Endometrial Cancer Screening and Risk Reduction Decisions Among Patients With Lynch Syndrome at a Multidisciplinary Clinic [ID 558]

INTRODUCTION: Standardized gynecological cancer screening guidelines in patients with Lynch syndrome (LS) suggest endometrial sampling (ES) every 1–2 years beginning at age 30–35. Surveillance is continued until total hysterectomy with bilateral salpingo-oophorectomy (TH/BSO) is recommended after discussion that includes desire for childbearing and cancer risk by patients’ early 40s. At the inherited risk gastrointestinal clinic, patients are routinely evaluated by a multidisciplinary team, including genetics and gynecology. This study aims to characterize guideline adherence among patients. METHODS: Medical records of female LS patients followed by clinic genetic counselors and gynecologists between 2016 and 2022 were retrospectively reviewed. Eligible patients had at least one annual follow-up, no prior gynecologic cancer, and intact uterus and ovaries. RESULTS: In our cohort of 82 patients, 47 (57.3%) were eligible for screening and risk reduction surgery. The other 35 had a prior history of TH/BSO. The median age among eligible patients was 39 (range 30–71), with 16 having prior nongynecologic cancer diagnoses. In total, 24 (51.1%) patients with a median age of 46 underwent TH/BSO, 2 of whom had endometrial intraepithelial neoplasia and 3 of whom had adenocarcinoma. Reasons delaying surgery included desire for childbearing (n=9), deferring surgical menopause (n=5), and unspecified (n=9). Among patients with intact uteri, 4 received ES every 1–2 years, 8 had partial adherence, and 11 were nonadherent. CONCLUSIONS/IMPLICATIONS: Risk management for gynecological cancer varied amongst LS patients due to respective preferences and medical history. Multidisciplinary clinics provide services that allow for prompt cancer detection and individualized risk management.