PMS2 gene - Cancer risk, management, and testing for genetic mutations

Associated Syndrome Name: Lynch syndrome/Hereditary non-polyposis colorectal cancer (HNPCC)

PMS2 Summary Cancer Risk Table

Cancer Genetic Cancer Risk
ColorectalHigh Risk
EndometrialHigh Risk

PMS2 gene Overview

Lynch syndrome 1, 2, 3, 4, 5, 6, 7, 8, 9
  • Individuals with mutations in PMS2 have Lynch syndrome. This condition is also known as hereditary non-polyposis colorectal cancer (HNPCC).
  • Men and women with Lynch syndrome due to mutations in PMS2 have a high risk of developing colorectal cancer, often at younger ages than seen in the general population. Colorectal cancer in patients with Lynch syndrome develops from adenomatous polyps which progress to cancer more quickly than polyps in individuals who do not have Lynch syndrome.
  • Women with Lynch syndrome due to mutations in PMS2 have a high risk for developing endometrial cancer and possibly an elevated risk for ovarian cancer, often at younger ages than typical in the general population.
  • There is still some uncertainty as to whether patients with Lynch syndrome due to PMS2 mutations have significantly increased risks for the wide variety of cancers associated with Lynch syndrome due to mutations in other genes. These cancers include small bowel, urinary tract, hepatobiliary tract, brain (usually glioblastoma), sebaceous gland, gastric, ovarian, prostate, and pancreatic. There are currently no specific medical management guidelines for screening of these cancers in PMS2 mutation carriers.
  • Cancer risks may be more significant in patients with a family history of particular cancers. Therefore, the general screening and management recommendations provided below should be modified based on individualized risk assessment and counseling.
  • Studies have investigated the possibility that patients with Lynch syndrome have an increased risk for other cancers, including breast cancer and adrenocortical carcinoma. However, the data are not conclusive at this time and there are currently no medical management guidelines related to these cancers.
  • Patients with Lynch syndrome have a high risk for developing second primary cancers following an initial diagnosis of colorectal or endometrial cancer. This includes a high risk for endometrial cancer in women following colorectal cancer and vice versa, a high risk for a second primary colorectal cancer in any portions of the colon or rectum remaining after surgical treatment, and in patients with Lynch syndrome due to mutations in PMS2 a possibly elevated risk for other Lynch associated cancers.
  • The timing of risk-reducing gynecological surgeries in individuals with Lynch syndrome due to mutations in PMS2 should be individualized based on whether childbearing is complete, the individual's medical and surgical history, family history, and other relevant factors.
  • Although there are high risks for cancer in patients with Lynch syndrome, many of these risks can be greatly reduced with appropriate medical management. Guidelines for the medical management of patients with Lynch syndrome have been developed by the National Comprehensive Cancer Network (NCCN) and other expert groups. These are listed below. It is recommended that patients with a PMS2 mutation and a diagnosis of Lynch syndrome be managed by a multidisciplinary team with expertise in medical genetics and the care of patients with this condition.

PMS2 gene Cancer Risk Table

Cancer Type Age Range Cancer Risk Risk for General Population
ColorectalTo age 702, 3, 10, 11, 12Up to 20%1.8%
EndometrialTo age 701, 2, 3, 10, 12, 13, 1412%-26%1.9%
Overall cancer risk (Lynch cancers)Risk for a second Lynch-related cancer after a first cancer diagnosis15, 16Increased riskNA

PMS2 Cancer Risk Management Table

The overview of medical management options provided is a summary of professional society guidelines. The most recent version of each guideline should be consulted for more detailed and up-to-date information before developing a treatment plan for a particular patient.

This overview is provided for informational purposes only and does not constitute a recommendation. While the medical society guidelines summarized herein provide important and useful information, medical management decisions for any particular patient should be made in consultation between that patient and his or her healthcare provider and may differ from society guidelines based on a complete understanding of the patient’s personal medical history, surgeries and other treatments.

