Departments of Gynecologic Oncology, Gastrointestinal Medicine and Nutrition, and Behavioral Science, University of Texas M.D. Anderson Cancer Center, Houston, TX.
J Oncol Pract. 2011 Jan;7(1):43-7. doi: 10.1200/JOP.2010.000038.
Endometrial and colorectal cancers are the most common cancers in Lynch syndrome. Consensus guidelines recommend annual endometrial biopsy (EMB) and regular colonoscopies. We assessed the feasibility of concurrently performing EMB and colonoscopy and evaluated women's perception of pain, satisfaction, and acceptability.
From July 2002 to December 2009, women who had a gene mutation for Lynch syndrome, met the Amsterdam II criteria, or had a high-risk situation that required screening were prospectively enrolled. After conscious sedation, the procedures were sequentially performed. Patients completed pre- and postprocedure questionnaires assessing pain, level of satisfaction, and acceptability. The Wilcoxon rank test and Mann-Whitney test were used to compare pain scores.
Forty-two women completed the study. Median age was 37 years (range, 25 to 73). Nineteen had previously had an EMB in the office setting. Women reported significantly lower median levels of pain in the combined procedure compared with previous office setting biopsies (P < .001). Regardless of parity, women reported significantly less pain for an EMB as part of the combined screen compared with an office EMB (parous, P = .003; nulliparous, P = .026). Women also reported a high level of satisfaction and more convenience in the combined procedure. All participants preferred combined to separately scheduled procedures and would recommend the combined procedure to their relatives.
Combined colon and endometrial cancer screening is a patient-centered approach that is feasible, acceptable, and may improve adherence to Lynch syndrome screening recommendations.
子宫内膜癌和结直肠癌是林奇综合征中最常见的癌症。共识指南建议每年进行子宫内膜活检（EMB）和定期结肠镜检查。我们评估了同时进行 EMB 和结肠镜检查的可行性，并评估了女性对疼痛、满意度和可接受性的感知。
从 2002 年 7 月到 2009 年 12 月，前瞻性纳入具有林奇综合征基因突变、符合阿姆斯特丹 II 标准或存在需要筛查的高危情况的女性。在清醒镇静后，依次进行这些程序。患者在术前和术后完成评估疼痛、满意度和可接受性的问卷。采用 Wilcoxon 秩和检验和 Mann-Whitney 检验比较疼痛评分。
42 名女性完成了这项研究。中位年龄为 37 岁（范围 25 至 73 岁）。19 名女性之前曾在办公室环境下进行过 EMB。与之前在办公室环境下进行的活检相比，女性在联合检查中报告的疼痛程度明显更低（P<0.001）。无论是否生育，与办公室 EMB 相比，女性报告在联合筛查中进行 EMB 的疼痛程度明显降低（已生育，P=0.003；未生育，P=0.026）。女性也报告了在联合检查中更高的满意度和更大的便利性。所有参与者更喜欢联合程序而不是单独安排的程序，并会向他们的亲属推荐联合程序。
联合结肠和子宫内膜癌筛查是一种以患者为中心的方法，是可行的、可接受的，并且可能提高对林奇综合征筛查建议的依从性。
