Modeling Suggests Later Starting Age and 3-Year Intervals for Colonoscopy in MSH6 and PMS2


Douglas K. Rex, MD, MASGE reviewing Kastrinos F, et al. Gastroenterology 2021 Apr 8.

Lynch syndrome is associated with increased cancer risk, particularly in the colorectum, as a result of germline mutations in any of 4 mismatch repair genes designated MLH1MSH2MSH6, and PMS2. The risk of colorectal cancer is lower in MSH6 and PMS2 compared to MLH1 and MSH2

In a modeling study, the optimal surveillance strategy for each mismatch repair gene was annually beginning at age 25 for MLH1, biennially from age 25 for MSH2, every 3 years starting at age 35 for MSH6, and every 3 years beginning at age 40 for PMS2.


These results support increasingly discussed recommendations to begin colonoscopy surveillance later in MSH6 and PMS2 Lynch syndrome, with surveillance every 3 years as optimal.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Kastrinos F, Ingram MA, Silver ER, et al. Gene-specific variation in colorectal cancer surveillance strategies for Lynch syndrome. Gastroenterology 2021 Apr 8. (Epub ahead of print) (