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. 2021 Mar;128(4):728-736.
doi: 10.1111/1471-0528.16432. Epub 2020 Aug 9.

A mismatch in care: results of a United Kingdom-wide patient and clinician survey of gynaecological services for women with Lynch syndrome

Naj Ryan  1   2 , M Nobes  3 , D Sedgewick  4 , S-N Teoh  5 , D G Evans  1   6 , E J Crosbie  2   7
Affiliations

A mismatch in care: results of a United Kingdom-wide patient and clinician survey of gynaecological services for women with Lynch syndrome

Naj Ryan et al. BJOG. 2021 Mar.

Abstract

Objective: To describe the current testing practice, referral pathways and gynaecological services available to women with Lynch syndrome (LS) in the UK.

Design: Cross-sectional nationwide survey of gynaecological oncologists and women with LS.

Setting: United Kingdom.

Methods: Gynaecological oncologists were contacted directly. Women with LS were identified from national and regional clinical databases and the patient support group, Lynch syndrome UK.

Main outcome measures: Gynaecological oncologists were asked to report rates of LS testing and current practice regarding risk-reducing strategies and gynaecological surveillance for women with LS. Women with LS were asked to describe their experiences of gynaecological care.

Results: In total, 41 gynaecological oncologists and 298 women with LS responded to the survey. Of the gynaecological oncologists surveyed, 37% were unfamiliar with any clinical guidelines for the management of LS. Only 29% of gynaecological oncologists supported universal testing of endometrial cancer for LS; one centre routinely performed such testing. In all, 83% said they perform risk-reducing gynaecological surgery and 43% were aware of a local gynaecological surveillance service for women with LS. Of women with LS, most had undergone a hysterectomy (n = 191/64.1%), most frequently to reduce their gynaecological cancer risk (n = 86/45%). A total of 10% were initially referred for LS testing by their gynaecologist and 55% of those eligible regularly attended gynaecological surveillance; however, 62% wanted more regular surveillance. Regional variation was evident across all standards of care.

Conclusions: There is widespread variation in the services offered to women with LS in the UK. As a community, gynaecological oncologists should move towards a nationally agreed provision of services.

Tweetable abstract: A mismatch in care for mismatch repair. Survey finds significant variation in gynaecological care for #Lynchsyndrome in the UK.

Keywords: Endometrial cancer; Lynch syndrome; gynaecological surveillance; ovarian cancer; risk-reducing surgery; screening.

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References

    1. Ryan NAJ, Morris J, Green K, Lalloo F, Woodward ER, Hill J, et al. Association of mismatch repair mutation with age at cancer onset in Lynch syndrome: implications for stratified surveillance strategies. JAMA Oncol 2017;3:1702-6.
    1. Ryan N, Glaire M, Evans D, Crosbie E. The proportion of endometrial cancers associated with Lynch syndrome: a systematic review of the literature and meta-analysis. Genet Med 2019;21:2167-80.
    1. Win AK, Jenkins MA, Dowty JG, Antoniou AC, Lee A, Giles GG, et al. Prevalence and Penetrance of Major Genes and Polygenes for Colorectal Cancer. Cancer Epidemiol Biomarkers 2017;26:404-12.
    1. Crosbie EJ, Ryan NAJ, Bosse T, Frayling IM, Hampel H, Kitchener HC, et al. The Manchester International Consensus Group recommendations for the management of gynecological cancers in Lynch syndrome. Genet Med 2019;21:2390-400.
    1. Snowsill TM, Ryan NAJ, Crosbie EJ. Cost-effectiveness of the manchester approach to identifying lynch syndrome in women with endometrial cancer. J Clin Med 2020;9:1664.

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