{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:02:15Z","timestamp":1785402135630,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"King Center for Lynch Syndrome"},{"id":[{"id":"https:\/\/ror.org\/03nxex423","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Jason and Julie Borrelli Lynch Syndrome Research Fund"},{"name":"NIH\/NIDDK Center for Molecular Studies in Digestive and Liver Diseases at the University of Pennsylvania","award":["P30DK050306"],"award-info":[{"award-number":["P30DK050306"]}]},{"award":["P30DK050306"],"award-info":[{"award-number":["P30DK050306"]}],"id":[{"id":"https:\/\/ror.org\/00b30xv10","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Biomedical Data Science Core"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Lynch syndrome (LS) is the most common hereditary cause of colorectal cancer (CRC), and colorectal surveillance has been shown to reduce death from CRC in this high-risk population. This study aimed to examine adherence to recommended endoscopic surveillance intervals in a LS cohort and identify factors associated with adherence. Methods: A retrospective review was performed of 1403 lower endoscopic procedure (LEP) reports from 540 individuals with LS completed between May 2001 and September 2023. Adherence was calculated by comparing the endoscopists\u2019 recommended interval to the actual date of the subsequent procedure. Reports from individuals with \u22652 LEPs and those with follow-up intervals within the study period were included (n = 1170). A mixed-effect logistic regression analysis identified factors associated with adherence. Results: Among 1170 LEPs from 295 LS carriers, 67.4% were performed within the recommended interval. However, 68.8% of individuals had at least one procedure that was delayed. Increased adherence was significantly associated with prior detection of CRC (OR 9.30, 95% CI 1.16\u201374.32, p = 0.035) on an LEP. Marital status was significantly associated with adherence, with higher rates among married (OR 1.73, 95% CI 1.05\u20132.85, p = 0.030) and divorced\/widowed individuals (OR 2.32, 95% CI 1.14\u20134.72, p = 0.020). Current smokers had a lower rate of adherence (OR 0.33, 95% CI 0.13\u20130.82, p = 0.018). No significant associations were observed with age, biological sex, race, or insurance status. Conclusions: Nearly one third of LEPs in our LS cohort were delayed. Efforts to address barriers and enhance adherence are essential to optimize outcomes for this high-risk population.<\/jats:p>","DOI":"10.3390\/cancers18122010","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:13:37Z","timestamp":1782195217000},"page":"2010","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated with Adherence to Recommended Colorectal Surveillance Intervals in Lynch Syndrome"],"prefix":"10.3390","volume":"18","author":[{"given":"Danielle","family":"Mirda","sequence":"first","affiliation":[{"name":"Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinxuan","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1634-9501","authenticated-orcid":false,"given":"Michaela","family":"Dungan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Youngman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongzhe","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0382-7890","authenticated-orcid":false,"given":"Jessica M.","family":"Long","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, Department of Medicine, Penn Medicine, Philadelphia, PA 19104, USA"},{"name":"King Center for Lynch Syndrome, Abramson Cancer Center, Penn Medicine, Philadelphia, PA 19104, 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, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"},{"name":"King Center for Lynch Syndrome, Abramson Cancer Center, Penn Medicine, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref_1","first-page":"10","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1055\/a-1016-4977","article-title":"Endoscopic management of Lynch syndrome and of familial risk of colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"51","author":"Roos","year":"2019","journal-title":"Endoscopy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.gim.2022.01.014","article-title":"Worldwide prevalence of Lynch syndrome in patients with colorectal cancer: Systematic review and meta-analysis","volume":"24","author":"Kaushik","year":"2022","journal-title":"Genet. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.cgh.2010.10.033","article-title":"Rapid development of colorectal neoplasia in patients with Lynch syndrome","volume":"9","author":"Edelstein","year":"2011","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Staffa, L., Echterdiek, F., Nelius, N., Benner, A., Werft, W., Lahrmann, B., Grabe, N., Schneider, M., Tariverdian, M., and von Knebel Doeberitz, M. (2015). Mismatch repair-deficient crypt foci in Lynch syndrome--molecular alterations and association with clinical parameters. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0121980"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/ijc.31300","article-title":"Three molecular pathways model colorectal carcinogenesis in Lynch syndrome","volume":"143","author":"Ahadova","year":"2018","journal-title":"Int. