Modifiable risk factors for cancer among people with lynch syndrome: an international, cross-sectional survey.
Cancer prevention
Colorectal cancer
Endometrial cancer
Lynch syndrome
Modifiable risk factors
Journal
Hereditary cancer in clinical practice
ISSN: 1731-2302
Titre abrégé: Hered Cancer Clin Pract
Pays: Poland
ID NLM: 101231179
Informations de publication
Date de publication:
14 Jun 2024
14 Jun 2024
Historique:
received:
10
03
2024
accepted:
14
05
2024
medline:
15
6
2024
pubmed:
15
6
2024
entrez:
14
6
2024
Statut:
epublish
Résumé
Lynch syndrome is the most common cause of hereditary colorectal and endometrial cancer. Lifestyle modification may provide an opportunity for adjunctive cancer prevention. In this study, we aimed to characterise modifiable risk factors in people with Lynch syndrome and compare this with international guidelines for cancer prevention. A cross-sectional study was carried out utilizing survey methodology. Following public and patient involvement, the survey was disseminated through patient advocacy groups and by social media. Self-reported demographic and health behaviours were collected in April 2023. Guidelines from the World Cancer Research Fund (WCRF) were used to compare percentage adherence to 9 lifestyle recommendations, including diet, physical activity, weight, and alcohol intake. Median adherence scores, as a surrogate for lifestyle risk, were calculated and compared between groups. 156 individuals with Lynch syndrome participated from 13 countries. The median age was 51, and 54% were cancer survivors. The mean BMI was 26.7 and the mean weekly duration of moderate to vigorous physical activity was 90 min. Median weekly consumption of ethanol was 60 g, and 3% reported current smoking. Adherence to WCRF recommendations for cancer prevention ranged from 9 to 73%, with all but one recommendation having < 50% adherence. The median adherence score was 2.5 out of 7. There was no significant association between median adherence scores and age (p = 0.27), sex (p = 0.31), or cancer history (p = 0.75). We have characterised the modifiable risk profile of people living with Lynch syndrome, outlining targets for intervention based on lifestyle guidelines for the general population. As evidence supporting the relevance of modifiable factors in Lynch syndrome emerges, behavioural modification may prove an impactful means of cancer prevention.
Sections du résumé
BACKGROUND
BACKGROUND
Lynch syndrome is the most common cause of hereditary colorectal and endometrial cancer. Lifestyle modification may provide an opportunity for adjunctive cancer prevention. In this study, we aimed to characterise modifiable risk factors in people with Lynch syndrome and compare this with international guidelines for cancer prevention.
METHODS
METHODS
A cross-sectional study was carried out utilizing survey methodology. Following public and patient involvement, the survey was disseminated through patient advocacy groups and by social media. Self-reported demographic and health behaviours were collected in April 2023. Guidelines from the World Cancer Research Fund (WCRF) were used to compare percentage adherence to 9 lifestyle recommendations, including diet, physical activity, weight, and alcohol intake. Median adherence scores, as a surrogate for lifestyle risk, were calculated and compared between groups.
RESULTS
RESULTS
156 individuals with Lynch syndrome participated from 13 countries. The median age was 51, and 54% were cancer survivors. The mean BMI was 26.7 and the mean weekly duration of moderate to vigorous physical activity was 90 min. Median weekly consumption of ethanol was 60 g, and 3% reported current smoking. Adherence to WCRF recommendations for cancer prevention ranged from 9 to 73%, with all but one recommendation having < 50% adherence. The median adherence score was 2.5 out of 7. There was no significant association between median adherence scores and age (p = 0.27), sex (p = 0.31), or cancer history (p = 0.75).
CONCLUSIONS
CONCLUSIONS
We have characterised the modifiable risk profile of people living with Lynch syndrome, outlining targets for intervention based on lifestyle guidelines for the general population. As evidence supporting the relevance of modifiable factors in Lynch syndrome emerges, behavioural modification may prove an impactful means of cancer prevention.
