Appropriate clinical management of patients with known or suspected inherited forms of high colorectal cancer risk such as familial adenomatous polyposis (FAP)and Lynch Syndrome is important for prevention of cancers in those patients and their families via screening.
Almost 400 gastroenterologists, colorectal surgeons, oncologists and radiologists completed the survey; the majority (69%) thought that the service for higher risk patients was adequate, but 64% also thought that it was provided by clinicians other than themselves. More than half of the centres lacked a formal patient pathway and many were also unaware of BSG guidelines for the management of hereditary cancer patients.
The report authors conclude that the widespread variability in care and inconsistent application of national guidelines for inherited colorectal cancers may be the result of the perception that other, unspecified clinicians are responsible for the service. They propose that every hospital should establish a lead clinician charged with delivery of such services, and that steps should be taken to establish quality standards, patient pathways and improved health professional education.
In particular, appropriate assessment and management of ‘moderate risk’ patients by gastroenterologists and colorectal surgeons are said to be needed, since those at the highest risk are more easily identified and referred to clinical genetics services.