title: Successful implementation of Lynch syndrome screening in a safety net institution.
abstract: Lynch syndrome (LS) is the most common cause of hereditary colorectal cancer (CRC), and national guidelines recommend screening patients with CRC for LS. However, there is a paucity of data related to Lynch syndrome in the underserved population, in which unique issues of access, cultural beliefs regarding cancer, language barriers, immigration status, and financial restraints exist. We performed a descriptive, retrospective review of a selective LS screening protocol at an urban safety net hospital between 2009 and 2014 with the aim of describing the detected prevalence of LS as well as reporting the high quality and suboptimal screening rates. A total of 154 cases of CRC were identified over the 5-year period, of which 57 met selective LS screening criteria. Eleven patients had a positive screen, and three patients were diagnosed with LS, leading to an overall detected LS prevalence of 1.9 %. The rate of high quality screen was greater than 90 %, consistent with prior studies. Thus, we show that screening for LS in a safety net hospital can be successful in achieving high quality screening and provide an example for other public hospitals considering implementation of hereditary cancer screening.
authors.affiliation: Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Trilokesh D
authors.initials: TD
authors.lastname: Kidambi
authors.affiliation: San Francisco and San Francisco General Hospital Cancer Genetics and Prevention Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Terdiman
authors.affiliation: Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA. Lukejohn.Day@ucsf.edu.|Division of Gastroenterology, San Francisco General Hospital, 1001 Potrero Ave, SFGH 5, San Francisco, CA, 94110, USA. Lukejohn.Day@ucsf.edu.
authors.forename: Lukejohn
authors.initials: L
authors.lastname: Day
keywords: Hereditary colon cancer; Immunohistochemistry; Lynch syndrome; Underserved screening