Cancer Type Procedure Age to Begin Frequency
(Unless otherwise indicated by findings)
ColorectalColonoscopy1730 to 35 years, or 2 to 5 years younger than the earliest colorectal cancer diagnosis in the family if it is under age 30Every 1 to 3 years
Consider the use of aspirin as a risk-reduction agent.17IndividualizedIndividualized
EndometrialPatient education about the importance of quickly seeking attention for endometrial cancer symptoms, such as abnormal bleeding or menstrual cycle irregularities17IndividualizedIndividualized
Consider endometrial biopsy.1730 to 35 yearsEvery 1 to 2 years
Consider transvaginal ultrasound.17After menopauseIndividualized
Consider hysterectomy.1750 yearsNA
Consider options for endometrial cancer risk-reduction agents (i.e. oral contraceptives, progestin intrauterine systems).17IndividualizedNA
For Patients With A Cancer DiagnosisFor patients with a gene mutation and a diagnosis of cancer, targeted therapies may be available as a treatment option for certain tumor types (e.g., antibodies to PD-1)18NANA

Benefits of Testing for PMS2 Gene Mutations:

Testing for PMS2 gene mutations with the MyRisk® Hereditary Cancer Test with RiskScore® provides critical insights to patients and providers about potential hereditary cancer risk. Identifying a PMS2 gene mutation can help clarify whether a patient is at increased risk for certain cancers and guide proactive, personalized care planning. With definitive answers from the MyRisk Test, healthcare providers can better tailor screening, prevention, and management strategies, while patients gain clarity and confidence about their hereditary cancer risk. In addition, understanding a PMS2 gene mutation allows family members to consider their own hereditary cancer risk, supporting informed decision-making and potentially life-saving early interventions. Learn more about the MyRisk® with RiskScore® Hereditary Cancer Test.

Information for Family Members

The following information for Family Members will appear as part of the MMT for a patient found to have a mutation in the PMS2 gene.

This patient's relatives are at risk for carrying the same mutation(s) and associated cancer risks as this patient. Cancer risks for females and males who have this/these mutation(s) are provided below.

Family members should talk to a healthcare provider about genetic testing. Close relatives such as parents, children, brothers and sisters have the highest chance of having the same mutation(s) as this patient. Other more distant relatives such as cousins, aunts, uncles, and grandparents also have a chance of carrying the same mutation(s). Testing of at-risk relatives can identify those family members with the same mutation(s) who may benefit from surveillance and early intervention.

In rare instances, an individual may inherit mutations in both copies of the PMS2 gene, leading to the condition constitutional mismatch repair-deficiency syndrome (CMMR-D). Individuals with CMMR-D often have significant complications in childhood, including colorectal polyposis and a high risk for colorectal, small bowel, brain, and hematologic cancers. Individuals with CMMR-D often have café-au-lait spots. The children of this patient are at risk of inheriting CMMR-D only if the other parent is also a carrier of a PMS2 mutation. Screening the other biological parent of any children for PMS2 mutations may be appropriate.7, 10

Parents who are concerned about the possibility of passing on a PMS2 mutation to a future child may want to discuss options for prenatal testing and assisted reproduction techniques, such as pre-implantation genetic diagnosis (PGD).17

