Hereditary Cancer and Genetic Testing

Risk management for people with inherited MLH1 mutations

The National Comprehensive Cancer Network (NCCN) provides risk management guidelines for men and women with MLH1 mutations.  We recommend that you speak with a genetics expert who can look at your personal and family history of cancer and can help you determine the best risk management plan. You can learn more about risk management options in our section on Screening and Risk Reduction by Cancer Type

NCCN risk management guidelines for people with MLH1 mutations include information on the following cancers:

People with an MLH1 mutation may also qualify for clinical trials looking for more effective screening or prevention for cancer.


Colorectal Cancer 

  • Colonoscopy beginning between ages 20-25 (or 2-5 years before the earliest age of colon cancer in the family, if diagnosed before age 25).
  • Repeat coloscopy every 1-2 years. Speak with your doctor about whether your screenings should be yearly or every two years. Men, people over age 40, and people with a personal history of colon cancer or colon polyps may benefit most from yearly screenings. 
  • Daily aspirin can decrease the risk for colorectal cancer. The best dose and timing for aspirin is not known. Speak with your doctor about the benefits and risks, best timing and dose.


Endometrial cancer 

  • Symptom awareness and biopsy: Endometrial cancer can often be caught early based on symptom awareness followed by a biopsy. For this reason, experts recommend that all women should be aware of endometrial symptoms and immediately report any of the following to their doctor. 
    • unusual vaginal bleeding
    • pelvic or abdominal pain
    • bloating or distended belly
    • difficulty eating
    • increased urination or pressure to urinate 

 

  • Screening: In the absence of symptoms, regular endometrial cancer screening through transvaginal ultrasound and/or endometrial biopsies does not appear to improve outcomes any better than symptom awareness followed with biopsy for any woman showing symptoms. Despite this, some women undergo regular screening through transvaginal ultrasound and endometrial biopsies. Transvaginal ultrasound is not recommended for premenopausal women. Women should speak with their doctors about the benefits, risks, costs and timing of transvaginal ultrasound and endometrial biopsies in order to make a decision about screening. 

 

  • Surgery: Removal of the uterus (hysterectomy) lowers the risk for endometrial cancer in women with Lynch syndrome. However, hysterectomy has not been shown to lower the risk for death from endometrial cancer. Women should speak with their doctor about the benefits and risks of hysterectomy after they complete childbearing. The best timing for surgery varies by gene mutation and family history of cancer. 

 

  • Medication: Oral contraceptive pills (birth control) may lower the risk for endometrial cancer in women with Lynch syndrome. Women should speak with their doctors about the benefits, risks and timing of oral contraceptives. 


Ovarian cancer

  • Surgery: Removal of the ovaries and fallopian tubes (salpingo-oophorectomy) can lower the risk for ovarian cancer in women with Lynch syndrome. Women should speak with their doctor about the benefits and risks of salpingo-oophorectomy after they complete childbearing. The best timing for surgery varies by gene mutation and family history of cancer. 

 

  • Symptom awareness: Experts recommend that all women know the list of ovarian cancer symptoms. Women should report to their doctor any of the following symptoms that persist for several weeks and are a change from normal:
    • pelvic or abdominal pain
    • bloating or distended belly
    • difficulty eating
    • feeling full sooner than normal
    • increased urination or pressure to urinate 

 

  • Screening: In the absence of symptoms, some women undergo regular screening through transvaginal ultrasound and CA125 blood tests. However, ovarian cancer screening does not detect ovarian cancer early. Women who are not planning surgery should speak with their doctors about the benefits, risks, costs and timing of transvaginal ultrasound and CA125.  

 

  • Medication: Oral contraceptive pills (birth control) may lower the risk for ovarian cancer in women with Lynch syndrome. Women should speak with their doctors about the benefits, risks and timing of oral contraceptives. 


Pancreatic cancer screening for people with a family history

  • People with an MLH1 mutation who have a first- or second-degree relative with pancreatic cancer, should consider screening beginning at age 50 or 10 years younger than the age of diagnosis of that relative. 
  • For people who choose pancreatic cancer screening, NCCN recommends that the screening be performed in an experienced facility. Before undergoing screening, people should have a conversation with their doctor about the potential benefits, risks, costs and limitations of screening.
  • Consider annual screening with contrast-enhanced MRI/MRCP (magnetic resonance cholangiopancreatography) and/or EUS (endoscopic ultrasound).

Prostate cancer

  • Consider annual PSA test and digital rectal exam beginning at age 40 after speaking with your doctor about the benefits and risks of screening for prostate cancer.


Bladder, kidney and ureteral cancer

  • Consider annual urinalysis beginning between ages 30-35, especially for men, and for people from families with a history of urinary tract cancer.


Brain cancer

  • Consider annual physical exam and neurologic exam beginning at age 25 - 30. 
     

Skin cancer

  • Consider skin exam every 1-2 years


Stomach cancer

  • For people with a family history of stomach cancer and/or people of Asian ancestry:
    • Consider stomach cancer screening using a procedure known as EGD (esophagogastroduodenocopy) every 3-5 years beginning at age 40.
    • If gastric screening is performed, considered testing for and treating H. pylori.


Breast cancer

  • Manage breast cancer risk based on family history. Risk-reducing mastectomy (surgical removal of the breasts) is not typically recommended.


Other cancer screening and prevention

Guidelines do not address screening or prevention of other cancers for people with MLH1 mutations. However, clinical trials may be available.

find-support

If you are a person with an MLH1 mutation, you can find peer support through the following resources:

clinical-trials

The following screening and prevention studies are open to people with an inherited MLH1 mutation. 

Multiple cancers

Colorectal cancer

Ovarian cancer

Prostate cancer

Pancreatic cancer

  • NCT02206360: Pancreatic Cancer Early Detection Program. This pancreatic cancer screening study uses esopheal ultrasound to screen for pancreatic cancer in high risk people. The study is open to people with a MLH1 mutation or other mutation linked to increased cancer risk who also have a family history of pancreatic cancer.
  • NCT03568630: Blood Markers of Early Pancreas Cancer.  This pancreatic cancer study involves blood samples over time to look for biomarkers of pancreatic cancer in high risk people. The study is open to people with an MLH1 mutation or other mutation linked to increased cancer risk.
  • NCT03250078: A Pancreatic Cancer Screening Study in Hereditary High Risk Individuals. The main goal of this study is to screen and detect pancreatic cancer and precursor lesions in individuals with a strong family history or genetic predisposition to pancreatic cancer. MRI and Magnetic cholangiopancreatography (MRI/MRCP) will be utilized to screen for early stage pancreatic lesions.

Visit our Research Search and Enroll Tool to find additional prevention and screening studies. 

Last updated September 03, 2021