Identifiants
pubmed: 38877502
doi: 10.1186/s13053-024-00280-w
pii: 10.1186/s13053-024-00280-w
doi:
Types de publication
Journal Article
Langues
eng
Pagination
10Informations de copyright
© 2024. The Author(s).
Références
Sinicrope FA. Lynch Syndrome–Associated Colorectal Cancer. N Engl J Med. 2018;379(8):764–73.
pubmed: 30134129
doi: 10.1056/NEJMcp1714533
Lynch HT, Snyder CL, Shaw TG, Heinen CD, Hitchins MP. Milestones of Lynch syndrome: 1895–2015. Nat Rev Cancer. 2015;15:181.
pubmed: 25673086
doi: 10.1038/nrc3878
Møller P, Seppälä T, Bernstein I, Holinski-Feder E, Sala P, Evans DG, et al. Cancer incidence and survival in Lynch syndrome patients receiving colonoscopic and gynaecological surveillance: first report from the prospective Lynch syndrome database. Gut. 2017;66(3):464–72.
pubmed: 26657901
doi: 10.1136/gutjnl-2015-309675
Møller P, Seppälä T, Bernstein I, Holinski-Feder E, Sala P, Evans DG, et al. Incidence of and survival after subsequent cancers in carriers of pathogenic MMR variants with previous cancer: a report from the prospective Lynch syndrome database. Gut. 2017;66(9):1657–64.
pubmed: 27261338
doi: 10.1136/gutjnl-2016-311403
Win AK, Young JP, Lindor NM, Tucker KM, Ahnen DJ, Young GP, et al. Colorectal and other Cancer risks for carriers and noncarriers from families with a DNA mismatch repair gene mutation: a prospective cohort study. J Clin Oncol. 2012;30(9):958–64.
pubmed: 22331944
pmcid: 3341109
doi: 10.1200/JCO.2011.39.5590
Dominguez-Valentin M, Sampson JR, Seppälä TT, Ten Broeke SW, Plazzer J-P, Nakken S, et al. Cancer risks by gene, age, and gender in 6350 carriers of pathogenic mismatch repair variants: findings from the prospective Lynch Syndrome Database. Genet Sci. 2020;22(1):15–25.
Seppälä TT, Latchford A, Negoi I, Sampaio Soares A, Jimenez-Rodriguez R, Sánchez-Guillén L, et al. European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender. Br J Surg. 2021;108(5):484–98.
pubmed: 34043773
pmcid: 10364896
doi: 10.1002/bjs.11902
Crosbie EJ, Ryan NAJ, Arends MJ, Bosse T, Burn J, Cornes JM, et al. The Manchester International Consensus Group recommendations for the management of gynecological cancers in Lynch syndrome. Genet Sci. 2019;21(10):2390–400.
Schmeler KM, Lynch HT, Chen L-M, Munsell MF, Soliman PT, Clark MB, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch Syndrome. N Engl J Med. 2006;354(3):261–9.
pubmed: 16421367
doi: 10.1056/NEJMoa052627
Järvinen HJ, Aarnio M, Mustonen H, Aktan–Collan K, Aaltonen LA, Peltomäki P, et al. Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer. Gastroenterology. 2000;118(5):829–34.
pubmed: 10784581
doi: 10.1016/S0016-5085(00)70168-5
Haanstra JF, Vasen HFA, Sanduleanu S, van der Wouden EJ, Koornstra JJ, Kleibeuker JH, et al. Quality colonoscopy and risk of interval cancer in Lynch syndrome. Int J Colorectal Dis. 2013;28(12):1643–9.
pubmed: 23857598
doi: 10.1007/s00384-013-1745-2
Warner NZ, Gleeson C, Fahey P, Horgan R, Groarke A. Experiences of living with Lynch Syndrome: a reflexive thematic analysis. Eur J Oncol Nurs. 2022;58:102117.
