One-Stop Colon and Endometrial Screening (ONCE): a prospective study of combined cancer screening for Lynch syndrome

Individuals with Lynch syndrome face up to a 60% lifetime risk of developing endometrial and gastrointestinal cancer. Established guidelines recommend colonoscopies every 1 to 2 years beginning at age 20 to 25 and endometrial biopsy every 1 to 2 years beginning at age 30 to 35. We evaluated the patient experience with a combined endometrial biopsy and gastrointestinal cancer screening procedure for patients with Lynch syndrome.

Patients with Lynch syndrome undergoing combined colon and endometrial screening from June 2021 to September 2023 were prospectively enrolled. Patients had both procedures during a single session using propofol sedation. Appropriate patients also underwent upper endoscopy. Patient satisfaction was assessed by questionnaire. Surveys were distributed to patients via email 1 day after their procedure. Twenty patients were enrolled, and 18 completed the survey (90%).

None of the patients reported pain during the procedure. The average combined procedure duration was 42 minutes (range 27-59) and average total operating room time was 54 minutes (range 37-93). One patient was found to have complex atypical endometrial hyperplasia and had a hysterectomy for stage 1 A uterine clear cell carcinoma. There were no cases of colon or gastric cancer. A total of six adenomatous polyps and five serrated polyps were removed.

Patients with Lynch syndrome undergoing One-Stop Colon and Endometrial Screening (ONCE) reported high satisfaction with the combined procedure. To maximize patient care, physicians and health care systems should consider support for and investment in the implementation of combined screening approaches.