Barriers to Lynch Syndrome Testing and Preoperative Result Availability in Earlyonset Colorectal Cancer: A National Physician Survey Study

作者：Alan G. Noll, Parth J. Parekh, Meijiao Zhou, Thomas K. Weber, Dennis J. Ahnen, Xiao‐Cheng Wu, Jordan J. Karlitz · 发表于：Clinical and Translational Gastroenterology · 年份：2018 · DOI：10.1038/s41424-018-0047-y · 被引用次数：50 · 研究领域：Genetic factors in colorectal cancer、Colorectal Cancer Screening and Detection、Colorectal Cancer Treatments and Studies

OBJECTIVE: Although widely recommended, Lynch syndrome (LS) testing with tumor microsatellite instability (MSI) and/or immunohistochemistry (IHC) is infrequently performed in early-onset colorectal cancer (CRC), and CRC generally. Reasons are poorly understood. Hence, we conducted a national survey focusing on gastroenterologists, as they are frequently first to diagnose CRC, assessing testing barriers and which specialist is felt responsible for ordering MSI/IHC. Additionally, we assessed factors influencing timing of MSI/IHC ordering; testing on colonoscopy biopsy, opposed to post-operative surgical specimens, assists decisions on preoperative germline genetic testing and extent of colonic resection (ECR). METHODS: A 21-question web-based survey was distributed through an American College of Gastroenterology email listing. RESULTS: In total 509 completed the survey. 442 confirmed gastroenterologists were analyzed. Only 33.4% felt gastroenterologists were responsible for MSI/IHC ordering; pathologists were believed most responsible (38.6%). Cost, unfamiliarity interpreting results and unavailable genetic counseling most commonly prevented routine ordering (33.3%, 29.2%, 24.9%, respectively). In multivariable analysis, non-academic and rural settings were associated with cost and genetic counseling barriers. Only 46.1% felt MSI/IHC should always be performed on colonoscopy biopsy. Guideline familiarity predicted whether respondents felt surgical resection should be delayed un...