Are CRC patients Assessed for Lynch Syndrome.

Frontline Gastroenterology -2014;5(1) :31-35 Research.

UK Colorectal Cancer Patients Are Inadequately Assessed for Lynch Syndrome
Maria Adelson, Samuel Pannick, James E East, Peter Risby, Peter Dawson, Kevin J MonahanAUTHORS AND DISCLOSURES
Maria Adelson1, Samuel Pannick2, James E East3, Peter Risby4, Peter Dawson1 and Kevin J Monahan1,2

1 Family History of Bowel Cancer Clinic, Department of Gastroenterology, West Middlesex University Hospital, London, UK
2 Department of Gastroenterology, Family History of Bowel Cancer Clinic, West Middlesex University Hospital, London, UK
3 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
4 Department of Clinical Genetics, Churchill Hospital, Oxford, UKDisclosures

Abstract
Objective -To establish whether colorectal cancer patients in two centres in the UK are screened appropriately for Lynch syndrome, in accordance with current international guidance.
Design – Patients newly diagnosed with colorectal cancer over an 18-month period were identified from the UK National Bowel Cancer Audit Programme. Their records and managment were reviewed retrospectively.
Setting – Two university teaching hospitals, Imperial College Healthcare and Oxford Radcliffe Hospitals NHS Trusts.

Outcomes measured – Whether patients were screened for Lynch syndrome—and the outcome of that evaluation, if it took place—were assessed from patients’ clinical records. The age, tumour location and family history of screened patients were compared to those of unscreened patients.

Results Five hundred and fifty three patients with newly diagnosed colorectal cancer were identified. Of these, 97 (17.5%) satisfied the revised Bethesda criteria, and should have undergone further assessment. There was no evidence that those guidelines had been contemporaneously applied to any patient. In practice, only 22 of the 97 (22.7%) eligible patients underwent evaluation. The results for 14 of those 22 (63.6%) supported a diagnosis of Lynch syndrome, but only nine of the 14 (64.3%) were referred for formal mismatch repair gene testing. No factors reliably predicted whether or not a patient would undergo Lynch syndrome screening.

Conclusions – Colorectal teams in the UK do not follow international guidance identifying the patients who should be screened for Lynch syndrome. Patients and their families are consequently excluded from programmes reducing colorectal cancer incidence and mortality. Multidisciplinary teams should work with their local genetics services to develop reliable algorithms for patient screening and referral.