Screening for Lynch Syndrome Beneficial at Acceptable Cost

Women in particular could increase life expectancy with screening, prophylactic surgery

TUESDAY, July 19 (HealthDay News) -- Identifying families with the Lynch syndrome could yield considerable benefits at acceptable costs, particularly for women, according to a study published online July 18 in the Annals of Internal Medicine.

Uri Ladabaum, M.D., from the Stanford University School of Medicine in Calif., and colleagues investigated the efficacy and cost-effectiveness of strategies to identify and treat the Lynch syndrome in individuals with newly diagnosed colorectal cancer and their relatives. Cost-effectiveness was estimated using the Markov model which incorporated risk for colorectal, endometrial, and ovarian cancer. Intervention strategies were based on clinical criteria and included testing followed by tailored screening, and risk-reducing surgery. The main outcome measures were life-years, cancer cases and deaths, costs, and incremental cost-effectiveness ratios.

The investigators found that the primary beneficiaries of all strategies were the relatives, particularly females, with a mutation associated with the Lynch syndrome. These women's life expectancies could increase by four years by undergoing hysterectomy, salpingo-oophorectomy, and regular colorectal cancer screenings. Deaths from colorectal and endometrial/ovarian cancer were reduced by 7 to 42 percent and 1 to 6 percent, respectively, by implementing current strategies. Immunochemistry followed by BRAF mutation testing had an incremental cost-effectiveness ratio of $36,200 per life-year gained. Implementation of this screening up to age 70 years cost $44,000 per incremental life-year gained, compared with screening only up to age 60 years; and screening without an upper age limit compared to up to age 70 years cost $88,700 per incremental life-year gained. For most strategies, testing of three to four relatives was required to meet a threshold of $50,000 per life-year gained.

"Widespread colorectal tumor testing to identify families with the Lynch syndrome could yield substantial benefits at acceptable costs," the authors write.

Two authors disclosed financial ties to the medical device and health care industries.

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