Prospective Study of Combined Colon and Endometrial Cancer Screening in Women With Lynch Syndrome: A Patient-Centered Approach

Huang, Marilyn; Sun, Charlotte C.; Boyd-Rogers, Stephanie; Burzawa, Jennifer K.; Milbourne, Andrea; Keeler, Elizabeth; Yzquierdo, Rebecca; Lynch, Patrick M.; Peterson, Susan K.; Lu, Karen H.

doi:10.1200/jop.2010.000038

Cited by 24 publications

(20 citation statements)

References 19 publications

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“…However, as time went on the gynecologist went first, in the interest of getting the quicker part of the procedure done, so the gynecologist could leave and not have to wait on the gastroenterologist to perform the colonoscopy. As shown in the feasibility study [16], the EMBx added a median time of 5 minutes (range, 1–12 minutes), whereas colonoscopy duration for the study endoscopist averages about 19 minutes. No increases in anesthetic medication dosing or change in type of sedation offered were necessitated by the addition of the EMBx.…”

Section: Discussionmentioning

confidence: 99%

“…Patients often experience moderate discomfort and cramps. Combined screening, with EMBx at the time of colonoscopy to take advantage of the intravenous sedation, has been shown to be feasible and acceptable to patients at our institution [16]. Following our proof of principal demonstration, combined screening is now being routinely performed.…”

Section: Introductionmentioning

confidence: 99%

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Combined colonoscopy and endometrial biopsy cancer screening results in women with Lynch syndrome

Nebgen

Rimes

et al. 2014

Gynecologic Oncology

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Objective Endometrial biopsy (EMBx) and colonoscopy performed under the same sedation is termed combined screening and has been shown to be feasible and to provide a less painful and more satisfactory experience for women with Lynch syndrome (LS). However, clinical results of these screening efforts have not been reported. The purpose of this study was to evaluate the long-term clinical outcomes and patient compliance with serial screenings over the last 10.5 years. Methods We retrospectively analyzed the data for 55 women with LS who underwent combined screening every 1–2 years between 2002 and 2013. Colonoscopy and endometrial biopsy were performed by a gastroenterologist and a gynecologist, with the patient under conscious sedation. Results Out of 111 screening visits in these 55 patients, endometrial biopsies detected one simple hyperplasia, three complex hyperplasia, and one endometrioid adenocarcinoma (FIGO Stage 1A). Seventy one colorectal polyps were removed in 29 patients, of which 29 were tubular adenomas. EMBx in our study detected endometrial cancer in 0.9% (1/111) of surveillance visits, and premalignant hyperplasia in 3.6% (4/111) of screening visits. No interval endometrial or colorectal cancers were detected. Conclusions Combined screening under sedation is feasible and less painful than EMBx alone. Our endometrial pathology detection rates were comparable to yearly screening studies. Our results indicate that screening of asymptomatic LS women with EMBx every 1–2 years, rather than annually, is effective in the early detection of (pre)cancerous lesions, leading to their prompt definitive management, and potential reduction in endometrial cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined colonoscopy and endometrial biopsy cancer screening results in women with Lynch syndrome

Nebgen

Rimes

et al. 2014

Gynecologic Oncology

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“…There was no significant difference between the pain scores for hysteroscopy and Pipelle biopsy. Huang et al 59 compared a new patient-centered approach by combining endometrial biopsies and colonoscopy under sedation. This approach was much more acceptable than an endometrial biopsy as a single procedure without sedation.…”

Section: Question Nomentioning

confidence: 99%

Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts

Vasen

Blanco

Aktán-Collán

et al. 2013

Gut

644

565

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Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for the clinical management of LS. Since then substantial new information has become available necessitating an update of the guidelines. In 2011 and 2012 workshops were organised in Palma de Mallorca. A total of 35 specialists from 13 countries participated in the meetings. The first step was to formulate important clinical questions. Then a systematic literature search was performed using the Pubmed database and manual searches of relevant articles. During the workshops the outcome of the literature search was discussed in detail. The guidelines described in this paper may be helpful for the appropriate management of families with LS. Prospective controlled studies should be undertaken to improve further the care of these families.

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“…Hereditary breast-ovarian cancer (HBOC) and Lynch syndrome are relatively common hereditary cancer syndromes associated with high risks and early onset for breast, ovarian, colon, endometrial, and other cancers, 1,2 necessitating more intensive screening [1][2][3][4] and prevention options. [5][6][7][8][9][10][11] Documenting family history is important for recognizing individuals who may have a predisposition to HBOC or Lynch syndrome, particularly individuals without a personal history of cancer who may have the most to gain from genetic risk assessment and resulting recommendations for risk-appropriate cancer screening and prevention.…”

Section: Introductionmentioning

confidence: 99%

A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians

Scheuner

Hamilton

Peredo

et al. 2014

Genetics in Medicine

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Purpose:We developed, implemented, and evaluated a multicomponent cancer genetics toolkit designed to improve recognition and appropriate referral of individuals at risk for hereditary cancer syndromes. Methods:We evaluated toolkit implementation in the women's clinics at a large Veterans Administration medical center using mixed methods, including pre-post semistructured interviews, clinician surveys, and chart reviews, and during implementation, monthly tracking of genetic consultation requests and use of a reminder in the electronic health record. We randomly sampled 10% of progress notes 6 months before (n = 139) and 18 months during implementation (n = 677). Results:The toolkit increased cancer family history documentation by almost 10% (26.6% pre-and 36.3% postimplementation). The reminder was a key component of the toolkit; when used, it was associated with a twofold increase in cancer family history documentation (odds ratio = 2.09; 95% confidence interval: 1.39-3.15), and the history was more complete. Patients whose clinicians completed the reminder were twice as likely to be referred for genetic consultation (4.1-9.6%, P < 0.0001). Conclusion:A multicomponent approach to the systematic collection and use of family history by primary-care clinicians increased access to genetic services.

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Prospective Study of Combined Colon and Endometrial Cancer Screening in Women With Lynch Syndrome: A Patient-Centered Approach

Abstract: Combined colon and endometrial cancer screening is a patient-centered approach that is feasible, acceptable, and may improve adherence to Lynch syndrome screening recommendations.

Cited by 24 publications

References 19 publications

Combined colonoscopy and endometrial biopsy cancer screening results in women with Lynch syndrome

Combined colonoscopy and endometrial biopsy cancer screening results in women with Lynch syndrome

Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts

A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians

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