Women with mutated genes for hereditary non-polyposis colon cancer (Lynch Syndrome) are at increased risk for both endometrial and ovarian cancer, as well as colon cancer.  A hysterectomy to remove uterus and ovaries is sometimes recommended to reduce the risk.

Researchers at the University of California at San Francisco and Stanford University considered the benefits of three different strategies to prevent endometrial and ovarian cancer in women with Lynch Syndrome.

• Annual gynecologic exams
• Annual screening with gynecological exams, transvaginal ultrasound, endometrial biopsy, and measurement of CA 125 in the blood beginning at age 30
• Prophylactic surgery to remove ovaries, fallopian tubes, and uterus (Hysterectomy with Bilateral Salpingo-oophorectomy)

Using Surveillance, Epidemiology and End Results (SEER) data from 1988 to 2001, they found that surgery was most effective in preventing both ovarian and endometrial cancer, following by screening,

• Ovarian cancer would be diagnosed in .0056 percent of women who had surgery, endometrial cancer in .0060 percent.
• 3.7 percent of those who had annual screenings would get ovarian cancer during their lives, 18.4 percent would get endometrial cancer.
• With annual gyn exams 8.3 percent would get ovarian cancer and 48.7 percent would be diagnosed with endometrial cancer during their lifetimes.

Writing for the research team, Lee-may Chen, MD, pointed out,

When comparing prophylactic surgery with the screening option, one would need to perform 75 surgeries to save one woman's entire life. For cancer prevention, however, only 28 and 6 prophylactic surgeries would need to be performed to prevent one case of ovarian and endometrial cancer, respectively.

She concluded,

Risk-reducing hysterectomy and bilateral salpingo-oophorectomy may be considered in women with Lynch/HNPCC to prevent gynecologic cancers and their associated morbidities.

SOURCE:  Chen et. al. Obstetrics and Gynecology, Volume 110, Issue 1, July 1, 2007.

WHAT THIS MEANS FOR PATIENTS

Women who carry a gene for Lynch Syndrome hereditary non-polyposis colon cancer may want to consider surgery to reduce their risk of ovarian or endometrial cancer.  An alternative to surgery is annual screening with with transvaginal ultrasound, uterine biopsy, and measurement of CA-125.   

Although removal of the ovaries and fallopian tubes greatly reduces risk of ovarian cancer, it does not prevent it entirely.  Ovarian cancer can develop within the peritoneal cavity even when there are no ovaries.

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