title: Prevalence and predictors of appropriate colorectal cancer surveillance in Lynch syndrome.
abstract: OBJECTIVE
  Lynch syndrome (LS) is a hereditary cancer syndrome that conveys a high risk of colorectal cancer (CRC). Guidelines recommend colonoscopy every 1 to 2 years. There is limited information about screening compliance in this high-risk group.
  
  
  METHODS
  Data about cancer screening behaviors were obtained from subjects recruited through four US cancer genetics clinics. The main outcome was prevalence of appropriate CRC surveillance for LS.
  
  
  RESULTS
  A total of 181 individuals had a family history that met the Amsterdam criteria for LS (n=154) and/or had an identified mutation in a mismatch repair (MMR) gene (n=105). Of these 181 individuals, 131 (73%) had appropriate LS surveillance with colonoscopies at least every 2 years for their age >25 years. Of those with inadequate surveillance, 26/49 (53%) had colonoscopies at 3- to 5-year intervals. There were no significant differences in health-care setting, perceived risk of CRC, or compliance with screening for other cancers. Rates of appropriate surveillance were higher among individuals who had been referred for genetic evaluation for LS compared with those who had not (109/136 (80%) vs. 23/45 (51%), respectively, P=0.0004). In multivariate analysis, personal history of CRC (odds ratio (OR) 2.81), having a first-degree relative with CRC at age <50 years (OR 2.61), and having undergone a genetic evaluation (OR 4.62) were associated with appropriate CRC surveillance for LS.
  
  
  CONCLUSIONS
  The time between colonoscopic exams in patients with LS is often longer than recommended by current guidelines and may place them at risk for interval cancers. Recognizing clinical features of LS and providing genetic counseling, evaluation, and intensive surveillance may improve cancer prevention for those at the highest risk for CRC.
authors.affiliation: Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. estoffel@partners.org
authors.forename: Elena M
authors.initials: EM
authors.lastname: Stoffel
authors.forename: Rowena C
authors.initials: RC
authors.lastname: Mercado
authors.forename: Wendy
authors.initials: W
authors.lastname: Kohlmann
authors.forename: Beth
authors.initials: B
authors.lastname: Ford
authors.forename: Shilpa
authors.initials: S
authors.lastname: Grover
authors.forename: Peggy
authors.initials: P
authors.lastname: Conrad
authors.forename: Amie
authors.initials: A
authors.lastname: Blanco
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Shannon
authors.forename: Mark
authors.initials: M
authors.lastname: Powell
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Chung
authors.forename: Jonathan
authors.initials: J
authors.lastname: Terdiman
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Gruber
authors.forename: Sapna
authors.initials: S
authors.lastname: Syngal
mesh_terms: D000328:Adult; D003113:Colonoscopy; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000453:epidemiology* / Q000235:genetics; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010349:Patient Compliance; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology