ABOUT LYNCH SYNDROME

Colon cancer at 40 doesn't feel random — because it wasn't. Half your family is asking whether it's coming for them, too.

Whole genome sequencing identifies the specific mismatch repair gene variant — giving you and your family the certainty to act on what you inherit before cancer develops.

MLH1
MSH2
MSH6
PMS2

About this condition

Lynch Syndrome

Lynch Syndrome is caused by inherited variants in genes that encode proteins of the DNA mismatch repair (MMR) system: MLH1, MSH2, MSH6, and PMS2. These proteins correct errors in DNA replication — when they fail, mutations accumulate unchecked, accelerating tumor formation. The result is a syndrome characterized by lifetime colorectal cancer risk of 40–80%, with endometrial cancer in women being the second most common manifestation.

Approximately 1 in 279 people carry a Lynch Syndrome variant, making it the most common hereditary colorectal cancer syndrome. The two most commonly implicated genes, MLH1 and MSH2, confer the highest cancer risks and the earliest age of onset. MSH6 and PMS2 variants are associated with later onset and lower overall lifetime cancer risk — yet still warrant enhanced surveillance. The syndrome also accounts for 2–5% of all colorectal cancers in the population.

Identifying the specific gene involved has immediate clinical implications. A Lynch variant follows autosomal dominant inheritance, meaning each child of a carrier has a 50% chance of inheritance. Colonoscopy screening every 1–2 years starting at age 20–25 reduces colorectal cancer mortality by approximately 65%. Women qualify for gynecological risk assessment and may elect risk-reducing surgery. For tumors that develop with MSI-high status, immunotherapy (pembrolizumab) produces dramatic responses. One person's genetic finding opens the door to preventive action across the entire family.

Lynch Syndrome is genetically stratifiable: MLH1 and MSH2 carriers have the highest cancer risks with earlier age of onset; MSH6 carriers have later onset with lower lifetime risk; PMS2 carriers have the mildest phenotype — these gene-specific risk profiles guide the intensity of surveillance.

Gene locus: MLH1 (3p22.2), MSH2 (2p21-p16.3), MSH6 (2p16.3), PMS2 (7p22.1)

Standard Lynch panels focus on MLH1, MSH2, MSH6, and PMS2 alone. Up to 20% of Lynch families have EPCAM deletions that standard sequencing misses entirely.

Structural variants slip through standard sequencing

Lynch Syndrome can be caused by large deletions in EPCAM (located upstream of MSH2) that silence MSH2 expression through promoter methylation. These rearrangements are not detectable by short-read sequencing panels — they require specialized deletion analysis that most standard tests do not perform. Whole genome sequencing reads the full DNA sequence at sufficient depth to identify structural variants, capturing the full variant landscape in Lynch families.

One result changes cancer prevention for your whole family

Lynch Syndrome variants follow predictable inheritance patterns, enabling cascade testing across families at risk. When a pathogenic MLH1, MSH2, MSH6, or PMS2 variant is identified, first-degree relatives can be offered targeted genetic testing — converting one person's diagnosis into actionable preventive opportunities for siblings, parents, and children. Relatives identified through cascade testing can begin surveillance at age 20–25, potentially preventing cancers before they develop.

One test. A lifetime of answers.

One kit, sent to your home. Your entire genome sequenced at the clinical standard used for diagnostic decisions. 200+ physician-ready reports delivered to your Genome Manager in 6–8 weeks — permanent and updated as science advances.

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