Hysterectomy Reduces Cancer Odds for High-Risk Women

Those with Lynch syndrome may benefit from removal of uterus and ovaries, study reports

WEDNESDAY, Jan. 18, 2006 (HealthDay News) -- If you're a woman who's been diagnosed with Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, a new study has found that having your uterus and ovaries removed may protect you from gynecological cancers.

That's important news because women with this syndrome face a significantly higher risk of endometrial cancer and ovarian cancer.

"Women who have this syndrome have a staggeringly high risk of endometrial cancer -- about 40 to 60 percent," said study author Dr. Karen Lu, an associate professor of gynecologic oncology at the University of Texas M.D. Anderson Cancer Center in Houston. "Their risk of ovarian cancer is also quite high -- about 10 to 12 percent."

In general, women without Lynch syndrome have between a 1 percent and 3 percent lifetime risk of endometrial or ovarian cancer, according to Lu.

The good news is that in this retrospective analysis of women with Lynch syndrome, the researchers found that none of the women who had hysterectomies -- including removal of the ovaries -- developed gynecological cancers. But in the group of women who didn't have the prophylactic surgery, 33 percent developed endometrial cancer and 5 percent developed ovarian cancer.

Results of the study appear in the Jan. 19 issue of the New England Journal of Medicine.

Lynch syndrome is a hereditary form of colon cancer that affects about one in every 1,000 Americans. This syndrome, which is caused by mutations in certain genes, is responsible for up to 7 percent of all colorectal cancers, according to the National Institutes of Health.

Lu's study included data from 315 women diagnosed with Lynch syndrome between 1973 and 2004.

Sixty-one of the women had hysterectomies, and 47 of those women also had their ovaries removed. Reasons for the surgery varied, but were generally for preventive reasons or due to a noncancerous condition. The remaining women had no prophylactic surgery.

Of the women who had the surgery, none developed endometrial or ovarian cancer. However, 69 of the women who didn't have the surgery developed endometrial cancer and 12 women developed ovarian cancer.

"Prior to this time, physicians' groups have not been able to recommend undergoing prophylactic hysterectomy, but this study provides definitive data that tells patients that they can prevent that risk of cancer by undergoing a hysterectomy," said Lu.

Dr. Noah Kauff is an assistant attending physician in clinical genetics and gynecology services at Memorial Sloan-Kettering Cancer Center in New York City. He agreed that prophylactic hysterectomy is an option for women with Lynch syndrome, but added that it may not be a woman's only option.

And, Kauff said, it's not necessarily the best option. But until a study is done comparing aggressive screening methods to prophylactic hysterectomy, physicians won't know for sure what the best option is, he added.

"Risk-reducing hysterectomy is an important option to consider after childbearing is completed, but there aren't data yet to compare its risks and benefits to intensive gynecological screening," said Kauff, who co-authored an accompanying editorial in the same issue of the journal. Intensive screening includes endometrial biopsy, transvaginal ultrasound and blood tests.

Lu's concern with screening is that there isn't as much data available on the efficacy of screening for ovarian and endometrial cancer as there is for colon cancer.

"We know we can decrease mortality by having yearly colonoscopy, but there's a lot less info for endometrial cancer, so we don't know if screening would be helpful," said Lu.

Both Lu and Kauff said the time to think about prophylactic hysterectomy is around age 35, or when you're done having children. Kauff said most women with Lynch syndrome would be advised not to delay childbearing into their late 30s or early 40s because of the increased cancer risk.

Kauff added that risk-reduction strategies are only helpful if women are identified as having the syndrome, and he said it's currently "exceedingly underdiagnosed."

Anyone who has a family with two or more members who have been diagnosed with early onset (before age 50) colorectal cancer or a gynecological cancer should bring this up with their doctor and undergo genetic testing, he said.

More information

To learn more about Lynch syndrome, visit the National Library of Medicine.

SOURCES: Karen Lu, M.D., associate professor, gynecologic oncology, University of Texas M.D. Anderson Cancer Center, Houston; Noah Kauff, M.D., assistant attending physician, clinic genetics and gynecology services, Memorial Sloan-Kettering Cancer Center, New York City; Jan. 19, 2006, New England Journal of Medicine
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