Colorectal cancer screening is becoming more accepted by the general public. Compliance rates have edged up to over 50%. Certain people are at extraordinary risk for developing this cancer. Many of those have Lynch Syndrome, or Hereditary non-Polyposis Colorectal Cancer Syndrome where people have multiple colon polyps (not as many as Familial Adenomatous Polyposis (where people get thousands of polyps), hence the misnomer; they do get polyps) get colon cancer at a younger age and get other cancers as well. Up to 3% of all people who get colon cancer have Lynch: they need to be screened for other cancers and their family members need to get screened at an earlier age. It is possible to decide who needs testing for Lynch but current algorithms miss up to 50% of all of those afflicted, a bad rate for a screening test. Oncologists at Ohio State and more recently at the Cleveland Clinic have taken the position that all people with colon cancer need to be screened for Lynch. The screening is three step: all people over age 72 with no family history are screened out; next the tumor is tested for a mutation called microsatellite instability. Those patients whose tumors are unstable then get extensive blood testing for several “mis-match repair” genes. If one of these is present the patient has Lynch Syndrome and all that goes with it: testing for other cancers and family screening with earlier colonoscopies. The Evaluation of Genomic Applications in Practice and Prevention Working Group in 2009 recommended that all people with newly diagnosed colon cancer get screened in this manner and “Healthy People 2020” a US Government initiative has as well.
So….if you are a personal injury lawyer and someone comes in complaining that he was not tested for Lynch Syndrome and his 40-year-old son is now dying of colon cancer, should you recommend that he sue his surgeon and oncologist for not testing him? At this point the answer is maybe, but in the next few years Dr. Stark recommends that the legal profession listen out to see whether any of these sorts of allegations sees the light of day. Within the last few years failure to recommend colonoscopy to a patient over 50 has become a basis to claim malpractice, as has failure to recommend BRCA testing for hereditary breast and ovarian cancer. Now Lynch is likely to be the next syndrome to form the basis for litigation.