Table 1.

Colorectal and gynecologic medical management recommendations for at-risk members of families with Lynch syndrome^a

Type of intervention	Recommendation	Quality of evidence
Colorectal cancer Screening
Colonoscopy	Annual or biennial beginning at 20–25 years old or 10 years younger than the youngest age at diagnosis in the family, whichever comes first	Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes
History and examination with detailed review of systems, education, and counseling regarding LS	Annual beginning at 21 years old	Evidence is insufficient to assess the effects on health outcomes
Prophylactic surgery
Colorectal resection	For at-risk persons without a previous diagnosis of CRC: generally not recommended, discuss as alternative to regular colonoscopy, with preferences for well-informed patient actively elicited	Evidence is insufficient to assess the effects on health outcomes
	For persons with a diagnosed CRC or polyp not resectable by colonoscopy, subtotal colectomy favored with preferences of well-informed patient actively elicited
Gynecologic cancer Screening
Endometrial biopsy	Annual beginning at 30–35 years old	Evidence is insufficient to assess the effects on health outcomes
Transvaginal ultrasound	Annual beginning at 30–35 years old	Evidence is insufficient to assess the effects on health outcomes
History and examination with detailed review of systems, education, and counseling regarding LS	Annual beginning at 21 years old	Evidence is insufficient to assess the effects on health outcomes
Prophylactic surgery
Hysterectomy or oophorectomy	Discuss as option after childbearing is complete	Good–fair

^aAdapted from Lindor et al. (3).