Suboptimal Adherence in Clinical Practice to Guidelines Recommendation to Screen for Lynch Syndrome

• Published in: Digestive diseases and sciences Vol. 64; no. 12; pp. 3489 - 3501
• Main Authors: Jain, A., Shafer, L., Rothenmund, H., Kim, C. A., Samadder, J., Gupta, S., Singh, H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2019; Springer; Springer Nature B.V
• Subjects: Age; Associations, institutions, etc; Biochemistry; Canada; Cancer; Clinical medicine; Colonoscopy; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - genetics; Colorectal Neoplasms - metabolism; Colorectal Neoplasms, Hereditary Nonpolyposis - diagnosis; Colorectal Neoplasms, Hereditary Nonpolyposis - genetics; Colorectal Neoplasms, Hereditary Nonpolyposis - metabolism; Confidence intervals; Early Detection of Cancer - statistics & numerical data; Endometrial cancer; Gastroenterologists; Gastroenterology; Genetic counseling; Genetic disorders; Guideline Adherence - statistics & numerical data; Health aspects; Hepatology; Humans; Immunohistochemistry; Internal medicine; Mass Screening; Medical screening; Medicine; Medicine & Public Health; Microsatellite Instability; Mortality; Mutation; Oncology; Original Article; Practice guidelines (Medicine); Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Prevention; Risk assessment; Societies; Surveillance; Surveys; Systematic review; Transplant Surgery; United States; Canada; United States; United States > US; Colon cancer screening; Hereditary risk; Lynch syndrome; Surveillance endoscopy
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05692-6

Background
Identification of Lynch syndrome (LS) followed by annual/biannual surveillance colonoscopy markedly reduces the risk of developing new colorectal cancer (CRC) among those with LS.
Aims
(1) To determine the current practice of identifying LS in the USA and Canada, and current surveillance and management practices for those diagnosed with LS; (2) to determine whether variances in current practice are physician/region dependent or influenced by ease of access to specialist clinics.
Methods
An online survey request was sent to practicing gastroenterologists through the Canadian Association of Gastroenterology and the American College of Gastroenterology. Fisher’s exact tests were performed to determine the factors associated with screening for LS and separately for follow-up, surveillance, and management.
Results
A total of 249 participants were recruited, of which 237 were gastroenterologists and included in the analysis. Less than one-third of practicing gastroenterologists indicated that their CRC patients were undergoing screening tests to identify LS. While 42% (65/153) of participants from the USA stated that their patients were undergoing universal LS screening (i.e., among all diagnosed with CRC), only 12% (6/49) of participants from Canada reported this practice (
p
 < 0.001). There was no difference in reported practice between the physicians that do and do not have access to hereditary clinics (35% vs. 34% testing;
p
 = 0.54). Appropriate surveillance interval to look for CRC in patients with LS was recommended by most.
Conclusion
This survey suggests there is a significant difference in practice between Canada and the USA in regard to identification of LS, with suboptimal practice throughout North America.