title: Implementation of routine screening for Lynch syndrome in university and safety-net health system settings: successes and challenges.
abstract: OBJECTIVE
  Routine screening for evidence of DNA mismatch repair abnormalities can identify colorectal cancer patients with Lynch syndrome, but impact in usual care settings requires study. After implementing routine screening at our university and safety-net health systems as usual practice, our aims were to determine outcomes, including screening process quality.
  
  
  METHODS
  We conducted a retrospective cohort study from 1 May 2010 to 1 May 2011. Screening included reflexive immunohistochemistry to evaluate DNA mismatch repair protein expression for patients with colorectal cancer aged ≤70 years, with a cancer genetics team following up results. Screening outcomes, as well as challenges to a high-quality screening process were evaluated.
  
  
  RESULTS
  We included 129 patients (mean age 56 years, 36% female); 100 had immunohistochemistry screening completed. Twelve patients had abnormal immunohistochemistry: four with definite Lynch syndrome, four with probable Lynch syndrome, and three without Lynch syndrome; one patient had an incomplete work-up. Lynch syndrome was confirmed for 6/13 asymptomatic relatives tested. Screening process quality was optimal for 77.5% of patients. Barriers to optimal quality screening included ensuring reflexive immunohistochemistry completion, complete follow-up of abnormal immunohistochemistry, and timely incorporation of results into clinical decision making.
  
  
  CONCLUSIONS
  Usual care implementation of routine screening for Lynch syndrome can result in significant rates of detection, even in a largely safety-net setting. To optimize implementation, challenges to high-quality Lynch syndrome screening, such as ensuring reflexive screening completion and clinically indicated genetic testing and follow-up for abnormal screens, must be identified and addressed.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Marquez
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Geng
authors.forename: Sarah
authors.initials: S
authors.lastname: Pass
authors.forename: Pia
authors.initials: P
authors.lastname: Summerour
authors.forename: Linda
authors.initials: L
authors.lastname: Robinson
authors.forename: Venetia
authors.initials: V
authors.lastname: Sarode
authors.forename: Samir
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000235:genetics*; D053843:DNA Mismatch Repair; D003695:Delivery of Health Care; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000592:standards*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D064876:Safety-net Providers; D014495:Universities; D055815:Young Adult