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Comparison of two Lynch screening strategies in endometrial cancer in a California health system.

Abstract：

OBJECTIVE:Compare detection of Lynch syndrome in endometrial cancer between regions of a health care system with different screening strategies. METHODS:A retrospective study of endometrial cancer (EC) cases from 2 regions of an integrated health care system (Kaiser Permanente Northern (KPNC) and Southern (KPSC) California). Within KPNC, immunohistochemistry tumor screening (IHC) was physician ordered and risk-based; within KPSC, IHC was universal and automated. Clinical risk factors associated with abnormal IHC and Lynch Syndrome (LS) were identified. RESULTS:During the study, there were 2045 endometrial cancers: 1399 in the physician-order group and 646 in the universal testing group. In the physician-order group: among women < age 60, 34% underwent IHC; 9.6% were abnormal, and 3% were possible LS after methylation testing; among women ≥60, 11% underwent IHC, 3% were abnormal and <1% were possible LS. In the universal group, 87% of women age <60 had IHC, 19.4% were abnormal, and 6% were possible LS; Among women age ≥60, 82% underwent IHC, 26% were abnormal, and 2% were possible LS. There were no differences in LS cases between the physician-order group and the universal group in either age strata (<60: 3% vs. 3.6%, p=0.62; ≥60: <1% vs. 1%, p=0.63) Factors associated with LS were younger age (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.04-0.29) and lower body mass index (BMI), (OR 0.38 95% CI 0.18-0.80). CONCLUSIONS:Universal IHC screening did not result in increased LS detection in EC.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

Lentz SE,Salyer CV,Dontsi M,Armstrong MA,Hoodfar E,Alvarado MM,Avila M,Nguyen NT,Powell CB

doi

10.1016/j.ygyno.2020.04.692

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

158-166

issue

1

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(20)30992-6

journal_volume

158

pub_type

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