Ovarian or Endometrial Cancer? Consider Lynch Syndrome
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the relevance of Lynch syndrome in the management of women with personal or family history of ovarian syndrome 2. Recall which cancers may be associated with Lynch syndrome
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Lynch syndrome, which has been previously referred to as hereditary non-polyposis colorectal cancer syndrome (HNPCC), increases gynecologic cancer risks namely endometrial, ovarian, and urothelial cancers in addition to colorectal and other associated cancers (gastric or small bowel cancers), glioblastoma, pancreatic or biliary tract cancer, and sebaceous adenocarcinoma.
Lynch syndrome should be considered in women with personal and/or family histories with features such as
Personal history of colorectal cancer
< age 50 or
≥ age 50 with a 1st degree relative (parent, child or sibling) also having a diagnosis of colorectal cancer or endometrial cancer
Women with multiple colorectal cancers or colorectal cancer and endometrial cancer
Level of suspicion should also be increased if other Lynch syndrome associated cancers are diagnosed in the patient and close relatives
Colorectal or endometrial cancer tumor profiles that demonstrate deficient mismatch repair, or microsatellite instability (MSI)
Genes implicated in Lynch syndrome are known as mismatch repair (MMR) genes
Women who report a known gene mutation predisposing to cancer in the family
Confirm the gene(s) tested and mutation(s) identified
NOTE: Because medical interventions can prevent severe morbidity and mortality, Lynch syndrome is on the ACMG list of ‘secondary’ findings. In summary, the ACMG document on reporting such findings makes the following recommendations
In the course of genetic testing for research or clinical care, the laboratory may identify variants in genes unrelated to the initial indication for testing, but nevertheless may have important health implications
Results of such ‘secondary findings’ should be communicated to the individuals who may benefit from this knowledge
An individual can ‘opt out’ of receiving ‘secondary findings’
ACMG secondary findings recommend reporting out known or expected pathogenic variants in the following MMR genes:
MLH1, MSH2, MSH6, and PMS2
Lynch syndrome is inherited in an autosomal dominant fashion, however because of variable expressivity and reduced penetrance, the patient’s personal and family history must be carefully assessed. It is important to note earlier ages of onset and multiple cancers that may suggest Lynch syndrome or another hereditary cancer syndrome. It is critical that those at high risk be identified and referred for genetic counseling. Genetic counseling will allow for discussion of appropriate genetic testing, cancer screening and risk reduction options.
When reviewing the family health history, remember that both the maternal and paternal family histories should both be carefully considered
Average lifetime risk in general population: 1.31%
Endometrial cancer: 25-60%
Average lifetime risk in general population: 2.78%
Colon cancer: 52–82%
Average lifetime risk in general population: 4.35% (females), 4.69% (males)
In the case of ovarian cancer, do not automatically assume BRCA1 or BRCA2 – consider Lynch syndrome and assess for additional clues such as other associated cancers
ACOG does address multigene panels and finds that “Genetic testing may be performed using a panel of multiple genes through next-generation sequencing technology”
Heritable cancer syndromes may overlap such that a strong family history for ovarian cancer may be the result of a pathogenic variant in BRCA1/2 or genes associated with Lynch Syndrome
The prospect of hereditary cancer risk can be anxiety provoking for the patient and family members, so it is important to reinforce the importance of information in allowing options for risk reduction and early cancer detection for those at highest risk
Note: NCCN recommends that, based on emerging data, referral to a genetics service to discuss multi-gene panel testing may be considered for anyone with a colorectal cancer diagnosis at any age
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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