Rate of implementation of universal testing for Lynch Syndrome in a county hospital system.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 533-533
Author(s):  
Ashish Sharma ◽  
Johanna Chan ◽  
Tony Trang ◽  
Milena Gould Suarez
Keyword(s):  
Colorectal Cancer ◽  
Lynch Syndrome ◽  
Clinical Decision Making ◽  
Safety Net ◽  
Cancer Surveillance ◽  
County Hospital ◽  
Mismatch Repair Gene ◽  
Hospital System ◽  
Hospital District ◽  
Universal Testing

533 Background: Lynch Syndrome (LS) is the most common cause of inherited colorectal cancer (CRC). Universal testing is recommended as a cost effective strategy for screening for LS in all patients with CRC diagnosed < 70 years of age. This has shown to be beneficial in clinical decision making and cancer surveillance of both the patient and at risk relatives. According to a study in 2012, 71% of NCI institutions were performing universal testing versus 15%-36% of programs in the community. The aim of our study was to determine the outcomes of Universal Testing for LS in CRC in a County Hospital System. Methods: IRB-approved retrospective chart review of all patients diagnosed with colorectal cancer from cancer registry at Harris County Hospital District from March 2010 to Dec 2013. Patients between 18-70 yr were included. We collected data on patient characteristics, universal testing [immunohistochemistry (IHC) at our institution], and LS diagnosis (confirmed with germline testing for mismatch repair gene) in our patient cohort diagnosed with CRC. Descriptive statistics were performed using t-test for continuous variables. Results: Overall, 430 patients had CRC diagnosis in our study period, and 54 years was median age of diagnosis. IHC was performed in 359/430 (83.4%) CRC cases. IHC was positive in overall 26/430 (6%) cases of CRC. LS was confirmed in 9/430 (2%) CRC cases. IHC was more often positive with CRC diagnosed in patients younger than 50 years than in patients 50 years or older (7.91% vs 3.09%; p = 0.04). Conclusions: Universal testing for screening of LS amongst patients with CRC can result in significant rates of detection. In this study we have shown that this is possible in a largely safety-net setting.

Prevalence of metabolic syndrome in older (50 years and older) vs younger (less than 50 years) patients with colorectal cancer diagnosed in a safety net hospital system.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 512-512
Author(s):  
Ashish Sharma ◽  
Johanna Chan ◽  
Tony Trang ◽  
Milena Gould Suarez
Keyword(s):  
Colorectal Cancer ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Older Patients ◽  
Safety Net ◽  
Categorical Variables ◽  
Hospital System ◽  
Younger Patients ◽  
Hospital District ◽  
Safety Net Hospital

512 Background: Colorectal cancer (CRC) incidence has declined overall with screening, though incidence in patients younger than 50 years has increased. Younger patients present with more aggressive and advanced stage CRC. Potential mechanisms are sporadic, genetics, and environmental (alcohol, smoking, metabolic syndrome). Metabolic syndrome (MetS) is an established risk factor for CRC. We examined the prevalence of MetS in younger patients ( < 50 yrs) compared with older patients ( ≥ 50 yrs) with CRC in a safety net hospital population. Methods: IRB-approved retrospective chart review of all patients diagnosed with CRC in the Harris County Hospital District cancer registry from Jan 2008 to Dec 2013. Data was collected for patient characteristics and metabolic syndrome to compare 2 patient groups: < 50 yr (younger) and ≥ 50 yr (older). MetS was defined using 2005 AHA/NHLBI criteria as ≥ 3 of the following components: abdominal obesity (waist circumference > 102 cm in men, > 88 cm in women), serum triglycerides (TG) ( > 150 mg/dL), serum HDL ( < 40 mg/dL in men and < 50 mg/dL in women), BP > 130/85 mmHg, fasting glucose/diabetes ( ≥ 100 mg/dL). Per WHO criteria, BMI > 30 was used as surrogate for waist circumference. Descriptive statistics were performed using t-test for continuous variables and Chi-square / Fisher’s exact test for categorical variables. Results: 625 cases of CRC diagnosed showed median age of 56.5 years and 54.7% female patients. The majority (77.76%) of cases occurred in the older group. Overall, 208/625 patients (33.28%) had MetS. Average BMI overall was 27.33. Prevalence of MetS was 38.27% vs 23% (older vs younger; p = 0.0001). In older compared with younger patients, average BMI 26.13 vs 25.05 (p = 0.02), obesity 25.92% vs 35.87% (p = 0.05), BP > 130/85 mmHg 56.3% vs 31.6% (p = 0.001), low HDL 41.7% vs 31.9% (p = 0.02), TG > 150 34.7 % vs 22.3 % (p = 0.02) and diabetes 36.2% vs 11.5% (p = 0.001). Conclusions: Overall prevalence of MetS in our patient cohort was similar to that of general population (which approximates 34%). Prevalence of MetS was higher in older patients with CRC than in younger patients, though this may reflect the natural history of MetS.

