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

Source

From the 1Office of Public Health Genomics, Centers for Disease Control and Prevention; 2Department of Human Genetics, Emory University School of Medicine; 3National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA; 4Michigan Department of Community Health, Lansing, MI; 5Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Comprehensive Cancer Center, Columbus, OH; 6Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; 7Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; 8Office of Educational Development and Research, University of Colorado School of Medicine, Aurora, CO; 9Laboratory Research and Evaluation Branch, Centers for Disease Control and Prevention, Atlanta, GA; 10Department of Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, UT; 11Department of Veterans Affairs, Greater Los Angeles Healthcare System and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; 12Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; 13Department of Surgery, Vanderbilt University Medical Center, Nashville, TN; and 14Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.

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 wide-spread 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 evidencebased 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.