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Suboptimal Adherence in Clinical Practice to Guidelines Recommendation to Screen for Lynch Syndrome
A Jain1, L Shafer1, H Rothenmund2
1Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.
Digestive Diseases and Sciences
|June 13, 2019
Summary
Identifying Lynch syndrome (LS) and providing surveillance colonoscopies significantly lowers colorectal cancer (CRC) risk. However, current LS identification practices vary significantly between the USA and Canada, indicating suboptimal screening across North America.
Area of Science:
- Gastroenterology
- Oncology
- Genetics
Background:
- Lynch syndrome (LS) increases colorectal cancer (CRC) risk.
- Surveillance colonoscopies for LS patients reduce CRC incidence.
- Current practices for LS identification and management are not well-defined.
Purpose of the Study:
- To assess current practices for identifying Lynch syndrome (LS) in the USA and Canada.
- To evaluate surveillance and management strategies for diagnosed LS patients.
- To determine if practice variations are physician/region-dependent or influenced by access to specialist clinics.
Main Methods:
- An online survey was distributed to gastroenterologists in the USA and Canada.
- Participants were recruited via the American College of Gastroenterology and Canadian Association of Gastroenterology.
- Fisher's exact tests analyzed factors associated with LS screening and patient follow-up.
Main Results:
- Less than one-third of gastroenterologists reported LS screening for CRC patients.
- USA physicians reported universal LS screening in 42% of cases, compared to 12% in Canada (p < 0.001).
- Access to hereditary clinics did not significantly influence LS testing rates (35% vs. 34%).
Conclusions:
- Significant disparities exist in Lynch syndrome (LS) identification practices between the USA and Canada.
- Current North American practices for LS screening and management are suboptimal.
- Further research is needed to optimize LS identification and surveillance protocols.
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