NEJM Editorial: Genetic Screening Urged By Creighton Hereditary Cancer Expert

In an editorial in the current edition of the New England Journal of Medicine, Henry T. Lynch, M.D., hereditary cancer expert and medical oncologist at Creighton University, recommends physicians conduct genetic screening tests for hereditary nonpolyposis colorectal cancer, also known as the Lynch Syndrome, named for Dr. Lynch. Dr. Lynch is the holder of the Charles F. and Mary C. Heider Endowed Chair in Cancer Research, professor of medicine and chairman of Preventive Medicine at Creighton University.

The screening recommended is a microsatellite-instability (MSI) and immunohistochemical molecular genetic staining test, which identifies the absence of proteins that can protect against colorectal cancer, the third most common cause of death from cancer in the U.S. As Dr. Lynch indicates in his editorial, co-authored by his son, Patrick M. Lynch, J.D., M.D., a gastroenterologist and associate professor of medicine a the University of Texas M.D. Anderson Cancer Center in Houston, these tests are efficient and economical ways to screen for the Lynch Syndrome, the most common of which is colorectal cancer. The MSI screening test Dr. Lynch recommends can have a strong impact on the families of patients who present with tumors in the Lynch Syndrome by helping to identify family members who are at high risk and who should have regular colonoscopies starting at age 25.

“MSI and immunohistochemical tests are important because of their significantly lower cost – approximately $300 – compared to the high cost – $2,000 – to test for the germ-line-mutations that predispose patients to the Lynch Syndrome,” said Dr. Lynch. “This diagnosis may then be fortified by a well-orchestrated cancer family history.”

According to Dr. Lynch, “I want to encourage new thinking among physicians about how to use molecular genetic information, along with the family history in order to do a better job in identifying patients at risk for the Lynch Syndrome so that we can then screen and manage them effectively for various types of cancer.”