SO05: Selective and universal screening strategies for Lynch syndrome: a perspective from the Royal Marsden Hospital

Bianca Desouza1, Andrew Wotherspoon2, Nazneen Rahman2,3, Helen Hanson4, Angela George 2,3.

1 – Northwick Park Hospital, London. 2 – Royal Marsden Hospital, London. 3 – Institute of Cancer Research. 4 – St George’s Hospital, London


We aimed to evaluate the outcomes of two different IHC-based Lynch syndrome (LS) screening strategies at the Royal Marsden Hospital.


A retrospective study of LS screening among colorectal cancer (CRC) patients undergoing oncological management in a tertiary referral centre. Outcomes from a ‘selective’ screening strategy utilised from 1st January to 31st December 2013 on CRC cases were compared with a ‘universal’ screening strategy of all CRC cases from 1st January to 31st December 2014. Patients with an IHC abnormality were referred for genetic counselling and offered genetic testing in accordance with the ICR/RMH clinical protocols (available at


A total of 292 patients with CRC were screened: 58 selectively and 285 universally. The prevalence of LS was 5.2% (3/58) and 2.1% (5/234) for the selective and universal screening strategies respectively (p=0.1977). Selective criteria failed to identify one of the five (20%) LS cases identified by the universal strategy. All patients were referred for genetic counselling, accepted the referral, and consented to genetic testing. There was only 88% compliance with LS screening during the universal screening phase.


The identification of LS patients was improved by the implementation of universal screening strategies, though system-level interventions must be introduced to improve compliance.