's New England Journal of Medicine coauthored by Dr. Henry Lynch, Creighton University Medical Center hereditary cancer expert and Lynch syndrome namesake.

An accompanying editorial in the journal says the article provides the "first useful estimate" of risk-reducing surgery's effects on Lynch syndrome.

But the editorial's authors noted that the tradeoffs of surgery (including infertility, early onset of menopause and higher risk of osteoporosis in women) may outweigh the benefits if gynecological cancers can be detected at early, curable stages. And it suggested that future studies should compare the effect of rigorous screening versus preventive surgery on cancer death rates.

For the article, Lynch and researchers at the M.D. Anderson Cancer Center in Houston and University of California at San Francisco reviewed medical records of about 300 female patients diagnosed with hereditary nonpolyposis colorectal cancer, or the Lynch syndrome.

The syndrome is associated with early cancer onset and multiple types of cancer, including that of the colon, rectum, endometrium, ovary, small bowel, ureter and renal pelvis.

Reached by phone in Singapore, where he is lecturing this week, Lynch said an estimated 2 percent to 7 percent of people with colorectal cancer have Lynch syndrome.

Women with Lynch syndrome have far higher lifetime risk than other women of developing gynecological cancers.

They have a 40 percent to 60 percent chance of developing endometrial cancer and a 10 percent to 12 percent chance of developing ovarian cancer, which is difficult to detect before it has spread elsewhere in the body.

The review found that none of the women who had hysterectomies (surgeries to remove the uterus) developed endometrial cancer. But one-third of the women who did not have surgery did develop the cancer.

None of the women who had surgeries to remove the ovaries and fallopian tubes developed ovarian or peritoneal cancers. But 5 percent of the patients who did not have surgery developed one or both of the cancers.

At the time of the review, 25 of the approximately 300 women had died -- 22 of them from the group that did not have surgery. One patient had surgical complications.

Lynch said he has been recommending preventive surgery for Lynch syndrome patients since the 1970s. "But it wasn't picked up by the medical community," he said.

He said the decision still is ultimately up to the patient, but his review suggests that doctors should at least include surgery as an option for Lynch syndrome women who don't intend to have more children.

"(With surgery), we're removing the very life-threatening issue of ovarian cancer and the risk of endometrial cancer," he said.

Source: Omaha World - Herald

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