Screening for gynecologic cancers among women in HNPCC families

Abstract

1023 Background: Hereditary non-polyposis colon cancer (HNPCC) syndrome confers 60% and 12% lifetime risks of endometrial cancer (EC) and ovarian cancer (OC), respectively, and EC is the second most commonly diagnosed cancer in this syndrome. Women at risk for HNPCC-related cancers are advised to begin annual EC and OC screening between ages 25–35 years. We evaluated EC and OC screening behaviors among women from HNPCC families, their attitudes toward screening, and communication with their physicians and family members about EC and OC risk and screening needs. Methods: Women age ≥ 25 years with an HNPCC-predisposing mutation and/or who met Amsterdam I or II criteria completed a study questionnaire. Those with prior hysterectomy and oophorectomy were excluded. Results: Twenty three women (median age=41 years) enrolled, and accrual is ongoing. Seventy four percent had an HNPCC-predisposing mutation, and all but one had received genetic counseling about their risk for HNPCC. Forty five percent or more had never undergone screening by endometrial biopsy, transvaginal ultrasound, or CA-125 serum testing. All respondents generally endorsed the importance and benefits of EC and OC screening; however, 43% were not aware of the recommended age range to begin screening. No participants recalled receiving advice from their gynecologists or other primary care physicians about EC or OC screening. Colonoscopy screening was discussed in all families more frequently compared with EC or OC screening. Although 61% had a family history of EC or OC, only 17% reported that their relatives had ever discussed EC or OC risk with them. Conclusions: HNPCC-affected families and their primary care physicians may lack accurate knowledge of EC and OC risks. Among HNPCC-affected families, there may be greater awareness of the need for screening colonoscopy than the need for gynecologic cancer screening. Nonetheless, women in these families may be receptive to advice and support from their families and physicians for adherence to these screening tests. No significant financial relationships to disclose.