Zachariah H Foda MD, PhD - CGA-IGC Communications committee
In this month's, CGA-IGC podcast episode, Dr. Pal Møller, founder of The Prospective Lynch Syndromes Database (PLSD), challenges long-held beliefs about colorectal cancer (CRC) development in Lynch syndrome patients. Hosted by Joshua Sommovilla, MD and co-hosted by T.J. Slavin, MD, this thought-provoking discussion delves into Møller's recent publication, “Incidences of colorectal adenomas and cancers under colonoscopy surveillance suggest an accelerated “Big Bang” pathway to CRC in three of the four Lynch syndromes” in Hereditary Cancer in Clinical Practice.
Møller emphasizes the inadequacies of colonoscopy in entirely preventing colorectal cancer, arguing that initiating the PLSD was necessary to question prevailing assumptions about surveillance efficacy. He critically assesses the traditional adenoma-carcinoma sequence, challenging the belief that adenomas consistently precede colorectal cancer, particularly in the context of Lynch syndrome. He suggests that significant colorectal cancer diagnoses can occur independent of adenomas, indicating a complex progression of malignancy influenced by various genetic factors.
This interesting discussion includes an exploration of the biological underpinnings of cancer development, where Dr. Møller posits that mutations may arise randomly and are not linear processes. He presents the notion of a "Big Bang" pathway to cancer, where multiple mutations may occur simultaneously, leading to a threshold that marks the transition to an irreversible cancer state.
The inadequacy of current screening intervals and methodologies for colonoscopy in Lynch syndrome carriers is highlighted, with Dr. Møller advocating for empirical studies to understand the effectiveness of screening protocols better. He suggests that early cancer detection via colonoscopy offers a high cure rate, though the data suggest no substantial benefit from increased frequency beyond three years.
Ultimately, Dr. Møller calls for collaborative efforts in expanding prospective studies to address unanswered questions about Lynch syndrome's broader implications, particularly regarding other Lynch related cancers outside colorectal cancer.
To gain further insights on cancer development and prevention in Lynch syndrome, listen to our podcast episode HERE
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If you enjoyed this podcast, you may like others from the CGA-IGC Podcast Series (Seasons 3, 4, 5, 6 & 7) presented by the CGA-IGC Education Committee. Or, explore our Expert Approach to Hereditary Gastrointestinal Cancers podcast series (Seasons 1 and 2).
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