A Single Institution Experience in Compliance with Universal Screening for Lynch Syndrome in Colorectal Cancer

Abstract

BackgroundDetection of Lynch syndrome has the potential to reduce morbidity and mortality among patients and their family members due to beneficial screening and treatment options. Several institutions have begun to adopt universal rather than risk-stratified screening protocols, but the lack of 100 % compliance rates requires identification of system-level interventions to improve screening practices. ObjectiveWe aimed to identify patient, tumor, and system factors associated with lack of screening and identify system-based interventions to improve Lynch syndrome screening. Design and SettingsThis study is a retrospective analysis of Lynch syndrome screening among colorectal cancer patients undergoing surgery in a single healthcare system. PatientsTwo hundred and sixty-two patients who underwent surgery for colorectal cancer were studied. Main Outcome MeasuresRate of Lynch syndrome screening. ResultsWe identified that 75 % of the total cohort was screened for Lynch syndrome. Of patients under the age of 50, 78 % percent were screened. Lower screening rates were found among patients with complete pathologic tumor response and lower pathologic stage of tumor. Higher screening rates were found at the academic hospital and with colorectal surgeons. In multivariable logistic regression analysis, lower screening rates were associated with community hospital location (OR, 0.22; 95 % CI, 0.08–0.56). LimitationsResults may not be generalizable to different hospital settings. ConclusionsSeveral potential system-level interventions were identified to improve screening rates including an emphasis on improved provider communication.