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Title: Lack of association between screening interval and cancer stage in Lynch syndrome may be accounted for by over-diagnosis; a prospective Lynch syndrome database report
Author: Seppälä, Toni T.
Ahadova, Aysel
Dominguez Valentin, Mev
Macrae, Finlay
Evans, D. Gareth
Therkildsen, Christina
Sampson, Julian R.
Scott, RodneyJ.
Burn, John
Moslein, Gabriela
Bernstein, Inge
Holinski-Feder, Elke
Pylvanainen, Kirsi
Renkonen Sinisalo
Lepisto, Anna
Lautrup, Charlotte K.
Lindblom, Annika
Plazzer, John Paul
Winship, Ingrid
Tjandra, Douglas
Katz, Lior
Aretz, Stefan
Hüneburg, Robert
Holzapfel, Stefanie
Heinimann, Karl
Della Valle, Adriana
Neffa, Florencia
Gluck, Nathan
De Vos Tot Nederveen Cappel, Wouter H. WH.
Vasen, Hans
Morak, Monika
Steinke-Lange, Verena
Engel, Christoph
Rahner, Nils
Schmiegel, Wolff
Vangala, Deepak
Thomas, Huw
Green, Kate
Lalloo, Fiona
Crosbie, Emma J.
Hill, James
Capellá, G. (Gabriel)
Pineda Riu, Marta
Navarro, Matilde
Blanco Guillermo, Ignacio
ten Broeke, Sanne W.
Nielsen, Maartje
Ljungmann, Ken
Nakken, Sigve
Lindor, Noralane
Frayling, Ian M.
Hovig, Eivind
Sunde, Lone
Kloor, Matthias
Mecklin, Jukka-Pekka
Kalager, Mette
Møller, Pål
Keywords: Colonoscòpia
Càncer colorectal
Colorectal cancer
Issue Date: 28-Feb-2019
Publisher: BioMed Central
Abstract: Background: Recent epidemiological evidence shows that colorectal cancer (CRC) continues to occur in carriers of pathogenic mismatch repair (path_MMR) variants despite frequent colonoscopy surveillance in expert centres. This observation conflicts with the paradigm that removal of all visible polyps should prevent the vast majority of CRC in path_MMR carriers, provided the screening interval is sufficiently short and colonoscopic practice is optimal. Methods: To inform the debate, we examined, in the Prospective Lynch Syndrome Database (PLSD), whether the time since last colonoscopy was associated with the pathological stage at which CRC was diagnosed during prospective surveillance. Path_MMR carriers were recruited for prospective surveillance by colonoscopy. Only variants scored by the InSiGHT Variant Interpretation Committee as class 4 and 5 (clinically actionable) were included. CRCs detected at the first planned colonoscopy, or within one year of this, were excluded as prevalent cancers. Results: Stage at diagnosis and interval between last prospective surveillance colonoscopy and diagnosis were available for 209 patients with 218 CRCs, including 162 path_MLH1, 45 path_MSH2, 10 path_MSH6 and 1 path_PMS2 carriers. The numbers of cancers detected within < 1.5, 1.5-2.5, 2.5-3.5 and at > 3.5 years since last colonoscopy were 36, 93, 56 and 33, respectively. Among these, 16.7, 19.4, 9.9 and 15.1% were stage III-IV, respectively (p = 0.34). The cancers detected more than 2.5 years after the last colonoscopy were not more advanced than those diagnosed earlier (p = 0.14). Conclusions: The CRC stage and interval since last colonoscopy were not correlated, which is in conflict with the accelerated adenoma-carcinoma paradigm. We have previously reported that more frequent colonoscopy is not associated with lower incidence of CRC in path_MMR carriers as was expected. In contrast, point estimates showed a higher incidence with shorter intervals between examinations, a situation that may parallel to over-diagnosis in breast cancer screening. Our findings raise the possibility that some CRCs in path_MMR carriers may spontaneously disappear: the host immune response may not only remove CRC precursor lesions in path_MMR carriers, but may remove infiltrating cancers as well. If confirmed, our suggested interpretation will have a bearing on surveillance policy for path_MMR carriers.
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It is part of: Hereditary Cancer in Clinical Practice , 2019, vol. 17, num. 8
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ISSN: 1731-2302
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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