Increasing Lynch syndrome identification through establishment of a hereditary colorectal cancer registry

BACKGROUND: Lynch syndrome contributes to 5% of all colorectal cancers. Patients seen in most surgical clinics have limited or no family histories documented and are rarely assessed for hereditary syndromes. In 2007 a clinic-based hereditary colorectal cancer registry was established to screen for Lynch syndrome and facilitate genetic counseling/testing. Objective: To evaluate the effectiveness of the hereditary colorectal cancer registry to identify high-risk colorectal cancer patients and have them referred for genetic counseling/testing for Lynch syndrome. DESIGN: A retrospective review and cohort comparison of both prospectively collected and retrospective data. Setting: The colorectal surgical clinic at Vanderbilt University Medical Center. Patients: A ll newly diagnosed colorectal cancer patients seen between January 2006 and October 2010. Main Outcom e Measures: To assess the identification of colorectal cancer patients at high risk for Lynch syndrome and for the occurrence of genetic counseling/testing before and after the establishment of a hereditary registry by comparing the results from the colorectal cancer patients seen the year prior to the establishment of the registry (January - December 2006, "control period") with those patients seen after initiation of the registry (January 2007 - October 2010, "registry period"). Results: During the "registry period," 495 colorectal cancer patients were seen in the clinic and 257 (51.9%) were high risk for Lynch syndrome. Forty-nine patients (9.8%) underwent genetic testing, with 27 (5.4%) positive for a gene mutation, of which half were >50 years old. By comparison, in 2006, 115 colorectal cancer patients were seen in the clinic but only 4 patients (3.5%) went on for further assessment, and only 1 had genetic testing. Retrospective assessment showed that at least 22 patients (19.1%) had warranted further investigation in 2006. Limitations: This was a single-institution, retrospective review. Conclus ion: Establishment of a hereditary colorectal cancer registry with a clinic-based protocol improves identification of Lynch syndrome.