pubmed: 35306248
doi: 10.1016/j.ejon.2022.102117
Esplen MJ, Wong J, Aronson M, Butler K, Rothenmund H, Semotiuk K, et al. Long-term psychosocial and behavioral adjustment in individuals receiving genetic test results in Lynch syndrome. Clin Genet. 2015;87(6):525–32.
pubmed: 25297893
doi: 10.1111/cge.12509
Dominguez-Valentin M, Haupt S, Seppälä TT, Sampson JR, Sunde L, Bernstein I, et al. Mortality by age, gene and gender in carriers of pathogenic mismatch repair gene variants receiving surveillance for early cancer diagnosis and treatment: a report from the prospective Lynch syndrome database. eClinicalMedicine. 2023;58:101909.
pubmed: 37181409
pmcid: 10166779
doi: 10.1016/j.eclinm.2023.101909
Clinton SK, Giovannucci EL, Hursting SD, The World Cancer Research Fund/American Institute for Cancer Research. Third Expert Report on Diet, Nutrition, Physical Activity, and Cancer: impact and future directions. J Nutr. 2020;150(4):663–71.
pubmed: 31758189
doi: 10.1093/jn/nxz268
Coletta AM, Peterson SK, Gatus LA, Krause KJ, Schembre SM, Gilchrist SC, et al. Energy balance related lifestyle factors and risk of endometrial and colorectal cancer among individuals with lynch syndrome: a systematic review. Fam Cancer. 2019;18(4):399–420.
pubmed: 31236808
pmcid: 6863045
doi: 10.1007/s10689-019-00135-7
Movahedi M, Bishop DT, Macrae F, Mecklin J-P, Moeslein G, Olschwang S, et al. Obesity, aspirin, and risk of Colorectal Cancer in Carriers of Hereditary Colorectal Cancer: a prospective investigation in the CAPP2 study. J Clin Oncol. 2015;33(31):3591–7.
pubmed: 26282643
doi: 10.1200/JCO.2014.58.9952
Dashti SG, Win AK, Hardikar SS, Glombicki SE, Mallenahalli S, Thirumurthi S, et al. Physical activity and the risk of colorectal cancer in Lynch syndrome. Int J Cancer. 2018;143(9):2250–60.
pubmed: 29904935
pmcid: 6195467
doi: 10.1002/ijc.31611
Dashti SG, Li WY, Buchanan DD, Clendenning M, Rosty C, Winship IM, et al. Type 2 diabetes mellitus, blood cholesterol, triglyceride and colorectal cancer risk in Lynch syndrome. Br J Cancer. 2019;121(10):869–76.
pubmed: 31551580
pmcid: 6888855
doi: 10.1038/s41416-019-0580-9
Sievänen T, Törmäkangas T, Laakkonen EK, Mecklin J-P, Pylvänäinen K, Seppälä TT, et al. Body Weight, Physical Activity, and risk of Cancer in Lynch Syndrome. Cancers. 2021;13(8):1849.
pubmed: 33924417
pmcid: 8069994
doi: 10.3390/cancers13081849
Power RF, Doherty DE, Parker I, Gallagher DJ, Lowery MA, Cadoo KA. Modifiable risk factors and risk of colorectal and endometrial cancers in Lynch Syndrome: a systematic review and Meta-analysis. JCO Precision Oncol. 2024(8):e2300196.
Win AK, Dowty JG, English DR, Campbell PT, Young JP, Winship I, et al. Body mass index in early adulthood and colorectal cancer risk for carriers and non-carriers of germline mutations in DNA mismatch repair genes. Br J Cancer. 2011;105(1):162–9.
pubmed: 21559014
pmcid: 3137400
doi: 10.1038/bjc.2011.172
Pande M, Lynch PM, Hopper JL, Jenkins MA, Gallinger S, Haile RW, et al. Smoking and colorectal cancer in Lynch syndrome: results from the Colon Cancer Family Registry and the University of Texas M.D. Anderson Cancer Center. Clin Cancer Res. 2010;16(4):1331–9.
