Issues

People with Lynch syndrome (LS) are at higher risk of cancer at multiple sites because of an inherited defect in a gene encoding one of proteins responsible for DNA mismatch repair. In this long-term follow-up of nearly 1000 people with LS who had been randomised to a supplement of resistant starch (RS; a form of dietary fibre) for mean 29 months, those given RS had fewer non-colorectal LS cancers than those randomised to placebo as shown by Mathers and colleagues starting on page 623. The reduced risk appeared to be particularly pronounced for cancers of the upper gastrointestinal (GI) tract (pancreas, bile duct, stomach and duodenum). This finding has important potential implications for the management of patients with LS because surveillance for such upper GI cancers is challenging and survival after upper GI cancer diagnosis is much lower than for other LS cancers, including colorectal cancer. Since LS appears to be a useful model for cancer in the general population, the findings from this study should stimulate research on RS (and, by analogy, dietary fibre) and risk of non-colorectal cancers. The cover background symbolises the inherited DNA damage that causes LS and depicts slightly under-ripe bananas as an example of a food that is rich in RS.