Screening for Lynch Syndrome in Colon Cancer Patients is Cost Effective
Reported July 19, 2011
(Ivanhoe Newswire) -- Screening every new colon cancer
patient for a particular familial disorder extends lives at a reasonable cost,
Stanford University School of Medicine researchers said. The team hopes the
results will encourage more medical centers to adopt widespread screening
policies.
Approximately 3 to 5 percent of colorectal tumors are caused by a heritable
condition called Lynch syndrome, which greatly increases the odds of colon and
other cancers in a person's lifetime. Siblings and children of someone with
Lynch syndrome each have a 50 percent chance of carrying the mutation, so the
first diagnosis in a family reveals the risk for many relatives. But early
detection can save lives.
"This is a situation where, if you find out genetic information, you can improve
your outcome," Uri Ladabaum, MD, associate professor of gastroenterology and
hepatology, and lead author of the study, was quoted as saying. Lynch syndrome
patients can take defensive steps (such as yearly colonoscopies) that can either
prevent cancer or alert them to get cancer treatment early, when it has the best
chance of working.
"We were interested in whether it would be cost-effective to test a lot of colon
tumors to find the few that are due to Lynch syndrome and, if so, what would be
the most cost-effective strategy," said Ladabaum. He and his colleagues used
computer simulations to compare the years of lives gained and the money spent if
all new cases of colorectal cancer were tested for Lynch syndrome. They found
that such screening programs can reduce cancer deaths at a price within the
typical range of U.S. health-care costs. The study will be published in the July
19 issue of Annals of Internal Medicine.
Prior to the availability of genetic testing, Lynch syndrome was identified by
sharp-eyed genetic counselors and physicians who noticed the high frequency of
cancers in certain families. But this method isn't foolproof, especially if a
patient doesn't know his or her family history. "We think there are other
families out there that have a predisposition for cancers," co-author James
Ford, MD, associate professor of oncology, of genetics and of pediatrics, was
quoted as saying. "The initial small investment of doing the screen is
ultimately going to pay off in terms of costs to society as well as in saving
lives."
An average person's lifetime risk of developing colon cancer is around 5
percent. For a person with Lynch syndrome that risk grows to 70 percent or more.
Lynch syndrome also raises the risk of other cancers, including uterine and
ovarian cancer. Female patients with the disorder who get regular tumor checks
and who choose to have preventative hysterectomies would benefit most from
widespread screening of colon tumors, according to the study.
The most cost-effective method involved checking whether tumors were missing any
molecular quality inspectors, followed by DNA sequencing of the suspected gene.
But no matter which testing methods were used, it was most important to test
multiple family members after the initial diagnosis. Pathologists use several
tests to identify the specific mutation in the first family member, but that
only needs to be done once. Subsequent diagnoses in relatives are much simpler.
The researchers found that three or four family members needed to be tested and
then follow recommended preventive measures for the process to have a reasonable
price tag. "All these interventions are more likely to be cost-effective if you
can spread the benefit across more relatives," said Ladabaum.
The study suggests that more medical centers could adopt tumor-screening
policies like Stanford's. "A systematic approach to identify families with Lynch
syndrome makes sense clinically, because it can save lives, and economically,
because its costs are comparable to other things we choose to spend our
health-care dollars on," said Ladabaum. "We advocate establishing similar
tumor-screening systems on a national level."
SOURCE: Stanford University Medical Center press release
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