Cancer Screening

Carriers of the Lynch Syndrome genes should undergo a more rigorous cancer screening program. This is based on the rapid growth of cancers in this population. This aggressive approach should be covered by insurance, provided Lynch Syndrome has been diagnosed. However, diagnosing Lynch Syndrome will affect the ability to obtain and the cost of certain types of insurance. While this approach is costly, it should allow cancers to be discovered at an early stage.

COLON

	Non-Lynch	Lynch
Initial Colonoscopy	Age 45 Or 10 years before a first degree relative with a colon cancer or colon polyps	MLH1 & MSH2, & EPCAM Age 20-25. Sooner based on family history. MSH6 & PMS2 Age 30-35. Sooner based on family history.
Follow-up Colonoscopy	Every 5-10 years based on history. Every 1-5 years based on biopsy results	MLH1 & MSH2, & EPCAM Every 1-2 years until age 39. Every year at age 40 MSH6 & PMS2 Every 1-3 years until age 39. Every year at age 40

Non-Lynch

Lynch

Initial Colonoscopy

Age 45

Or 10 years before a first degree relative with a colon cancer or colon polyps

MLH1 & MSH2, & EPCAM
Age 20-25. Sooner based on family history.

MSH6 & PMS2
Age 30-35. Sooner based on family history.

Follow-up Colonoscopy

Every 5-10 years based on history.

Every 1-5 years based on biopsy results

MLH1 & MSH2, & EPCAM
Every 1-2 years until age 39.
Every year at age 40

MSH6 & PMS2
Every 1-3 years until age 39.
Every year at age 40

UTERINE – ENDOMETRIAL

	Non-Lynch	Lynch
Pelvic Examination	Every 1-2 years	Every year
Endometrial Biopsy	Based on symptoms or examination	Every year starting age 30-35
Ultrasound	Based on symptoms or examination	Every year starting age 30-35
Hysterectomy	Based on symptoms	Consider for cancer prevention in high risk groups

OVARIAN

	Non-Lynch	Lynch
Pelvic Examination	Every 1-2 years	Every year at age 30
Pelvic Ultrasound	Based on symptoms or examination	Every year starting age 30-35 Sooner per exam or symptoms
Oophorectomy	Based on symptoms or abnormal exmination Optional if having a hysterectomy	Consider for cancer prevention Recommended if having a hysterectomy

Non-Lynch

Lynch

Pelvic Examination

Every 1-2 years

Every year at age 30

Pelvic Ultrasound

Based on symptoms or examination

Every year starting age 30-35

Sooner per exam or symptoms

Oophorectomy

Based on symptoms or abnormal exmination

Optional if having a hysterectomy

Consider for cancer prevention

Recommended if having a hysterectomy

STOMACH

	Non-Lynch	Lynch
EGD	Based on symptoms	Consider every 1-5 years when a colonoscopy is performed
CAT Scan	Based on Symptoms	Based on symptoms, but low threshold to order scans

PANCREATIC

	Non-Lynch	Lynch
MRI Scan	Based on Symptoms	Based on Symptoms, but low threshold to order scans

Please note: The above recommendations are for average risk patients. If there is a family history of pancreatic cancer the patient may be at high risk. If so, an MRI scan of the pancreas, Endoscopic Ultrasound (EUS), and one of the newer pancreatic blood tests may be indicated on a yearly basis. These newer tests use biomarkers, such as DNA or RNA fragments specifically for pancreatic cancer. They include PancreaSure, PAC-MANN (still in development), and Avantect. Note that the CA 19-9 test has not been shown to be effective for screening the general population; it is primarily used to monitor treatment response

RENAL

	Non-Lynch	Lynch
UA	Based on symptoms or with a routine physical	Every year from age 25
CAT Scan	Based on Symptoms or labs	Based on symptoms or labs with a low threshold to order scan