scholarly journals Feasibility of Screening for Lynch Syndrome Among Patients With Colorectal Cancer

2008 ◽  
Vol 26 (35) ◽  
pp. 5783-5788 ◽  
Author(s):  
Heather Hampel ◽  
Wendy L. Frankel ◽  
Edward Martin ◽  
Mark Arnold ◽  
Karamjit Khanduja ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lynch Syndrome ◽  
Mismatch Repair ◽  
Cancer Surveillance ◽  
Study Cohort ◽  
Entire Study ◽  
Gene Testing ◽  
Revised Bethesda Guidelines ◽  
Repair Genes ◽  
Entire Study Cohort

Purpose Identifying individuals with Lynch syndrome (LS) is highly beneficial. However, it is unclear whether microsatellite instability (MSI) or immunohistochemistry (IHC) should be used as the screening test and whether screening should target all patients with colorectal cancer (CRC) or those in high-risk subgroups. Patients and Methods MSI testing and IHC for the four mismatch repair proteins was performed on 500 tumors from unselected patients with CRC. If either MSI or IHC was abnormal, complete mutation analysis for the mismatch repair genes was performed. Results Among the 500 patients, 18 patients (3.6%) had LS. All 18 patients detected with LS (100%) had MSI-high tumors; 17 (94%) of 18 patients with LS were correctly predicted by IHC. Of the 18 probands, only eight patients (44%) were diagnosed at age younger than 50 years, and only 13 patients (72%) met the revised Bethesda guidelines. When these results were added to data on 1,066 previously studied patients, the entire study cohort (N = 1,566) showed an overall prevalence of 44 of 1,566 patients (2.8%; 95% CI, 2.1% to 3.8%) for LS. For each proband, on average, three additional family members carried MMR mutations. Conclusion One of every 35 patients with CRC has LS, and each has at least three relatives with LS; all of whom can benefit from increased cancer surveillance. For screening, IHC is almost equally sensitive as MSI, but IHC is more readily available and helps to direct gene testing. Limiting tumor analysis to patients who fulfill Bethesda criteria would fail to identify 28% (or one in four) cases of LS.

Gene-Specific Variation in Colorectal Cancer Surveillance Strategies for Lynch Syndrome

2021 ◽  
Author(s):  
Fay Kastrinos ◽  
Myles A. Ingram ◽  
Elisabeth R. Silver ◽  
Aaron Oh ◽  
Monika Laszkowska ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lynch Syndrome ◽  
Cancer Surveillance ◽  
Specific Variation ◽  
Colorectal Cancer Surveillance

Sa1779 Universal Testing of Mismatch Repair Protein Deficiency in Colorectal Cancer and Its Usefulness for Identification of Lynch Syndrome Patients

2016 ◽  
Vol 150 (4) ◽  
pp. S364
Author(s):  
Takeshi Nakajima ◽  
Shigeki Sekine ◽  
Yoshimi Nakajima ◽  
Mineko Ushiama ◽  
Taku Sakamoto ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lynch Syndrome ◽  
Mismatch Repair ◽  
Protein Deficiency ◽  
Universal Testing ◽  
Repair Protein ◽  
Mismatch Repair Protein

scholarly journals Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States

2018 ◽  
Vol 21 (1-2) ◽  
pp. 26-35 ◽  
Author(s):  
Bijal A Balasubramanian ◽  
Katelyn K Jetelina ◽  
Michael Bowen ◽  
Noel O Santini ◽  
Simon Craddock Lee
Keyword(s):  
Colorectal Cancer ◽  
United States ◽  
Primary Care ◽  
Health Insurance ◽  
Cancer Recurrence ◽  
Safety Net ◽  
The United States ◽  
Cancer Surveillance ◽  
Care Providers ◽  
Colorectal Cancer Surveillance

