Why is lifelong colonoscopic surveillance recommended in Lynch syndrome?

• A. Because lifetime risk remains elevated and surveillance reduces mortality.
• B. Because risk drops to baseline after puberty.
• C. Because colonoscopy cures colorectal cancer.
• D. Because surveillance is optional.

Answer: (A)

Lifelong colonoscopic surveillance is recommended in Lynch syndrome because the cancer risk remains elevated throughout life due to inherited mismatch repair gene mutations, and regular colonoscopy with polypectomy and early cancer detection reduces both cancer incidence and cancer-related mortality. Starting at a young age and continuing at frequent intervals (often every 1–2 years) catches pre-cancerous polyps before they progress and detects cancers at a more treatable stage, improving outcomes. The elevated risk does not return to baseline after puberty, and colonoscopy is a screening tool that lowers risk by prevention and early treatment, not a cure. Surveillance is recommended rather than optional because adherence directly impacts survival.