Factors Associated with Adherence to Recommended Colorectal Surveillance Intervals in Lynch Syndrome

Background: Lynch syndrome (LS) is the most common hereditary cause of colorectal cancer (CRC), and colorectal surveillance has been shown to reduce death from CRC in this high-risk population. This study aimed to examine adherence to recommended endoscopic surveillance intervals in a LS cohort and identify factors associated with adherence. Methods: A retrospective review was performed of 1403 lower endoscopic procedure (LEP) reports from 540 individuals with LS completed between May 2001 and September 2023. Adherence was calculated by comparing the endoscopists' recommended interval to the actual date of the subsequent procedure. Reports from individuals with ≥2 LEPs and those with follow-up intervals within the study period were included (n = 1170). A mixed-effect logistic regression analysis identified factors associated with adherence. Results: Among 1170 LEPs from 295 LS carriers, 67.4% were performed within the recommended interval. However, 68.8% of individuals had at least one procedure that was delayed. Increased adherence was significantly associated with prior detection of CRC (OR 9.30, 95% CI 1.16-74.32, p = 0.035) on an LEP. Marital status was significantly associated with adherence, with higher rates among married (OR 1.73, 95% CI 1.05-2.85, p = 0.030) and divorced/widowed individuals (OR 2.32, 95% CI 1.14-4.72, p = 0.020). Current smokers had a lower rate of adherence (OR 0.33, 95% CI 0.13-0.82, p = 0.018). No significant associations were observed with age, biological sex, race, or insurance status. Conclusions: Nearly one third of LEPs in our LS cohort were delayed. Efforts to address barriers and enhance adherence are essential to optimize outcomes for this high-risk population.