title: Initiation of universal tumor screening for Lynch syndrome in colorectal cancer patients as a model for the implementation of genetic information into clinical oncology practice.
abstract: BACKGROUND
  Lynch syndrome confers a hereditary predisposition to colorectal and other cancers. Universal tumor screening (UTS) for Lynch syndrome is recommended by several professional societies, but the implementation can be complex. This article describes the evaluation, process development, and initiation of Lynch syndrome UTS at a tertiary referral cancer center.
  
  
  METHODS
  A multidisciplinary team developed the new process design. Issues in 5 themes were noted: timing, funding, second-opinion patients, result processing, and the role of genetics providers. A committee approach was used to examine each issue for process-improvement development.
  
  
  RESULTS
  The issues related to testing were addressed individually for the successful implementation of UTS at the institutional level. In the conventional-care period, 9 of 30 cases (30%) received Lynch syndrome screening, and 4 cases were referred to medical genetics. During the 6 months following the implementation of UTS, 32 of 44 patients (73%) received Lynch syndrome screening. The 13 unscreened patients all had identified reasons for nonscreening (eg, financial limitations). Ten patients were referred to medical genetics, which identified no new cases of Lynch syndrome, but a low-risk adenomatous polyposis coli (APC) variant was detected in 1 individual.
  
  
  CONCLUSIONS
  The implementation of effective Lynch syndrome UTS can feasibly alter practice at the institutional level. This experience with the assessment and management of issues relevant to the successful implementation of a new clinical care paradigm based on emerging technology has implications for the uptake of advances across molecular oncology into clinical practice, and this is highly relevant in the current era of rapidly evolving genomic technology.
authors.affiliation: Division of Oncology, University of Washington, Seattle, Washington.|Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Cohen
authors.affiliation: Division of Medical Genetics, University of Washington, Seattle, Washington.|Genetic Counseling, Seattle Cancer Care Alliance, Seattle, Washington.|Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Mercy
authors.initials: M
authors.lastname: Laurino
authors.affiliation: Department of Bioethics and Humanities, University of Washington, Seattle, Washington.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Bowen
authors.affiliation: Department of Pathology, University of Washington, Seattle, Washington.
authors.forename: Melissa P
authors.initials: MP
authors.lastname: Upton
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: Colin
authors.initials: C
authors.lastname: Pritchard
authors.affiliation: Division of Medical Genetics, University of Washington, Seattle, Washington.
authors.forename: Fuki
authors.initials: F
authors.lastname: Hisama
authors.affiliation: Division of Medical Genetics, University of Washington, Seattle, Washington.|Department of Genome Sciences, University of Washington, Seattle, Washington.
authors.forename: Gail
authors.initials: G
authors.lastname: Jarvik
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fichera
authors.affiliation: Genetic Counseling, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Britta
authors.initials: B
authors.lastname: Sjoding
authors.affiliation: Division of Medical Genetics, University of Washington, Seattle, Washington.|Genetic Counseling, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Bennett
authors.affiliation: Division of Medical Genetics, University of Washington, Seattle, Washington.|Genetic Counseling, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Naylor
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: Angela
authors.initials: A
authors.lastname: Jacobson
authors.affiliation: Department of Bioethics and Humanities, University of Washington, Seattle, Washington.
authors.forename: Wylie
authors.initials: W
authors.lastname: Burke
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.|Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.|Division of Gastroenterology, University of Washington, Seattle, Washington.
authors.forename: William M
authors.initials: WM
authors.lastname: Grady
mesh_terms: D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities; D015179:Colorectal Neoplasms / Q000150:complications / Q000191:economics; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000191:economics / Q000235:genetics*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D057089:Pathology, Molecular / Q000379:methods; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D014861:Washington
keywords: Lynch syndrome; genetics; genomics; microsatellite instability; molecular oncology