Abstract

BackgroundDue to increased risk of endometrial and ovarian cancer, women belonging to known Lynch Syndrome (LS) families are recommended to undergo germline testing. Current practice in Finland is to offer counselling to women with pathogenic variant and advocate risk-reducing surgery (RRS) after completion of childbirth. The present study aimed to clarify the impacts of positive germline testing on family planning and reproductive decisions of these women, which are relatively unknown.MethodsSeventy-nine carriers of germline MMR gene pathogenic variant (path_MMR) were identified from the Finnish LS Registry as having genetic testing performed before the age of 45 years and not having undergone hysterectomy or oophorectomy. These women were sent a questionnaire concerning family planning, intimate relationships and psychosocial wellbeing.ResultsThirty-five women (44.3%) responded. Parity of path_MMR carriers (2.1) was slightly higher than parity among Finnish women in general (1.8). No significant differences were found between parity, number of induced abortions or sterilizations before and after genetic testing. Only minority of subjects reported any influence on family planning (20%) or negative impact on feminine self and body image (14%).ConclusionsThe positive germline testing does not seem to have a major negative impact on family planning, intimate relationships or feminine self and body image. According to the open comments, counselling, supportive and empathic attitude of the professionals seem to have a significant impact on this. These results are a valuable addition to the counselling of LS women at reproductive age.

Highlights

  • Due to increased risk of endometrial and ovarian cancer, women belonging to known Lynch Syndrome (LS) families are recommended to undergo germline testing

  • Soon after positive germline testing and counselling by a clinical geneticist, Finnish women with LS are offered a visit at a tertiary hospital with an expert gynecologist providing additional counselling and clinical gynecological and ultrasound examination

  • The study protocol was approved by Tampere University Hospital (TAUH) Ethical Committee (January 2011) and an informed consent was obtained from all the study participants

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Summary

Introduction

Due to increased risk of endometrial and ovarian cancer, women belonging to known Lynch Syndrome (LS) families are recommended to undergo germline testing. At the time of the present study, the procedure in Finland was a gynecological surveillance including pelvic ultrasound examination and endometrial biopsy with one or 2 years interval, beginning at age of 35 [5]. Soon after positive germline testing and counselling by a clinical geneticist, Finnish women with LS are offered a visit at a tertiary hospital with an expert gynecologist providing additional counselling and clinical gynecological and ultrasound examination. Visits, including gynecological ultrasound examination and endometrial biopsy, are suggested if dysfunctional bleeding occurs. Risk-reducing hysterectomy, possibly with oophorectomy, is recommended when childbearing is complete or at the age of 50 years at the latest and carriers of path_MMR are usually invited to discuss the timing of RRS at the age of 40 years [5]

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