pubmed: 20145170
pmcid: 2822883
doi: 10.1158/1078-0432.CCR-09-1877
Kamiza AB, Hsieh L-L, Tang R, Chien H-T, Lai C-H, Chiu L-L, et al. Risk factors Associated with Colorectal Cancer in a subset of patients with mutations in MLH1 and MSH2 in Taiwan fulfilling the Amsterdam II Criteria for Lynch Syndrome. PLoS ONE. 2015;10(6):e0130018.
pubmed: 26053027
pmcid: 4460082
doi: 10.1371/journal.pone.0130018
Burn J, Sheth H, Elliott F, Reed L, Macrae F, Mecklin J-P, et al. Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial. Lancet. 2020;395(10240):1855–63.
pubmed: 32534647
pmcid: 7294238
doi: 10.1016/S0140-6736(20)30366-4
Eijkelboom AH, Brouwer JGM, Vasen HFA, Bisseling TM, Koornstra JJ, Kampman E, et al. Diet quality and colorectal tumor risk in persons with Lynch syndrome. Cancer Epidemiol. 2020;69:101809.
pubmed: 32947154
doi: 10.1016/j.canep.2020.101809
Watson P, Ashwathnarayan R, Lynch HT, Roy HK. Tobacco Use and increased colorectal Cancer risk in patients with Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome). Arch Intern Med. 2004;164(22):2429.
pubmed: 15596632
doi: 10.1001/archinte.164.22.2429
Dashti SG, Chau R, Ouakrim DA, Buchanan DD, Clendenning M, Young JP, et al. Female hormonal factors and the risk of Endometrial Cancer in Lynch Syndrome. JAMA. 2015;314(1):61.
pubmed: 26151267
pmcid: 4688894
doi: 10.1001/jama.2015.6789
Johnson CM, Wei C, Ensor JE, Smolenski DJ, Amos CI, Levin B, et al. Meta-analyses of colorectal cancer risk factors. Cancer Causes Control. 2013;24(6):1207–22.
pubmed: 23563998
pmcid: 4161278
doi: 10.1007/s10552-013-0201-5
Raglan O, Kalliala I, Markozannes G, Cividini S, Gunter MJ, Nautiyal J, et al. Risk factors for endometrial cancer: an umbrella review of the literature. Int J Cancer. 2019;145(7):1719–30.
pubmed: 30387875
doi: 10.1002/ijc.31961
Rock CL, Thomson CA, Sullivan KR, Howe CL, Kushi LH, Caan BJ, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. Cancer J Clin. 2022;72(3):230–62.
doi: 10.3322/caac.21719
Turati F, Bravi F, Di Maso M, Bosetti C, Polesel J, Serraino D, et al. Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and colorectal cancer risk. Eur J Cancer. 2017;85:86–94.
pubmed: 28892777
doi: 10.1016/j.ejca.2017.08.015
Kabat GC, Matthews CE, Kamensky V, Hollenbeck AR, Rohan TE. Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study. Am J Clin Nutr. 2015;101(3):558–69.
pubmed: 25733641
pmcid: 4340061
doi: 10.3945/ajcn.114.094854
Middha P, Weinstein SJ, Männistö S, Albanes D, Mondul AM. β-Carotene supplementation and Lung Cancer incidence in the Alpha-Tocopherol, Beta-carotene Cancer Prevention Study: the role of Tar and Nicotine. Nicotine Tob Res. 2019;21(8):1045–50.
pubmed: 29889248
doi: 10.1093/ntr/nty115
Chau R, Dashti SG, Ait Ouakrim D, Buchanan DD, Clendenning M, Rosty C, et al. Multivitamin, calcium and folic acid supplements and the risk of colorectal cancer in Lynch syndrome. Int J Epidemiol. 2016;45(3):940–53.
pubmed: 27063605
pmcid: 5697347
doi: 10.1093/ije/dyw036
Castelló A, Martín M, Ruiz A, Casas AM, Baena-Cañada JM, Lope V, et al. Lower breast Cancer risk among women following the World Cancer Research Fund and American Institute for Cancer Research Lifestyle Recommendations: EpiGEICAM Case-Control Study. PLoS ONE. 2015;10(5):e0126096.
