Dr. Roach: Lynch syndrome could link family’s cancers

Keith Roach
To Your Health

Dear Dr. Roach: On my mother’s side of the family, all four sisters out of seven children were diagnosed with cancer and have died from the disease. Their ages at the time they passed ranged between 60 and 70, and the type of cancer was different for each of them (lung, gallbladder, uterus and stomach). The men in the family do not seem to be affected even though all were raised in the same household with the same parents. Clearly the vulnerability lies with the women.

Is there any genetic test or other proactive step that female (or male?) children can take to detect predisposition to cancer? My family doctor tells me that since the cancer was different for each, the best advice is to stay current with normal screenings, such as mammograms and Pap smears.

Is there anything else you would recommend? Does this maternal family history typically reoccur with each new generation?

— O.N.

Dear O.N.: There are many cancers that run in families, but fewer syndromes that increase the risk for multiple cancers. One to be concerned with in your family’s situation is Lynch syndrome, also called hereditary nonpolyposis colorectal cancer. People with Lynch syndrome may get cancers of the stomach and gallbladder as your family members have, in addition to the colon cancer, which is common. Less common are cancer of the small intestine, urinary tract, brain and skin. Women are at risk for ovarian cancer as well as uterine cancer.

Not everyone with Lynch syndrome will develop these types of cancer, nor necessarily cancer at all. It is often unrecognized. I am not at all sure your family is affected by this syndrome caused by specific genetic mutations; the lung cancer does not fit the pattern. However, given your family history, I would ask your doctor about referral to a licensed genetic counselor with experience in this condition.

I’m not as sure as you are that the vulnerability lies only with the women. It’s possible it was just chance that the men were not affected.

Dr. Roach writes: In 2014, I answered a letter from a woman whose son, who had a history of drug addiction, was being treated with 11 different psychiatric medicines. I answered that I was very worried about that list, that there was a high potential for bad drug interactions, and that some of the medicines used were dangerous for a person with a history of drug addiction.

Unfortunately, before my response was published, her son died of respiratory failure. She took action against the physician who prescribed all the medicines to her son.

This week, she wrote me that the physician was found guilty of gross negligence and is permanently barred from prescribing controlled substances. The hospital as well was found to be at fault, required to comply with protocol changes, and will be closely monitored for years.

She wrote: “This was a very long process but worth the work and wait. Somehow it feels like it was the last act of love that I could do for my son. I miss him so, so much!”

I’m writing this in my column because there are a few incompetent physicians. It is painful to see a tragedy such as what happened. Patients and family members should trust their instincts when it comes to questioning a care plan, and in the face of warning signs, never be afraid to seek a second opinion. My heart aches for my anonymous reader, but I am glad that she took the steps to help prevent another person from being a victim of this physician’s dangerous incompetence.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.