title: Standards of care in diagnosis and testing for hereditary colon cancer.
abstract: Inherited colorectal cancer predisposition involves a rather heterogeneous range of rare, yet relatively well-defined disorders, including Familial Adenomatous Polyposis (FAP), Hereditary Non-polyposis Colorectal Cancer (HNPCC) or Lynch syndrome, Peutz-Jeghers syndrome, Juvenile Polyposis, and their respective variants. Due to their individual rarity and highly specialized genetic diagnostic and management demands, patients and families are often seen in tertiary referral centers. For the practitioner encountering a patient suspected of having one of these conditions, guidance is usually necessary. Fortunately, detailed clinical practice guidelines have been promulgated by leading medical specialty societies. Such guidelines, which specifically do include these conditions, have the effect of codifying best or recommended approaches. It is not clear that such guidelines actually codify standards of care. To the extent such guidelines enunciate a standard of care, their impact on the legal process remains largely undefined. Because clinical practice guidelines are readily available to patients and lawyers alike through easily accessible websites, practitioners may expect to be increasingly held accountable for departing from such guidelines. Since the medical-legal implications are evident, we expect these guidelines to impact the management of familial cancer, even in the persistent absence of clear precedents in the medical malpractice arena. This paper undertakes to provide practitioners and academics some perspective on clinical practice guidelines and their potential for medical-legal application.
authors: Department of Gastrointestinal Medicine & Nutrition - 436, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77230-1402, USA. plynch@mdanderson.org
authors: Patrick M
authors: PM
authors: Lynch
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000175:diagnosis / Q000235:genetics; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis / Q000235:genetics; D005817:Genetic Counseling / Q000331:legislation & jurisprudence / Q000592:standards*; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000592:standards*; D006801:Humans; D007390:International Agencies / Q000592:standards; D008318:Malpractice; D008495:Medical Oncology / Q000331:legislation & jurisprudence / Q000592:standards; D010580:Peutz-Jeghers Syndrome / Q000175:diagnosis* / Q000235:genetics*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D014481:United States
references: JAMA. 1997 Mar 19;277(11):915-9
references: 9062331
references: Ann Intern Med. 1995 Mar 15;122(6):450-5
references: 7856994
references: Med J Aust. 1998 Sep 21;169(6):330-3
references: 9785532
references: J Genet Couns. 2004 Apr;13(2):83-114
references: 15604628
references: J R Soc Med. 2003 Mar;96(3):133-8
references: 12612117
references: JAMA. 2004 Sep 22;292(12):1469-73
references: 15383518
references: Heart. 2002 May;87(5):472-9
references: 11997427
references: JAMA. 2006 Sep 27;296(12):1507-17
references: 17003399
references: Gut. 2003 May;52 Suppl 2:ii19-22
references: 12651878
references: Gastroenterology. 2003 Feb;124(2):544-60
references: 12557158
references: BMJ. 2004 Oct 30;329(7473):1024-8
references: 15514351