<em>Decision-IQ</em>: A Case-Based Overview of Screening for Lynch Syndrome in a Patient With Uterine Cancer

Decision-IQ: A Case-Based Overview of Screening for Lynch Syndrome in a Patient With Uterine Cancer

Expiring Soon

Developed in collaboration
Med-IQ      Duke Medicine

Released: 1/26/2021
Expires: 1/25/2022
Max Credits: 0.25
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Rebecca A. Previs, MD
Assistant Professor of Obstetrics and Gynecology
Division of Gynecologic Oncology
Duke University Medical Center
Durham, NC
Activity Planners
Iwona Misiuta, PhD, MHA
Clinical Content Manager
Baltimore, MD

Rebecca Julian, MS, ELS
Senior Manager, Editorial
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD
Learning Objectives
Upon completion, participants should be able to:

  • Use appropriate methods to screen patients diagnosed with uterine cancer for Lynch syndrome
  • List other types of malignancies that may be diagnosed in patients with Lynch syndrome

Target Audience
This activity is intended for primary care providers, gynecologists, and advanced practice providers in women’s health.
Statement of Need
Lynch syndrome, also known historically as hereditary nonpolyposis colorectal cancer (HNPCC), is an underdiagnosed condition that increases the risk of gynecologic, gastrointestinal, and other cancers. Lynch syndrome accounts for 2% to 3% of all colorectal cancers in the United States, and the estimated prevalence is 1 in about 400 in the general population. People with the syndrome are estimated to have a 40% to 80% lifetime cumulative risk of colorectal cancer. In addition, women with Lynch syndrome have a 50% percent higher risk of uterine cancers and a 4- to 5-fold increased risk of ovarian cancer. Notably, people with Lynch syndrome are usually diagnosed with cancer at younger ages, often in their 30s and 40s.

Lynch syndrome is caused by inherited mutations affecting any of 4 DNA mismatch repair (MMR) genes, MSH2, MLH1, PMS2, or MSH6, or by a deletion in the epithelial cellular adhesion molecule (EPCAM) gene. Diagnosing Lynch syndrome requires direct germline testing, but microsatellite instability testing and immunohistochemical analyses can be used for screening. Clinicians need to be aware of Lynch syndrome and understand how to diagnose it to effectively manage patients with this condition.   

Collaborator Statement
This activity was developed by Med-IQ in collaboration with Duke Health.
Med-IQ      Duke Medicine

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Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Med-IQ designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse practitioners, physician assistants, and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available. 
Medium/Method of Participation
This CME/CE activity consists of a 0.25-credit online publication. To receive credit, read the introductory CME material, read the publication, and complete the post-survey, evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.  
Initial Release Date: January 26, 2021
Expiration Date: January 25, 2022
Estimated Time to Complete This Activity: 15 minutes

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Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation. 

Rebecca A. Previs, MD
Consulting fees/advisory boards: Myriad Genetics

The peer reviewers and activity planners have no financial relationships to disclose. 
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Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.
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Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available at the "Continue" button below.

  • Lynch syndrome is underdiagnosed; only 1.2% of individuals with Lynch syndrome are aware of their condition
  • Lynch syndrome is caused by inherited mutations affecting any of 4 DNA MMR genes, MSH2, MLH1, PMS2, or MSH6, or by a deletion in the EPCAM gene
  • Patients with Lynch syndrome have an increased risk of gynecologic, gastrointestinal, and other cancers; therefore, detecting this condition presents an opportunity for cancer prevention efforts
  • Women with Lynch syndrome have up to a 74% risk of colorectal cancer and as high as a 61% risk of endometrial cancer
  • Lynch syndrome can be diagnosed by direct germline DNA testing, MSI testing, or IHC analyses

View reference list.

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Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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