title: Risk of urothelial bladder cancer in Lynch syndrome is increased, in particular among MSH2 mutation carriers.
abstract: BACKGROUND
  Colorectal, endometrial and upper urinary tract tumours are characteristic for Lynch syndrome (hereditary non-polyposis colon carcinoma, HNPCC). The aim of the present study was to establish whether carriers of mutations in mismatch repair genes MLH1, MSH2 or MSH6 are at increased risk of urinary bladder cancer.
  
  
  METHODS
  Carriers and first degree relatives of 95 families with a germline mutation in the MLH1 (n=26), MSH2 (n=43), or MSH6 (n=26) gene were systematically questioned about the occurrence of carcinoma. The cumulative risk of cancer occurring before the age of 70 years (CR70) was compared to the CR70 of the general Dutch population. Microsatellite instability (MSI) testing and/or immunohistochemistry (IHC) for mismatch repair proteins was performed on bladder tumour tissue.
  
  
  RESULTS
  Bladder cancer was diagnosed in 21 patients (90% men) from 19 Lynch syndrome families (2 MLH1, 15 MSH2, and 4 MSH6). CR70 for bladder cancer was 7.5% (95% CI 3.1% to 11.9%) for men and 1.0% (95% CI 0% to 2.4%) for women, resulting in relative risks for mutation carriers and first degree relatives of 4.2 (95% CI 2.2 to 7.2) for men and 2.2 (95% CI 0.3 to 8.0) for women. Men carrying an MSH2 mutation and their first degree relatives were at highest risks: CR70 for bladder and upper urinary tract cancer being 12.3% (95% CI 4.3% to 20.3%) and 5.9% (95% CI 0.7% to 11.1%). Bladder cancer tissue was MSI positive in 6/7 tumours and loss of IHC staining was found in 14/17 tumours, indicating Lynch syndrome aetiology.
  
  
  CONCLUSIONS
  Patients with Lynch syndrome carrying an MSH2 mutation are at increased risk of urinary tract cancer including bladder cancer. In these cases surveillance should be considered.
authors.affiliation: Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: van der Post
authors.forename: L A
authors.initials: LA
authors.lastname: Kiemeney
authors.forename: M J L
authors.initials: MJ
authors.lastname: Ligtenberg
authors.forename: J A
authors.initials: JA
authors.lastname: Witjes
authors.forename: C A
authors.initials: CA
authors.lastname: Hulsbergen-van de Kaa
authors.forename: D
authors.initials: D
authors.lastname: Bodmer
authors.forename: L
authors.initials: L
authors.lastname: Schaap
authors.forename: C M
authors.initials: CM
authors.lastname: Kets
authors.forename: J H J M
authors.initials: JH
authors.lastname: van Krieken
authors.forename: N
authors.initials: N
authors.lastname: Hoogerbrugge
mesh_terms: D048868:Adaptor Proteins, Signal Transducing / Q000378:metabolism; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000150:complications / Q000235:genetics; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D000070957:MutL Protein Homolog 1; D051718:MutS Homolog 2 Protein / Q000235:genetics* / Q000378:metabolism; D009154:Mutation; D009687:Nuclear Proteins / Q000378:metabolism; D010375:Pedigree; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000235:genetics*; D019459:Urothelium
chemical_list: D048868:Adaptor Proteins, Signal Transducing; C501486:MLH1 protein, human; D009687:Nuclear Proteins; C497172:MSH2 protein, human; D000070957:MutL Protein Homolog 1; D051718:MutS Homolog 2 Protein