Implementing screening for Lynch syndrome among patients with newly diagnosed colorectal cancer: summary of a public health/clinical collaborative meeting

Abstract

Lynch syndrome is the most common cause of inherited colorectal cancer, accounting for approximately 3% of all colorectal cancer cases in the United States. In 2009, an evidence-based review process conducted by the independent Evaluation of Genomic Applications in Practice and Prevention Working Group resulted in a recommendation to offer genetic testing for Lynch syndrome to all individuals with newly diagnosed colorectal cancer, with the intent of reducing morbidity and mortality in family members. To explore issues surrounding implementation of this recommendation, the Centers for Disease Control and Prevention convened a multidisciplinary working group meeting in September 2010. This article reviews background information regarding screening for Lynch syndrome and summarizes existing clinical paradigms, potential implementation strategies, and conclusions which emerged from the meeting. It was recognized that widespread implementation will present substantial challenges, and additional data from pilot studies will be needed. However, evidence of feasibility and population health benefits and the advantages of considering a public health approach were acknowledged. Lynch syndrome can potentially serve as a model to facilitate the development and implementation of population-level programs for evidence-based genomic medicine applications involving follow-up testing of at-risk relatives. Such endeavors will require multilevel and multidisciplinary approaches building on collaborative public health and clinical partnerships.

Figure 1. Potential population health impact of universal screening for Lynch syndrome

CRC, colorectal cancer; EC, endometrial cancer; LS, Lynch syndrome.

Figure 2. The Ohio State University—clinical Lynch syndrome screening strategy: follow-up of IHC testing on all colorectal cancers

IHC, immunohistochemistry; MSI, microsatellite instability. ^aReferral to genetic counseling if warranted by clinical or family history.

Figure 3. Huntsman Cancer Institute—routine testing strategy for Lynch syndrome

IHC, immunohistochemistry. ^aPatients usually seen during surgical follow-up appointment.