title: Availability and scope of integrated screening for patients with Lynch syndrome.
abstract: OBJECTIVE
  To assess the availability and capacity of US-based integrated centers for the management of Lynch syndrome.
  
  
  METHODS
  A cross-sectional survey of practice patterns in the care of patients with Lynch syndrome was conducted at 33 National Cancer Institute-designated cancer centers in the USA from March 1 to June 1, 2013. Each cancer center was contacted by telephone and the caller used a uniform scripted greeting and survey format.
  
  
  RESULTS
  All centers routinely recommended colonoscopy. Other recommended screening modalities were hysterectomy and bilateral salpingo-oophorectomy (29/33; 88%), endoscopy (27/33; 82%), urinalysis (23/33; 70%), endometrial sampling (21/33; 64%), dermatologic examination (19/32; 59%), pelvic ultrasonography (18/33; 55%), serum CA125 level (14/33; 42%), urine cytology (14/33; 42%), computed tomography (1/33; 3%), and magnetic resonance imaging (1/33; 3%). Each center had a multidisciplinary team but the composition varied. A designated team leader was present at 21 centers (64%). Having a team leader was associated with an increased likelihood of recommending endoscopy (P=0.04) and dermatologic surveillance (P=0.01). Only 23 centers (70%) had a system in place for communicating follow-up with patients.
  
  
  CONCLUSIONS
  The lack of consensus in practice patterns recorded among participating centers probably reflected the limited existing evidence on the usefulness of most screening modalities.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Medical Center, New York, NY, USA. Electronic address: Melissa.Frey@nyumc.org.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Frey
authors.affiliation: Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Pauk
authors.affiliation: Department of Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Caputo
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Haley A
authors.initials: HA
authors.lastname: Moss
authors.affiliation: Department of Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Sapra
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Gerber
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stewart
mesh_terms: D000328:Adult; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000592:standards / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D016099:Endoscopy, Gastrointestinal; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States
keywords: Colonoscopy; Endometrial biopsy; Lynch syndrome; National Cancer Institute-designated cancer centers; Screening; Surveillance