title: Testing women with endometrial cancer to detect Lynch syndrome.
abstract: OBJECTIVE
  Women with endometrial cancer as a result of Lynch syndrome may not be identified as such by Amsterdam II criteria. We estimated the costs and benefits of different testing criteria to identify Lynch syndrome in women with endometrial cancer.
  
  
  METHODS
  We developed a Markov Monte Carlo simulation model to compare six criteria for Lynch syndrome testing for women with endometrial cancer: Amsterdam II criteria; age younger than 50 years with at least one first-degree relative having a Lynch-associated cancer at any age (FDR); immunohistochemistry (IHC) triage if age younger than 50 years; IHC triage if age younger than 60 years; IHC triage at any age if 1 FDR; and IHC triage of all endometrial cancers. Net health benefit was life expectancy, and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of new colorectal cancers associated with each strategy.
  
  
  RESULTS
  IHC triage of women with endometrial cancer having at least 1 FDR yielded a favorable ICER of $9,126 per year of life gained. This strategy would subject fewer cases to IHC but identify more mutation carriers than age thresholds of 50 or 60 years. IHC triage of all endometrial cancers could identify the most mutation carriers and prevent the most colorectal cancers but at considerable cost ($648,494 per year of life gained).
  
  
  CONCLUSIONS
  IHC triage of women with endometrial cancer at any age having at least 1 FDR with a Lynch-associated cancer is a cost-effective strategy for detecting Lynch syndrome.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada. jkwon@post.harvard.edu
authors.forename: Janice S
authors.initials: JS
authors.lastname: Kwon
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Scott
authors.forename: C Blake
authors.initials: CB
authors.lastname: Gilks
authors.forename: Molly S
authors.initials: MS
authors.lastname: Daniels
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.forename: Karen H
authors.initials: KH
authors.lastname: Lu
mesh_terms: D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications* / Q000175:diagnosis* / Q000235:genetics; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000191:economics / Q000209:etiology*; D005260:Female; D005820:Genetic Testing / Q000191:economics* / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D010375:Pedigree; D012680:Sensitivity and Specificity