Can Lynch syndrome be prevented?
Lynch syndrome is an inherited condition and cannot be prevented. However, patients with Lynch syndrome should undergo lifelong cancer screening beginning in adulthood. The screening recommendations are:
For colorectal cancers:
- Colonoscopy, starting at age 20, repeated every 1 to 2 years until age 40. Colonoscopy every year after age 40.
- If cancer is found, colectomy (removing entire colon) should be considered. Continue annual screening for rectal cancer.
- Prophylactic (preventative) removal of the colon is sometimes considered in cases when colonoscopy cannot be performed.
- Regular colonoscopy, every 1 to 2 years, for individuals with Lynch syndrome has been proven to decrease the colorectal cancer risk by more than 50 percent.
For endometrial and ovarian cancers:
- Transvaginal ultrasound and a CA-125 blood test every year beginning at age 30. Unfortunately, screening for ovarian cancer has not been shown to be effective. Therefore, some women with Lynch syndrome consider having a total hysterectomy (removal of the uterus) with salpingo-oophorectomy (removal of both fallopian tubes and ovaries) to eliminate their risk for developing endometrial cancer and to reduce the risk for ovarian cancer. This should be considered after age 35 or once childbearing is complete, whichever is later.
For other cancers:
- Stomach cancer. Upper endoscopy starting at age 30, with follow up no less than every 3 years.
- Skin cancer. Annual exam beginning year after diagnosis.
- Urothelial cancer (bladder, ureters, urethra) cancer or a mutation in the MSH2 gene. Ultrasound repeated every 5 years after diagnosis.
- Small bowel cancer. Capsule endoscopy starting at age 30, with follow up every 3 years.
- Urine testing. All patients diagnosed with Lynch syndrome should have a urinalysis every year beginning at age 35.
Are there any other steps that can be taken to reduce the risk of developing the cancers caused by Lynch syndrome?
While aspirin has been shown to reduce risk, the exact dosage of aspirin is still being determined. Therefore, we have not made prescribing this part of our routine practice until dosage information is more fully investigated.