Study confirms higher risk of pancreatic cancer in Lynch syndrome families
Stephen B. Gruber, M.D., Ph.D., M.P.H.
A new study has documented a ninefold higher risk of pancreatic cancer in individuals with Lynch syndrome, a rare genetic cancer predisposition syndrome.
The study, published in the Journal of the American Medical Association
, is the first using rigorous statistical methods to confirm the elevated risk, the
authors say. Previous studies yielded conflicting results.
"In light of these findings, we believe that if you have Lynch syndrome and there is pancreatic cancer in your family, you should be aggressively screened," said
Sapna Syngal, M.D., M.P.H., of Dana-Farber and Brigham and Women's Hospital.
Syngal is the report's senior author along with Stephen B. Gruber, M.D., Ph.D., M.P.H., associate director for cancer prevention and control at the University of
Michigan Comprehensive Cancer Center.
Carriers of the Lynch syndrome gene mutations have an 80% risk of colorectal cancer beginning at a young age, as well as an array of other cancers of the digestive
system, brain and skin, and endometrium andovaries in women.
While colorectal cancer is increasingly being detected early and prevented thorough colonoscopies and removal of precancerous polyps, there is currently no effective means of early
diagnosis for pancreatic cancer. Scientists are testing imaging techniques and are searching for biomarkers that might signal the early stages of the disease.
Mutations in several "mismatch repair" genes that fix copying errors in DNA underlie Lynch syndrome. The researchers designed the study to estimate the risk of pancreatic
cancer in families with these inherited mutations. A total of 147 families were drawn from colorectal cancer registries at Dana-Farber and the U-M Cancer Center.
"Because pancreatic cancer is a relatively rare cancer, pooling together the databases at the University of Michigan and Dana-Farber was critical to this
analysis," said co-first author Bhramar Mukherjee, Ph.D., a biostatistician at the U-M School of Public Health.
The analysis revealed a nine-fold increase in risk of the disease compared with the general population, and the cancer tended to appear earlier. The absolute risk
of pancreatic cancer in the Lynch families was 1.31% at age 50 and 3.68% at 70 years. In the general population, there is only a 0.04% risk at 50 years
and a 0.52% risk at age 70.
Syngal noted that pancreatic cancers appear to "cluster" in some Lynch syndrome families, while others don't have an increased incidence of the disease. For that
reason, she said, screening is recommended
only for patients carrying the Lynch
mutations who also have a family history
of pancreatic cancer.
Read the full press release.
MRI May Cause More Harm Than Good in Newly Diagnosed Early Breast Cancer
Daniel F. Hayes, M.D.
A new review says using magnetic resonance imaging before surgery to assess the extent of early breast cancer has not
been shown to improve surgical planning, reduce follow-up surgery or reduce the risk
of local recurrences.
The review, appearing in CA: A Cancer Journal for Clinicians, says evidence shows
that MRI increases the chances of more extensive surgery over conservative approaches,
with no evidence that it improves surgical care or prognosis.
Randomized controlled trials have shown that women with early stage breast cancer who are treated with lumpectomy followed by radiation have the same survival rates as
those who undergo mastectomy. Recently, MRI has been used in preoperative staging for women with newly diagnosed breast cancer because it detects additional areas of
cancer that do not show up on conventional imaging.
In this review, Nehmat Houssami, MBBS, Ph.D., of the University of Sydney, Australia, and Daniel F. Hayes, M.D., director of the breast oncology program at the University of Michigan
Comprehensive Cancer Center, reviewed available data on preoperative MRI's detection capability and its impact on treatment.
The use of preoperative MRI scans in women with early stage breast cancer has been based on assumptions that MRI's detection capability will improve treatment by
guiding surgeons to remove additional disease detected by MRI and by potentially reducing recurrence in the treated breast.
The authors say emerging data show that this approach leads to more women being treated with mastectomy without evidence of improvement in surgical
outcomes or long-term prognosis.
"Overall, there is growing evidence that MRI does not improve surgical care, and it could be argued that it has a potentially harmful effect," conclude the authors.
They say well-designed, randomized controlled
trials are needed to quantify potential benefit
and harm, including careful evaluation of its
impact on quality of life.
Read the full press release.
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