pubmed: 25978407
pmcid: 4433351
doi: 10.1371/journal.pone.0126096
Catsburg C, Miller AB, Rohan TE. Adherence to cancer prevention guidelines and risk of breast cancer. Int J Cancer. 2014;135(10):2444–52.
pubmed: 24723234
doi: 10.1002/ijc.28887
Lucas AL, Bravi F, Boffetta P, Polesel J, Serraino D, Vecchia CL, et al. Adherence to World Cancer Research Fund/American Institute for Cancer Research recommendations and pancreatic cancer risk. Cancer Epidemiol. 2016;40:15–21.
pubmed: 26605429
doi: 10.1016/j.canep.2015.10.026
Romaguera D, Ward H, Wark PA, Vergnaud A-C, Peeters PH, Van Gils CH et al. Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study. BMC Med. 2015;13(1).
Hastert TA, Beresford SAA, Sheppard L, White E. Adherence to the WCRF/AICR cancer prevention recommendations and cancer-specific mortality: results from the vitamins and Lifestyle (VITAL) study. Cancer Causes Control. 2014;25(5):541–52.
pubmed: 24557428
pmcid: 4009723
doi: 10.1007/s10552-014-0358-6
Vergnaud A-C, Romaguera D, Peeters PH, van Gils CH, Chan DSM, Romieu I, et al. Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European prospective investigation into Nutrition and Cancer cohort study12345. Am J Clin Nutr. 2013;97(5):1107–20.
pubmed: 23553166
doi: 10.3945/ajcn.112.049569
Kaluza J, Harris HR, Håkansson N, Wolk A. Adherence to the WCRF/AICR 2018 recommendations for cancer prevention and risk of cancer: prospective cohort studies of men and women. Br J Cancer. 2020;122(10):1562–70.
pubmed: 32210367
pmcid: 7217975
doi: 10.1038/s41416-020-0806-x
Terranova CO, Winkler EAH, Healy GN, Demark-Wahnefried W, Eakin EG, Reeves MM. Dietary and physical activity changes and adherence to WCRF/AICR Cancer Prevention Recommendations following a remotely delivered weight loss intervention for female breast Cancer survivors: the Living well after breast Cancer Randomized Controlled Trial. J Acad Nutr Dietetics. 2022;122(9):1644–e647.
doi: 10.1016/j.jand.2022.02.009
Hoedjes M, Vrieling A, De Brauwer L, Visser A, Gómez García E, Hoogerbrugge N, et al. Determinants of adherence to recommendations on physical activity, red and processed meat intake, and body weight among lynch syndrome patients. Fam Cancer. 2023;22(2):155–66.
pubmed: 36151358
doi: 10.1007/s10689-022-00315-y
Karlsen RV, Bidstrup PE, Christensen J, Larsen SB, Tjønneland A, Dalton SO, et al. Men with cancer change their health behaviour: a prospective study from the Danish Diet, Cancer and Health Study. Br J Cancer. 2012;107(1):201–6.
pubmed: 22644301
pmcid: 3389426
doi: 10.1038/bjc.2012.238
Skeie G, Hjartåker A, Braaten T, Lund E. Dietary change among breast and colorectal cancer survivors and cancer-free women in the Norwegian women and Cancer cohort study. Cancer Causes Control. 2009;20(10):1955–66.
pubmed: 19565341
doi: 10.1007/s10552-009-9390-3
Brouwer JGM, Snellen M, Bisseling TM, Koornstra JJ, Vasen HFA, Kampman E, et al. Is a colorectal neoplasm diagnosis a trigger to change dietary and other lifestyle habits for persons with Lynch syndrome? A prospective cohort study. Fam Cancer. 2021;20(2):125–35.
