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    Cancer Risks for PMS2-Associated Lynch Syndrome

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    Author
    ten Broeke, SW; van der Klift, HM; Tops, CMJ; Aretz, S; Bernstein, I; Buchanan, DD; de la Chapelle, A; Capella, G; Clendenning, M; Engel, C; ...
    Date
    2018-10-10
    Source Title
    JOURNAL OF CLINICAL ONCOLOGY
    Publisher
    AMER SOC CLINICAL ONCOLOGY
    University of Melbourne Author/s
    Rosty, Christophe; Hopper, John; Win, Aung Ko; Winship, Ingrid; Jenkins, Mark; Clendenning, Mark; Buchanan, Daniel
    Affiliation
    Clinical Pathology
    Medicine and Radiology
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    ten Broeke, S. W., van der Klift, H. M., Tops, C. M. J., Aretz, S., Bernstein, I., Buchanan, D. D., de la Chapelle, A., Capella, G., Clendenning, M., Engel, C., Gallinger, S., Gomez Garcia, E., Figueiredo, J. C., Haile, R., Hampel, H. L., Hopper, J. L., Hoogerbrugge, N., Doeberitz, M. V. K., Le Marchand, L. ,... Win, A. K. (2018). Cancer Risks for PMS2-Associated Lynch Syndrome. JOURNAL OF CLINICAL ONCOLOGY, 36 (29), pp.2961-+. https://doi.org/10.1200/JCO.2018.78.4777.
    Access Status
    Access this item via the Open Access location
    URI
    http://hdl.handle.net/11343/240358
    DOI
    10.1200/JCO.2018.78.4777
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349460
    NHMRC Grant code
    NHMRC/1141746
    Abstract
    PURPOSE: Lynch syndrome due to pathogenic variants in the DNA mismatch repair genes MLH1, MSH2, and MSH6 is predominantly associated with colorectal and endometrial cancer, although extracolonic cancers have been described within the Lynch tumor spectrum. However, the age-specific cumulative risk (penetrance) of these cancers is still poorly defined for PMS2-associated Lynch syndrome. Using a large data set from a worldwide collaboration, our aim was to determine accurate penetrance measures of cancers for carriers of heterozygous pathogenic PMS2 variants. METHODS: A modified segregation analysis was conducted that incorporated both genotyped and nongenotyped relatives, with conditioning for ascertainment to estimates corrected for bias. Hazard ratios (HRs) and corresponding 95% CIs were estimated for each cancer site for mutation carriers compared with the general population, followed by estimation of penetrance. RESULTS: In total, 284 families consisting of 4,878 first- and second-degree family members were included in the analysis. PMS2 mutation carriers were at increased risk for colorectal cancer (cumulative risk to age 80 years of 13% [95% CI, 7.9% to 22%] for males and 12% [95% CI, 6.7% to 21%] for females) and endometrial cancer (13% [95% CI, 7.0%-24%]), compared with the general population (6.6%, 4.7%, and 2.4%, respectively). There was no clear evidence of an increased risk of ovarian, gastric, hepatobiliary, bladder, renal, brain, breast, prostate, or small bowel cancer. CONCLUSION: Heterozygous PMS2 mutation carriers were at small increased risk for colorectal and endometrial cancer but not for any other Lynch syndrome-associated cancer. This finding justifies that PMS2-specific screening protocols could be restricted to colonoscopies. The role of risk-reducing hysterectomy and bilateral salpingo-oophorectomy for PMS2 mutation carriers needs further discussion.

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