Colonoscopy screening compliance and outcomes in patients with Lynch Syndrome.

Newton K1, Green K, Lalloo F, Evans D, Hill J.

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Abstract

AIM:

Colonic surveillance reduces life time risk of colorectal cancer from 60-80% to 10% and confers a seven-year survival advantage in patients with Lynch syndrome (HNPCC). The British Society of Gastroenterologists recommends colonoscopy at least every two years from age 25. Currently in the UK, genetic diagnosis is made by a regional genetics service and screening recommendations are made to the referring clinician. The aim of this study was to investigate compliance with and the effectiveness of large bowel surveillance in Lynch syndrome.

METHOD:

A retrospective longitudinal study of Lynch syndrome mutation carriers on the Regional Familial Colorectal Cancer Registry under and not under screening was conducted. To investigate screening compliance, patients were included if alive at the start of the study. Data were gathered on timeliness, quality and outcome of screening. To examine the effectiveness of screening, the cumulative incidence of colorectal cancer was estimated using Kaplan-Meier and the screened population compared to that in patients not being screened.

RESULTS:

227 Lynch Syndrome mutation carriers were under screening at 26 hospitals. 439 colonoscopies were assessed for timeliness of which 68% were compliant (interval <27 months). Compliance on 01/11/2011 was 87%. Cumulative incidence of colorectal cancer to age 70 was 25% (95% CI 17-32%) in the surveillance population and 81% (95% CI 78-84%) in 689 mutation positive patients not being screened (p<0.0001).

CONCLUSION:

Overall 68% of colonoscopies were on time. The incidence of colorectal cancer was greatly reduced by screening but remained significant. Lynch syndrome patients need pro-active surveillance management. This article is protected by copyright. All rights reserved.