講演情報
[P14-3]地域中核病院におけるリンチ症候群に対するユニバーサルスクリーニングの導入
○吉岡 貴裕, 稲田 涼, 黒田 絵理, 公文 剣斗, 大石 一行 (高知医療センター 消化器外科・一般外科)
Background; Genetic testing (GT) for Lynch syndrome (LS) is not yet covered by insurance in Japan, and the system of genetic counseling is not well established nationwide, while universal screening (US) for LS is widely accepted in Western countries. Approximately 260 colorectal cancer surgeries were carried out per year in our institution, and we have introduced US. Here we report our current status as a local core hospital in Japan.Subject; The subjects are those who fall under either 1) or 2) and agree to undergo the MSI examination as US. 1) Of 1251 colorectal malignancy surgeries performed in our department from April 2017 to March 2022, adenocarcinoma fulfilling one of the following histological types: less than 50 years old, multiple cancers, overlapping LS-related cancers, or pathological characteristics of MSI-H. 2) Primary colorectal adenocarcinoma resected after April 2022.Method; In cases of MSI-H, BRAF reflex test should be performed. In the case of BRAF wild type, a visit to an outpatient genetic oncology clinic is recommended and genetic counseling by a certificated clinical geneticist is provided. In case a definite diagnosis of LS is made, surveillance for associated tumors should be performed.Discussion; As MSI and BRAF tests are now covered by insurance as screening tests for LS, the constitution of LS is being recognized widely among Japanese health care providers. Not only university hospitals and cancer centers, local core hospitals also need to establish a system of genetic counseling and improve the support system for LS patients.