title: Decrease in mortality in Lynch syndrome families because of surveillance.
abstract: OBJECTIVE
  Lynch syndrome family members have a high risk of developing colorectal (CRC), endometrial (EC), and other cancers. A large-scale surveillance program was introduced in The Netherlands in the late 1980s. The aims of the study were to evaluate the effectiveness of this program by assessing mortality because of CRC and EC before and after 1990 and to compare mortality because of all cancers (except CRC/EC) with mortality in the general population.
  
  
  METHODS
  Family members with at least 50% probability of being a carrier were selected for the study. The standardized mortality ratio (SMR) because of cancer and the absolute excess risk of death (AER) were calculated.
  
  
  RESULTS
  In the total cohort (N = 2788), 445 subjects had died because of cancer. The 3 most frequent causes of cancer-related deaths were CRC (50.3%), EC (6.7%), and brain tumors (6.7%). A significant decrease (70%) in SMR for CRC over time was observed (P < .001); the SMR for EC showed no decreasing trend over time. A significantly increased SMR was found for cancer of the small bowel (SMR = 18.3), brain (SMR = 9.1), kidney/ureter (SMR = 5.9), ovarium (SMR = 2.3), pancreas (SMR = 2.2), and stomach (SMR = 2.1). The AER was significantly increased for brain tumors only.
  
  
  CONCLUSIONS
  Since the introduction of surveillance, the mortality because of CRC has decreased. Except for brain tumors, we did not find a significantly increased AER for tumors other than CRC/EC.
authors.affiliation: The Netherlands Foundation for the Detection of Hereditary Tumors, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: de Jong
authors.forename: Yvonne M C
authors.initials: YM
authors.lastname: Hendriks
authors.forename: Jan H
authors.initials: JH
authors.lastname: Kleibeuker
authors.forename: Sybrand Y
authors.initials: SY
authors.lastname: de Boer
authors.forename: Annemieke
authors.initials: A
authors.lastname: Cats
authors.forename: Gerrit
authors.initials: G
authors.lastname: Griffioen
authors.forename: Fokko M
authors.initials: FM
authors.lastname: Nagengast
authors.forename: Frits G
authors.initials: FG
authors.lastname: Nelis
authors.forename: Matti A
authors.initials: MA
authors.lastname: Rookus
authors.forename: Hans F A
authors.initials: HF
authors.lastname: Vasen
mesh_terms: D000328:Adult; D000368:Aged; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000235:genetics / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics