{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T09:22:46Z","timestamp":1788600166650,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,2,26]],"date-time":"2022-02-26T00:00:00Z","timestamp":1645833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Genetic Counseling"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Clinical guidelines recommend universal tumor screening (UTS) of colorectal and endometrial cancers for Lynch syndrome (LS). There are limited guidelines for how to integrate germline testing and somatic tumor testing after a mismatch repair deficient (dMMR) tumor is identified. We sought to characterize current practice patterns and barriers to preferred practice among clinical providers in high\u2010risk cancer programs. A clinical practice survey was sent to 423 active members of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer (CGA\u2010IGC) with a follow\u2010up survey sent to 103 clinician responders. The survey outlined clinical vignettes and asked respondents their preferred next test. The survey intended to assess: (1) the role of patient age and family history in risk assessment and (2) barriers to preferred genetic testing. Genetic test options included targeted germline testing based on dMMR expression, germline testing for LS, germline testing with a multigene cancer panel including LS, or paired tumor\/germline testing including LS. In October 2020, 117 of 423 (28%) members completed the initial survey including 103 (88%) currently active clinicians. In April 2021, a follow\u2010up survey was sent to active clinicians, with 45 (44%) completing this second survey. After selecting their preferred next germline or paired tumor\/germline tumor test based on the clinical vignette, 39% of respondents reported wanting to make a different choice for the initial genetic test without any testing barriers. The proportion of respondents choosing a different initial genetic test was dependent on the proband's age at diagnosis and specified family history. The reported barriers included patient's lack of insurance coverage, patient unable\/unwilling to self\u2010pay for proposed testing, and inadequate tumor tissue. Responders reported insurance, financial constraints, and limited tumor tissue as influencing preferred genetic testing in high\u2010risk clinics, thus resulting in possible under\u2010diagnosis of LS and impacting potential surveillance and cascade testing of at\u2010risk relatives.<\/jats:p>","DOI":"10.1002\/jgc4.1567","type":"journal-article","created":{"date-parts":[[2022,2,26]],"date-time":"2022-02-26T19:19:44Z","timestamp":1645903184000},"page":"949-955","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Patterns of germline and somatic testing after universal tumor screening for Lynch syndrome: A clinical practice survey of active members of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2887-4079","authenticated-orcid":false,"given":"Rachel","family":"Hodan","sequence":"first","affiliation":[{"name":"Cancer Genetics Stanford Health Care  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3956-5821","authenticated-orcid":false,"given":"Linda","family":"Rodgers\u2010Fouche","sequence":"additional","affiliation":[{"name":"Center for Cancer Risk Assessment Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8273-589X","authenticated-orcid":false,"given":"Sanjeevani","family":"Arora","sequence":"additional","affiliation":[{"name":"Cancer Prevention and Control Program Fox Chase Cancer Center  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7856-0057","authenticated-orcid":false,"given":"Mev","family":"Dominguez\u2010Valentin","sequence":"additional","affiliation":[{"name":"Department of Tumor Biology Institute of Cancer Research The Norwegian Radium Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-1516","authenticated-orcid":false,"given":"Priyanka","family":"Kanth","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Utah Health and Huntsman Cancer Institute  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8186-9119","authenticated-orcid":false,"given":"Bryson W.","family":"Katona","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Pennsylvania Perelman School of Medicine  Philadelphia 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M.","family":"Soto\u2010Azghani","sequence":"additional","affiliation":[{"name":"Independent \u2010 Clinical Research Nurse  Tyler Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall E","family":"Brand","sequence":"additional","affiliation":[{"name":"Gastrointestinal Malignancy Early Detection, Diagnosis and Prevention Program University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9205-3756","authenticated-orcid":false,"given":"Edward D.","family":"Esplin","sequence":"additional","affiliation":[{"name":"Invitae  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5745-2994","authenticated-orcid":false,"given":"Kimberly","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dana\u2010Farber Cancer Institute\/ Harvard Medical School  Boston 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