pubmed: 32770331
doi: 10.1007/s10689-020-00201-5
Serrano D, Patrignani P, Stigliano V, Turchetti D, Sciallero S, Roviello F, et al. Aspirin Colorectal Cancer Prevention in Lynch Syndrome: recommendations in the era of Precision Medicine. Genes. 2022;13(3):460.
pubmed: 35328014
pmcid: 8952565
doi: 10.3390/genes13030460
Monahan KJ, Bradshaw N, Dolwani S, Desouza B, Dunlop MG, East JE, et al. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut. 2020;69(3):411–44.
pubmed: 31780574
doi: 10.1136/gutjnl-2019-319915
NCCN. Genetic/Familial high-risk Assessment: colorectal. Version 1.2023 — may 30, 2023 ed. NCCN.org: NCCN Clinical Practice guidelines in Oncology (NCCN Guidelines®); 2023.
Ryan N, Nobes M, Sedgewick D, Teoh SN, Evans D, Crosbie E. A mismatch in care: results of a United Kingdom-wide patient and clinician survey of gynaecological services for women with Lynch syndrome. BJOG: Int J Obstet Gynecol. 2021;128(4):728–36.
doi: 10.1111/1471-0528.16432
Dominguez-Valentin M, Seppälä TT, Engel C, Aretz S, Macrae F, Winship I, et al. Risk-reducing gynecological surgery in Lynch Syndrome: results of an International Survey from the prospective Lynch Syndrome Database. J Clin Med. 2020;9(7):2290.
pubmed: 32708519
pmcid: 7408942
doi: 10.3390/jcm9072290
Nebgen DR, Domchek SM, Kotsopoulos J, De Hullu JA, Crosbie EJ, Paramanandam VS, et al. Care after premenopausal risk-reducing salpingo‐oophorectomy in high‐risk women: scoping review and international consensus recommendations. BJOG: An International Journal of Obstetrics & Gynaecology; 2023.
Lazzeroni M, Bellerba F, Calvello M, Macrae F, Win AK, Jenkins M, et al. A Meta-analysis of obesity and risk of Colorectal Cancer in patients with Lynch Syndrome: the Impact of Sex and Genetics. Nutrients. 2021;13(5):1736.
pubmed: 34065344
pmcid: 8160758
doi: 10.3390/nu13051736
Diez De Los Rios, De La Serna C, Fernández-Ortega P, Lluch-Canut T. Lifestyle behavior interventions for preventing Cancer in adults with inherited Cancer syndromes: systematic review. Int J Environ Res Public Health. 2022;19(21):14098.
doi: 10.3390/ijerph192114098
Vrieling A, Visser A, Hoedjes M, Hurks M, Gómez García E, Hoogerbrugge N, et al. Increasing awareness and knowledge of lifestyle recommendations for cancer prevention in Lynch syndrome carriers: Randomized controlled trial. Clin Genet. 2018;93(1):67–77.
pubmed: 28632915
doi: 10.1111/cge.13076
Smith GL, Banegas MP, Acquati C, Chang S, Chino F, Conti RM, et al. Navigating financial toxicity in patients with cancer: a multidisciplinary management approach. Cancer J Clin. 2022;72(5):437–53.
doi: 10.3322/caac.21730
Morton K, Kohut K, Turner L, Smith S, Crosbie EJ, Ryan N et al. Person-based co-design of a decision aid template for people with a genetic predisposition to cancer. Front Digit Health. 2022;4.
Actkins KEV, Srinivasan S, Spees LP, Turbitt E, Allen CG, Roberts MC. Uptake of genetic testing among patients with Cancer at risk for Lynch Syndrome in the National Health interview survey. Cancer Prev Res. 2021;14(10):927–32.
doi: 10.1158/1940-6207.CAPR-21-0073
Shams-White MM, Brockton NT, Mitrou P, Romaguera D, Brown S, Bender A, et al. Operationalizing the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention recommendations: a standardized scoring system. Nutrients. 2019;11(7):1572.
pubmed: 31336836
pmcid: 6682977
doi: 10.3390/nu11071572