What is the recommended colon cancer surveillance for PMS2 mutation carriers?

What is the recommended colon cancer surveillance for PMS2 mutation carriers?

• A. Colonoscopy every 1-2 years starting around age 20-25.
• B. Colonoscopy every 5-10 years.
• C. No surveillance is recommended.
• D. Colonoscopy every year starting at age 60.

Answer: (A)

PMS2 mutation carriers have Lynch syndrome, which carries a higher risk of colorectal cancer and can present at a younger age than the average population. Because of this, surveillance is more aggressive: colonoscopy is used not just as a screening tool but also to remove polyps when found, reducing cancer risk. For PMS2, the recommended approach is to start colonoscopy around ages 20–25 and repeat every 1–2 years. This balance aims to detect cancers or precancerous polyps early while considering the relatively lower penetrance of PMS2 compared with other Lynch genes. Less frequent surveillance (every 5–10 years) would miss early cancers; starting at 60 is too late for cancers that can arise much earlier; and surveillance every year starting at 60 is unnecessary and not aligned with risk timing.

PMS2 mutation carriers have Lynch syndrome, which carries a higher risk of colorectal cancer and can present at a younger age than the average population. Because of this, surveillance is more aggressive: colonoscopy is used not just as a screening tool but also to remove polyps when found, reducing cancer risk. For PMS2, the recommended approach is to start colonoscopy around ages 20–25 and repeat every 1–2 years. This balance aims to detect cancers or precancerous polyps early while considering the relatively lower penetrance of PMS2 compared with other Lynch genes.

Less frequent surveillance (every 5–10 years) would miss early cancers; starting at 60 is too late for cancers that can arise much earlier; and surveillance every year starting at 60 is unnecessary and not aligned with risk timing.