Cancer risk and survival in path_MMR carriers by gene and gender up to 75 years of age; a report from the Prospective Lynch Syndrome Database

Pal Moller, Toni Seppälä, Inge Bernstein, Elke Holinski-Feder, Paola Sala, Dafydd Evans, Annika Lindblom, Finlay Macrae, Ignacio Blanco, Rolf Sijmons, Jacqueline Jeffries, Hans Vasen, John Burn, Sigve Nakken, Eivind Hovig, Einar Andreas Rødland, Kukatharmini Tharmaratnam, Wouter H de Vos Tot Nederveen Cappel, James Hill, Juul WijnenMark Jenkins, Kate Green, Fiona Lalloo, Lone Sunde, Miriam Mints, Lucio Bertario, Marta Pineda, Matilde Navarro , Monika Morak, Laura Renkonen-Sinisalo, Mev Dominguez Valentin, Ian M Frayling, John-Paul Plazzer, Kirsi Pylvanainen, Maurizio Genuardi, Jukka-Pekka Mecklin, Gabriela Möslein, Julian Sampson, Gabriel Capella

Research output: Contribution to journalArticlepeer-review


Background: Most patients with a path_MMR variant gene variants (Lynch Syndrome, LS) now survive both their first and subsequent cancers. As a consequence, there is a growing number of older LS patients for whom limited information exists on cancer risk and survival.
Objective and design: This observational, international, multicenter study aimed to determine prospectively observed incidences of cancers and survival in path_MMR carriers up to 75 years of age.
Results: 3,119 patients were followed for a total of 24,475 years. Risks for colorectal cancer were 50%, 50% and 23% in path_MLH1, path_MSH2 and path_MSH6 carriers; for endometrial cancer 43%, 58% and 46%; for ovarian cancer 10%, 17% and 13%; for upper-gastrointestinal (gastric, duodenal, bile duct or pancreatic) cancers 23%, 12% and 8%; for urinary tract cancers 9%, 28% and 12%; for prostate cancer 18%, 35% and 21%; and for brain tumours 1%, 6% and 1%, respectively. Ovarian cancer occurred mainly pre-menopausally. By contrast, upper-intestinal, urinary tract and prostate cancers occurred predominantly at older ages. Overall five-year survival for prostate cancer was 100%, bladder 93%, ureter 85%, duodenum 67%, stomach 61%, bile duct 29%, brain 22% and pancreas 0%. Path_PMS2 carriers had a lower risks for cancer.

Conclusion: Carriers of pathogenic variants in different MMR genes exhibit distinct patterns of cancer risk and survival as they age. Risk estimates for counselling and planning of surveillance and treatment should be tailored to each patient’s age, gender and genetic variant. We have updated our open-access website to facilitate this.
Original languageEnglish
Publication statusPublished - 28 Jul 2017


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