Uptake of hysterectomy and bilateral salpingo-oophorectomy in carriers of pathogenic mismatch repair variants: A Prospective Lynch Syndrome Database report

SEPPÄLÄ, TONI T.; DOMINGUEZ-VALENTIN, MEV; VACCARO CA; PIÑERO, TAMARA A.; PAVICIC WH; KALFAYAN PG; EVANS, D. GARETH; MOLLER P

EUROPEAN JOURNAL OF CANCER

ELSEVIER SCI LTD

Lugar: Amsterdam; Año: 2021

0959-8049

PurposeTo report the uptake of hysterectomy and/or bilateral salpingo-oophorectomy (BSO) to prevent gynecological cancers (Risk Reducing Surgery, RRS) in carriers of pathogenic MMR (path_MMR) variants.MethodsThe Prospective Lynch Syndrome Database (PLSD) was used to investigate RRS by cross-sectional study in 2292 female path_MMR carriers aged 30 to 69 years.ResultsOverall, 144, 79 and 517 carriers underwent risk-reducing hysterectomy, BSO, or both combined, respectively. Two-thirds of procedures before 50 years of age were combined hysterectomy and BSO, and 81% of all procedures included BSO. Risk-reducing hysterectomy was performed before age 50 years in 28%, 25% 15% and 9%, and BSO in 26%, 25%, 14% and 13%, of path_MLH1, path_MSH2, path_MSH6 and path_PMS2 carriers, respectively. Before 50 years of age, 107/188 (57%) BSO and 126/204 (62%) hysterectomies were performed in women without any prior cancer, and only 5% (20/392) were performed simultaneously with colorectal cancer (CRC) surgery.ConclusionUptake of RRS before 50 years of age was low and RRS was rarely undertaken in association with surgical treatment of CRC. Uptake of RRS aligned poorly with gene- and age-associated risk estimates for endometrial or ovarian cancer that were published recently from PLSD, and did not correspond well with current clinical guidelines. The reasons should be clarified. Decision-making on opting for or against RRS and its timing should be better aligned with predicted risk and mortality for endometrial and ovarian cancer in LS in order to improve outcomes.