Hereditary Syndromes Manifesting as Endometrial Carcinoma: How Can Pathological Features Aid Risk Assessment?
Table 4
Guidelines for screening at-risk or affected persons with Lynch syndrome. Recommendations are based on the strength of confidence and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). GRADE is a well-accepted rating of evidence relying on expert consensus about whether new research is likely to change the confidence level (CL) of recommendations (adapted from [43]).
Intervention
Recommendation
Strength of recommendation
Colonoscopy
Every 1 to 2 years beginning at age 20 to 25 or 2 to 5 years younger than youngest age at diagnosis of colorectal carcinoma in family if diagnosis before age 25. Considerations: start at age 30 in MSH6 and age 35 in PMS2 families Annual colonoscopy in MMR mutation carriers
Strong recommendation: Level of evidence (III): well-designed and conducted cohort or case-controlled studies from more than 1 group with cancer #GRADE rating: moderate
Pelvic examination with endometrial sampling
Annually beginning at age 30 to 35
Offer to patient: Level of evidence (V): expert consensus #GRADE rating: low
Transvaginal ultrasound
Annually beginning at age 30 to 35
Offer to patient: Level of evidence (V): expert consensus #GRADE rating: low
Esophagogastroduodenoscopy with biopsy of the gastric antrum
Beginning at age 30 to 35 and subsequent surveillance every 2 to 3 years can be considered based on patient risk factors
Offer to patient: Level of evidence (V): expert consensus #GRADE rating: low
Urinalysis
Annually beginning at age 30 to 35
Consideration: Level of evidence (V): expert consensus #GRADE rating: low
