, Volume 18, Issue 3, pp 313-314
Date: 15 Oct 2013

Invited comment on Warrier et al.: hereditary colorectal cancer screening and management practices by colorectal surgeons

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Despite a low survey response rate of 10 % and the potential for non-response bias, the Warrier study in this month’s issue raises significant issues about genetic evaluation and surgical management in young patients suspected of having hereditary colorectal cancer (CRC)/polyposis syndromes [1]. Perhaps most important is the fact that there is great heterogeneity among colorectal surgeons in the preoperative, operative and postoperative management practices of these patients. For example, in patients with CRC under age 50 without a family history of CRC, 33.1 % of surgeons would proceed to definitive surgery without a preoperative genetic evaluation, while 48.9 % would request some form of tumor analysis to help risk stratify the patient. In this latter group, there was again significant heterogeneity with differing practices regarding the ordering of microsatellite instability (MSI), immunohistochemistry (IHC) or combination (MSI/IHC) testing. The key question, which is not answered b ...