Risk-reducing gynecologic surgery decisions in Lynch syndrome at a safety-net hospital and university medical center.

OBJECTIVE

To explore uptake of risk-reducing gynecologic surgery in a diverse patient population with Lynch syndrome.

METHODS

Chart reviews of women with Lynch syndrome were conducted at a safety-net hospital and university medical center, including women over age 30 with an intact uterus and/or ovaries and no prior history of uterine or ovarian cancer. Potential factors associated with uptake of surgery and time to risk-reducing surgery were analyzed.

RESULTS

The 65 women studied included 27 (41.5%) White, non-Hispanic, 30 (46.2%) Hispanic, 5 (7.7%) Asian, and 3 (4.6%) other. The diagnosis of Lynch syndrome was made at a median of 41.0 years (IQR 31.0 to 48.0) with pathogenic variants in MLH1 (27, 41.5%), MSH2 (14, 21.5%), MSH6 (5, 7.7%), PMS2 (17, 26.2%), or EPCAM (2, 3.1%). The majority (35, 53.8%) had a history of colon or other cancer, and 24 (36.9%) were Spanish-language preferring. Safety-net hospital patients were more likely to undergo risk-reducing surgery (19/28, 67.9%) compared to university medical center patients (13/37, 35.1%), even when controlling for age and prior history of non-gynecologic cancer (HR = 2.43, p = 0.02). Safety-net hospital patients also demonstrated quicker uptake of surgery (p = 0.005). Age, parity, Lynch-associated gene, benign gynecologic diagnosis, family history, race/ethnicity, or language preference were not significantly associated with undergoing surgery.

CONCLUSION

This exploratory analysis suggested a higher uptake of risk-reducing surgery at the safety-net hospital than at the university medical center. Understanding factors contributing to this difference will be critical to supporting gynecologic cancer risk management in Lynch syndrome.