January 18, 2006

Surgery Can Fight Cancers in Lynch Syndrome

By Gene Emery

BOSTON (Reuters) - Women genetically predisposed to two types of reproductive cancer can virtually end that risk by having their uterus and ovaries removed once they are done having children, a study showed on Wednesday.

The genetic disorder, known as Lynch syndrome, is found in one of every 1,000 people. Women who carry the defect have a 60 percent chance of developing endometrial cancer, a disease of the lining of the uterus, in their lifetime.

The risk for women without the disorder is 3 percent.

Those with Lynch syndrome also have a 12 percent chance of developing ovarian cancer, compared to 1 or 2 percent for women without the disorder.

"Although it's a small group of individuals (with Lynch syndrome), their risk is exponentially high," Karen Lu, author of the new study published in this week's New England Journal of Medicine, told Reuters.

She and her colleagues examined the records of 315 women where genetic testing revealed Lynch syndrome to determine if women who have the surgery still have ovarian or other reproductive cancer cells left in their bodies that will then affect other organs.

Of the 61 who had a hysterectomy to remove their uterus and 47 who had their ovaries removed, none developed ovarian or endometrial cancer in tissues left behind after surgery.

But in a group of 254 women with no surgery, 69 developed endometrial cancer and 12 were diagnosed with ovarian cancer.

The finding "allows physicians to say to women, 'This is something you can actively do to prevent getting endometrial cancer, and probably ovarian cancer as well,"' Lu said.

Tests for Lynch syndrome usually are not done until a family member develops cancer at an early age, usually colon cancer. And even then, many doctors fail to realize that it raises the risk of reproductive tumors, she said.

Although cancer prevention surgery carries risks, "my experience is that most women, when they've completed their childbearing, have no problem undergoing a hysterectomy, especially when they've seen family members die of endometrial or ovarian cancer," said Lu.

"In comparison to what could happen to them, they don't have a problem with it," she added.

Women who decide not to have children should consider surgery beginning at age 35, the researchers said.

In a Journal editorial, Kenneth Offit and Noah Kauff of the Memorial Sloan-Kettering Cancer Center in New York said the new study should only be a starting point because it was an after-the-fact look at cancer cases.

It also remains unclear that surgery will increase survival because the success rate for treating such cancers is high. Aggressive screening, they said, might eliminate the need for pre-emptive surgery.

Lu said many doctors are unaware of Lynch syndrome so few try to identify people who have it.

"We're trying to get the medical community, as well as the lay community to be aware of the syndrome," she said. "We need to focus on people before they get their cancers."