domingo, 9 de julio de 2017

Community Practice Implementation of a Self-administered Version of PREMM1,2,6 to Assess Risk for Lynch Syndrome. - PubMed - NCBI

2017 Jun 28. pii: S1542-3565(17)30784-X. doi: 10.1016/j.cgh.2017.06.038. [Epub ahead of print]

Community Practice Implementation of a Self-administered Version of PREMM1,2,6 to Assess Risk for Lynch Syndrome.

Luba DG1, DiSario JA1, Rock C2, Saraiya D2, Moyes K2, Brown K2, Rushton K2, Ogara MM1, Raphael M1, Zimmerman D1, Garrido K1, Silguero E1, Nelson J3, Yurgelun MB4, Kastrinos F5, Wenstrup RJ2, Syngal S6.

Author information

Abstract

BACKGROUND & AIMS:

Lynch syndrome is a genetic disorder that greatly increases risk for colorectal and other cancers, though it is underdiagnosed. PREMM1,2,6 is a web-based tool that analyzes individuals' personal/family histories of cancer to quantify their likelihood of carrying a germline mutation associated with Lynch syndrome. We investigated the feasibility of systematic risk assessment for Lynch syndrome in a community gastroenterology practice using a patient-completed version of PREMM1,2,6.

METHODS:

PREMM1,2,6 was adapted into a computer tablet version designed for self-administration by patients. Individual presenting to a community gastroenterology office and endoscopy facility in California completed the PREMM1,2,6 assessment before their visit (n=3134). The total study duration (8 months) comprised a 2-month initiation period (May 1, 2013 to June 30, 2013) and a 6-month study period (July 1, 2013 to December 31, 2013). Genetic counseling and germline analysis for mutations in genes associated with Lynch syndrome (MLH1, MSH2, MSH6, PMS2, and EPCAM) were offered to individuals with PREMM1,2,6 scores of 5% or higher. Patients and providers completed surveys to evaluate the feasibility and satisfaction with the process.

RESULTS:

Of the 3134 individuals assessed by PREMM1,2,6 during the 6-month study period, 177 individuals (5.6%) had scores of 5% or higher. Of these, 146 individuals underwent genetic testing, along with 28 additional participants recruited nonconsecutively during the initiation period Mutations associated with Lynch syndrome were detected in 3 of the 146 individuals (2.1%) with PREMM1,2,6 scores of 5% or higher who underwent germline testing, and 3 of the 28 patients (10.7%) recruited during study initiation with PREMM1,2,6 scores of 5% or higher. Of the participants who underwent genetic analysis, 98.6% stated that the understood the information provided to them. All of the surveyed providers stated that they were satisfied with the incorporation of PREMM1,2,6 into their clinical practice, and that they would continue to using it to assess risk for Lynch syndrome.

CONCLUSION:

A patient self-administered version of the PREMM1,2,6 Lynch syndrome risk assessment model can be systematically used in community-based gastroenterology and endoscopy practices.