1513 Introduction: In addition to colorectal cancer (CRC), Lynch syndrome (LS) patients are at increased risk of extracolonic malignancies including endometrial (EC), ovarian (OC), upper gastrointestinal and urothelial tract cancers. Although the efficacy of extracolonic cancer screening in LS has not been clearly demonstrated, multi-organ screening is routinely recommended for LS patients (Lindor et al., JAMA 2006). Anecdotal evidence suggests that adherence to such screening may be inferior to CRC screening. Methods: 35 adults, identified in the context of genetic counseling and testing (GCT) as being from LS kindreds, were given recommendations for multi-organ screening and enrolled on a prospective follow-up study. For participants with relevant organs at risk, these included colonoscopy, urine cytology, transvaginal ultrasound (TVUS), CA-125 level and endometrial sampling all to be performed at least annually. Adherence with screening, perceived risk of cancer subtype and future intentions regarding screening were evaluated at least 12 months after GCT. Results: Median age at time of GCT was 44, 66% were female and 69% were diagnosed with a LS- related cancer prior to GCT (15 CRC; 9 EC). At time of follow-up, 89% of patients without CRC had a colonoscopy within the year. Among women at-risk for OC, 25% had TVUS and 38% had CA-125 level within the year. Among women at risk for EC, 22% had TVUS and 22% had endometrial sampling within the year. Of all participants, 40% had urine cytology within the year. Of participants with relevant organs at-risk, 72%, 33%, 75% and 12% reported their risk of developing CRC, EC, OC, and urothelial tract cancer, respectively, as “moderately”, “very” or “extremely” high. Of patients with previous colonoscopy, 93% had definitive intentions to continue on schedule screening. However, only 68%, 50%, 60% and 50% of patients who underwent previous urine cytology, TVUS, CA-125 or endometrial sampling, respectively, had definitive intentions of continuing on schedule screening. Conclusions: Adherence with extracolonic cancer screening in LS kindreds is poor and patients persistently underestimate their extracolonic risk despite GCT. Possible interventions should be aimed at better educating patients about extracolonic cancer risk and importance of on-going surveillance. No significant financial relationships to disclose.
Carcinoma of the Lower Uterine Segment: A Newly Described Association With Lynch Syndrome