Assessment of urothelial cancer screening outcomes among patients with Lynch syndrome at rural multidisciplinary clinic.

Abstract

e22618 Background: The National Comprehensive Cancer Network (NCCN) indicates an increased risk for urinary tract and bladder malignancies in Lynch Syndrome (LS) but notes that evidence is lacking to support regular surveillance. Given the low cost and noninvasive nature of urinalysis, Geisinger’s multidisciplinary clinic in rural Pennsylvania supports consideration of annual urinalysis to screen for asymptomatic microscopic hematuria. Patients are evaluated by a multidisciplinary team, including genetics, urology, internal medicine, gastroenterology, and gynecology. This study aims to characterize urinalysis-based screening outcomes among LS patients. Methods: Medical records of LS patients at the clinic between 2016 and 2023 were retrospectively reviewed. Eligible clinic patients include those with no prior history of urothelial carcinoma, and age ≥30. Pearson's chi-squared test was used to evaluate the association between the remaining parameters and screening completion with significance level p < 0.05. Results: Overall, 184 patients were eligible for urothelial cancer screening. The median age among eligible patients was 48 years (interquartile range 39-59) and 70.7% of which were female. There were 43 (23.4%) patients with a known family history of urothelial cancer, and 88 (47.8%) with a personal history of smoking. In total, 72 patients (39.1%) were fully adherent to the clinic’s recommended surveillance, 102 (55.4%) had at least one or more screenings completed but not consecutively, and 10 (5.5%) did not complete any screenings. Full screening completion was significantly associated with a family history of urothelial cancer (p = 0.01). Sex, specific LS variant, and history of smoking were not associated with full screening completion. Asymptomatic microscopic hematuria was found in 19 out of 372 screenings. Out of the 19 positive screenings, six patients had a negative repeat urinalysis, one patient underwent cystoscopy, one patient underwent CT urogram, one patient underwent cystoscopy and renal ultrasound, eight patients underwent both cystoscopy and CT urogram, and two patients declined further evaluation. Additional evaluation among patients with positive screening showed no evidence of cancerous findings. Two patients eligible for screening were diagnosed with urothelial carcinoma in which both initially presented with gross hematuria. Conclusions: Screening adherence for urothelial carcinoma varied amongst LS patients. Most patients with positive screenings consistently had adequate evaluation based on urology recommendations at clinic. No patients with asymptomatic microscopic hematuria found on screening were diagnosed with urothelial cancer supporting NCCN guidelines that there is limited evidence to support urothelial cancer screening in LS.