講演情報
[PE4-1]Lynch症候群ユニバーサルスクリーニングに対する多職種チームの有用性
○立田 協太1, 阪田 麻裕1, 岩泉 守哉2, 小島 梨紗3, 杉山 洸裕1, 小嶋 忠浩1, 赤井 俊也1, 鈴木 克徳1, 倉地 清隆1, 竹内 裕也1 (1.浜松医科大学外科学第二講座, 2.浜松医科大学臨床検査医学, 3.浜松医科大学遺伝子診療部)
Objectives: This study aimed to evaluate the changes in the rates of genetic counseling and genetic testing as well as the diagnosis rate of Lynch syndrome (LS)-associated colorectal cancer before and after multistep approach with multidisciplinary team.Methods: In September 2016, we started universal screening for LS via immunohistochemical analyses. In January 2020, we started multistep approach with multidisciplinary team (MA) consisting of several surgeons, one genetic counselors, one medical geneticists, and several pathologists. MA aimed to compensate for the lack of knowledge about hereditary diseases revealed by the results of the patient interviews. MA was designed as a system that could be performed by a small number of medical genetic specialists.A total of 522 patients were included during the study duration, 323 and 199 patients in the pre-MA (P-MA) group and MA group, respectively.Results: Universal screening in P-MA group revealed that the rates of genetic counseling and genetic testing as well as the diagnostic rate of LS were 7.7%, 3.8%, and 0.3%, respectively. In MA group, the addition of surgeon-led case selection, step-by-step explanations by a genetic counselor and medical geneticists, and reviews on each case significantly increased the number of patients receiving genetic counseling and genetic testing. Moreover, the diagnosis rate of LS-associated colorectal cancer was significantly higher in MA group (2.5%) than in P-MA group (0.3%) (P = 0.03).Conclusions: The introduction of MA increased LS-associated colorectal cancer after universal screening.