Surgery May Lower Women’s Cancer Risk

By Nichole Aksamit

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

That’s according to an article in today’s New England Journal of Medicine co-authored 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 said the tradeoffs of surgery (including infertility, early onset of menopause and higher risk of osteoporosis) may outweigh the benefits if gynecological cancers can be detected at early, curable stages.

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 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 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 getting 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 developed endometrial cancer. But one-third of those who did not have surgery developed 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 without surgery. One had surgical complications.

Lynch said he has been recommending preventive surgery for Lynch syndrome patients since the 1970s.

He said the decision is up to the patient, but his review suggests doctors should at least include the surgery as an option for Lynch syndrome women finished with childbearing.

“(With surgery), we’re removing the very life-threatening issue of ovarian cancer and the risk of endometrial cancer.”