References

  1. Møller P, et al. Cancer incidence and survival in Lynch syndrome patients receiving colonoscopic and gynaecological surveillance: first report from the prospective Lynch syndrome database. Gut. 2017 66:464-472. PMID: 26657901.
  2. Dominguez-Valentin M, et al. Cancer risks by gene, age, and gender in 6350 carriers of pathogenic mismatch repair variants: findings from the Prospective Lynch Syndrome Database. Genet Med. 2020 22:15-25. PMID: 31337882.
  3. Ten Broeke SW, van der Klift HM, Tops CMJ, Aretz S, Bernstein I, Buchanan DD, de la Chapelle A, Capella G, Clendenning M, Engel C, Gallinger S, Gomez Garcia E, Figueiredo JC, Haile R, Hampel HL, Hopper JL, Hoogerbrugge N, von Knebel Doeberitz M, Le Marchand L, Letteboer TGW, Jenkins MA, Lindblom A, Lindor NM, Mensenkamp AR, Møller P, Newcomb PA, van Os TAM, Pearlman R, Pineda M, Rahner N, Redeker EJW, Olderode-Berends MJW, Rosty C, Schackert HK, Scott R, Senter L, Spruijt L, Steinke-Lange V, Suerink M, Thibodeau S, Vos YJ, Wagner A, Winship I, Hes FJ, Vasen HFA, Wijnen JT, Nielsen M, Win AK. Cancer Risks for PMS2-Associated Lynch Syndrome. J Clin Oncol. 2018 Oct 10;36(29):2961-2968. doi: 10.1200/JCO.2018.78.4777. Epub 2018 Aug 30. Erratum in: J Clin Oncol. 2019 Mar 20;37(9):761. PMID: 30161022; PMCID: PMC6349460.
  4. Ryan S, et al. Risk of prostate cancer in Lynch syndrome: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014 23:437-49. PMID: 24425144.
  5. Grindedal EM, et al. Germ-line mutations in mismatch repair genes associated with prostate cancer. Cancer Epidemiol Biomarkers Prev. 2009 18:2460-7. PMID: 19723918.
  6. Raymond VM, et al. Elevated risk of prostate cancer among men with Lynch syndrome. J Clin Oncol. 2013 31:1713-8. oi: 10.1200/JCO.2012.44.1238. Epub 2013 Mar 25. PMID: 23530095.
  7. Idos G, Valle L. Lynch Syndrome. 2021 Feb 4. In:Pagon RA, et al., editors. GeneReviews® [Internet]. PMID: 20301390.
  8. Joost P, et al. Urinary Tract Cancer in Lynch Syndrome; Increased Risk in Carriers of MSH2 Mutations. Urology. 2015 86:1212-7. PMID: 26385421.
  9. Kastrinos F, et al. Risk of pancreatic cancer in families with Lynch syndrome. JAMA. 2009 302:1790-5. PMID: 19861671.
  10. Senter L, et al. The clinical phenotype of Lynch syndrome due to germline PMS2 mutations. Gastroenterology. 2008 135:419-28. PMID: 18602922.
  11. Suerink M, et al. An alternative approach to establishing unbiased colorectal cancer risk estimation in Lynch syndrome. Genet Med. 2019 21:2706-2712. PMID: 31204389.
  12. SEER*Explorer: An interactive website for SEER cancer statistics [Internet]. Surveillance Research Program, National Cancer Institute. [Cited 2025 Aug 12]. Available from https://seer.cancer.gov/explorer/.
  13. Møller P, et al. Cancer risk and survival in path_MMR carriers by gene and gender up to 75 years of age: a report from the Prospective Lynch Syndrome Database. Gut. 2018 67:1306-1316. PMID: 28754778.
  14. Vasen HF, et al. Hereditary cancer registries improve the care of patients with a genetic predisposition to cancer: contributions from the Dutch Lynch syndrome registry. Fam Cancer. 2016 15:429-35. PMID: 26973060.
  15. Win AK, et al. Risks of primary extracolonic cancers following colorectal cancer in lynch syndrome. J Natl Cancer Inst. 2012 104:1363-72. PMID: 22933731.
  16. Win AK, et al. Risks of colorectal and other cancers after endometrial cancer for women with Lynch syndrome. J Natl Cancer Inst. 2013 105:274-9. PMID: 23385444.
  17. Gupta S, et al. NCCN Clinical Practice Guidelines in Oncology® Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric. V 1.2025. Jun 13. Available at https://www.nccn.org.
  18. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/125514s031lbl.pdf.
Last Updated on 15-Sep-2025