Introduction Guideline-recommended surveillance reduces the likelihood of colorectal cancer recurrence, yet surveillance rates are low in the United States. Little is known about colorectal cancer surveillance rates among patients without health insurance and their primary care clinicians/oncologists’ attitudes toward surveillance care. Methods A retrospective study of 205 patients diagnosed with Stage I–III colorectal cancer from 2008 to 2010 was conducted in an integrated system with a network of clinics and health care providers, delivering care to patients lacking health insurance coverage. Surveillance patterns were characterized from medical records, and logistic regression models examined correlates of guideline-concordant surveillance. Forty-four Parkland primary care physicians (PCPs) and 24 oncologists completed surveys to assess their attitudes and practices regarding colorectal cancer surveillance. Results Thirty-eight percent of colorectal cancer patients received guideline-concordant surveillance; those with early stage cancers were less likely to receive surveillance (odds ratio = 0.35; 95 confidence interval: 0.14, 0.87). PCPs and oncologists differed markedly on who is responsible for cancer surveillance care. Seventy-seven percent of oncologists responded that PCPs evaluated patients for cancer recurrence, while 76% of PCPs responded that these services were either ordered by oncologists or shared with PCPs. Sixty-seven percent of oncologists said that they rarely provide a treatment and surveillance care plan to survivors, and over half said that they infrequently communicate with patients’ other physicians about who will follow patients for their cancer and other medical issues. Discussion Care coordination between PCP and oncologist is needed to improve colorectal cancer surveillance. New models of shared care clearly delineating roles for oncologists and PCPs are needed to improve colorectal cancer survivorship care.

Assessment of the MMRpredict model for prediction of DNA mismatch repair gene mutations (Lynch Syndrome)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4127-4127
Author(s):  
S. K. Nigon ◽  
N. M. Lindor
Keyword(s):  
Colorectal Cancer ◽  
Mismatch Repair ◽  
Dna Mismatch Repair ◽  
Cancer Surveillance ◽  
Mismatch Repair Gene ◽  
Repair Gene ◽  
Dna Mismatch ◽  
Proximal Site ◽  
Stage 1 ◽  
Distal Site

4127 Background: The MMRpredict model, developed at the University of Edinburgh, is a web-based model developed to predict which patients diagnosed with colorectal cancer (CRC) under age 55 years have germline mutations in a DNA mismatch repair (MMR) gene [Barnetson et al., NEngJMed 2006;354:2751–63]. Stage 1 MMRpredict estimates the carrier probability for MMR mutations from clinical parameters (age of diagnosis of colorectal cancer, proximal vs distal site, family history, multiple primary CRCs). We evaluated the performance of Stage 1 of this model in a well characterized cohort of colorectal cancer patients. Methods: Cases with CRC were identified through the Minnesota Cancer Surveillance System (MCSS), a population based registry and Mayo Clinic Rochester, a clinical practice. All were consented participants in the Mayo Colon Cancer Family Registry. Of 342 cases tested for MMR mutations (MLH1, MSH2, MSH6), 45 had insufficient information on colon site and 62 were older than 55 and could not be used in the study. The remaining 235 included 110 females/125 males; 90 cases with proximal site/145 with distal site; 229/235 were self-identified as White. Results: We defined 5 probability risk groups based on output from the MMRpredict web model Stage 1: 1–10%, 11–25%, 26–50%, 51–75%, and 76–100%. In our study, the number of cases in each of these groups was 60, 45, 65, 34, and 31, respectively. The corresponding number of mutations in each group was 1 (1.7%), 4 (8.9%), 9 (13.8%), 3 (8.8%), and 11 (35.5%). Overall, 28/235 patients were found to have mutations (11.9%), compared to predicted range of 62–107 (26–45%). Conclusion: MMRpredict Stage 1 over-estimated the probability of detecting a MMR gene mutation in this study. This may reflect ascertainment issues or genetics of different populations. No significant financial relationships to disclose.

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