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Identification of people with Lynch syndrome from those presenting with colorectal cancer in England: baseline analysis of the diagnostic pathway

Lookup NU author(s): Dr Gillian Borthwick, Dr Steven Hardy, Professor Sir John BurnORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© The Author(s) 2024.It is believed that >95% of people with Lynch syndrome (LS) remain undiagnosed. Within the National Health Service (NHS) in England, formal guidelines issued in 2017 state that all colorectal cancers (CRC) should be tested for DNA Mismatch Repair deficiency (dMMR). We used a comprehensive population-level national dataset to analyse implementation of the agreed diagnostic pathway at a baseline point 2 years post-publication of official guidelines. Using real-world data collected and curated by the National Cancer Registration and Analysis Service (NCRAS), we retrospectively followed up all people diagnosed with CRC in England in 2019. Nationwide laboratory diagnostic data incorporated somatic (tumour) testing for dMMR (via immunohistochemistry or microsatellite instability), somatic testing for MLH1 promoter methylation and BRAF status, and constitutional (germline) testing of MMR genes. Only 44% of CRCs were screened for dMMR; these figures varied over four-fold with respect to geography. Of those CRCs identified as dMMR, only 51% underwent subsequent diagnostic testing. Overall, only 1.3% of patients with colorectal cancer had a germline MMR genetic test performed; up to 37% of these tests occurred outside of NICE guidelines. The low rates of molecular diagnostic testing in CRC support the premise that Lynch syndrome is underdiagnosed, with significant attrition at all stages of the testing pathway. Applying our methodology to subsequent years’ data will allow ongoing monitoring and analysis of the impact of recent investment. If the diagnostic guidelines were fully implemented, we estimate that up to 700 additional people with LS could be identified each year.

Publication metadata

Author(s): McRonald FE, Pethick J, Santaniello F, Shand B, Tyson A, Tulloch O, Goel S, Luchtenborg M, Borthwick GM, Turnbull C, Shaw AC, Monahan KJ, Frayling IM, Hardy S, Burn J

Publication type: Article

Publication status: Published

Journal: European Journal of Human Genetics

Year: 2024

Volume: 32

Issue: 5

Pages: 529-538

Print publication date: 01/05/2024

Online publication date: 15/02/2024

Acceptance date: 23/01/2024

Date deposited: 09/09/2026

ISSN (print): 1018-4813

ISSN (electronic): 1476-5438

Publisher: Springer Nature

URL: https://doi.org/10.1038/s41431-024-01550-w

DOI: 10.1038/s41431-024-01550-w

Data Access Statement: Data are held within the National Disease Registration Service (NDRS), which is part of NHS England. Formal data requests may be made through the Data Access Request Service (DARS): https://digital.nhs.uk/services/data-access-request-service-dars.

PubMed id: 38355963

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