A mismatch in care: results of a United Kingdom-wide patient and clinician survey of gynaecological services for women with Lynch syndrome

Neil A J Ryan 1 2, Molly Nobes 3, Danielle Sedgewick 4, Sin-Nee Teoh 5, D Gareth Evans 1 6, Emma J Crosbie 2 7

Affiliations

PMID: 32725920
DOI: 10.1111/1471-0528.16432

Abstract

Objective: To describe the current testing practice, referral pathways and gynaecological services available to women with Lynch syndrome (LS) in the United Kingdom.

Design: Cross sectional nationwide survey of gynaecological oncologists and women with LS.

Setting: United Kingdom METHODS: Gynaecological oncologists were contacted directly. Women with LS were identified from national and regional clinical databases and the patient support group, Lynch syndrome UK.

Main outcome measures: Gynaecological oncologists were asked to report rates of LS testing and current practice regarding risk-reducing strategies and gynaecological surveillance for women with LS. Women with LS were asked to describe their experiences of gynaecological care.

Results: In total, 41 gynaecological oncologists and 298 women with LS responded to the survey. Of the gynaecological oncologists surveyed, 37% were unfamiliar with any clinical guidelines for the management of LS. Only 29% of gynaecological oncologists supported universal testing of endometrial cancer for LS; one centre routinely performed such testing. 83% said they perform risk-reducing gynaecological surgery and 43% were aware of a local gynaecological surveillance service for women with LS. Of women with LS, most had undergone a hysterectomy (n=191/64.1%), most frequently to reduce their gynaecological cancer risk (n=86/45%). 10% were initially referred for LS testing by their gynaecologist. 55% of those eligible regularly attended gynaecological surveillance however, 62% wanted more regular surveillance. Regional variation was evident across all standards of care.

Conclusions: There is widespread variation in the services offered to women with LS in the UK. As a community, gynaecological oncologists should move towards a nationally agreed provision of services.

Keywords: Lynch syndrome; endometrial cancer; gynaecological surveillance; ovarian cancer; risk-reducing surgery; screening.