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1111\/codi.14926","article-title":"Benefit from extended surveillance interval on colorectal cancer risk in Lynch syndrome","volume":"22","author":"Lindberg","year":"2020","journal-title":"Colorectal Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/S0016-5085(00)70168-5","article-title":"Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer","volume":"118","author":"Aarnio","year":"2000","journal-title":"Gastroenterology"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ferrari, D., Rausa, E., Lauricella, S., Brignola, C., Zaccara, A., Signoroni, S., and Ricci, M.T. (2024). Factors influencing the colorectal surveillance adherence in Lynch Syndrome: A retrospective monocentric study. Tumori, 3008916241308119.","DOI":"10.1177\/03008916241308119"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1136\/gutjnl-2017-314057","article-title":"Cancer risk and survival in path_MMR carriers by gene and gender up to 75 years of age: A report from the Prospective Lynch Syndrome Database","volume":"67","author":"Bernstein","year":"2018","journal-title":"Gut"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13053-017-0078-5","article-title":"Colorectal cancer incidence in path_MLH1 carriers subjected to different follow-up protocols: A Prospective Lynch Syndrome Database report","volume":"15","author":"Evans","year":"2017","journal-title":"Hered. Cancer Clin. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1053\/j.gastro.2018.07.030","article-title":"No Difference in Colorectal Cancer Incidence or Stage at Detection by Colonoscopy Among 3 Countries With Different Lynch Syndrome Surveillance Policies","volume":"155","author":"Engel","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1093\/jnci\/djad058","article-title":"Evaluating colonoscopy screening intervals in patients with Lynch syndrome from a large Canadian registry","volume":"115","author":"Aronson","year":"2023","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_14","unstructured":"Gupta, S., Weiss, J., Burke, C., Chung, D., Clayback, K., Dallas, S., Felder, S., Giardiello, F., Grady, W., and Hagemann, A. (2023). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae) for Genetic\/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric v1.2025, NCCN."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1038\/ajg.2010.120","article-title":"Prevalence and predictors of appropriate colorectal cancer surveillance in Lynch syndrome","volume":"105","author":"Stoffel","year":"2010","journal-title":"Am. J. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13053-019-0130-8","article-title":"Recommended care and care adherence following a diagnosis of Lynch syndrome: A mixed-methods study","volume":"17","author":"Mittendorf","year":"2019","journal-title":"Hered. Cancer Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1053\/j.gastro.2004.11.002","article-title":"Screening behavior of individuals at high risk for colorectal cancer","volume":"128","author":"Bleiker","year":"2005","journal-title":"Gastroenterology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/codi.12778","article-title":"Colonoscopy screening compliance and outcomes in patients with Lynch syndrome","volume":"17","author":"Newton","year":"2015","journal-title":"Colorectal Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s10689-023-00333-4","article-title":"Colonoscopy surveillance in Lynch syndrome is burdensome and frequently delayed","volume":"22","author":"Jacobs","year":"2023","journal-title":"Fam. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s10689-005-5442-3","article-title":"Compliance and Satisfaction with Long-Term Surveillance in Finnish HNPCC Families","volume":"5","author":"Kairaluoma","year":"2006","journal-title":"Fam. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13053-026-00334-1","article-title":"Utilization of care and alignment of screening with NCCN guidelines for patients with Lynch syndrome: A retrospective cohort study","volume":"24","author":"Lowry","year":"2026","journal-title":"Hered. Cancer Clin. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e037945","DOI":"10.1136\/bmjopen-2020-037945","article-title":"The association between cigarette smoking, cancer screening, and cancer stage: A prospective study of the women\u2019s health initiative observational cohort","volume":"10","author":"Eng","year":"2020","journal-title":"BMJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e193759","DOI":"10.1001\/jamanetworkopen.2019.3759","article-title":"Cancer Screening Patterns Among Current, Former, and Never Smokers in the United States, 2010\u20132015","volume":"2","author":"Sanford","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1038\/bjc.2015.148","article-title":"Smoking is associated with pessimistic and avoidant beliefs about cancer: Results from the International Cancer Benchmarking Partnership","volume":"112","author":"Quaife","year":"2015","journal-title":"Br. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.cgh.2020.12.025","article-title":"Racial and Ethnic Disparities in Germline Genetic Testing of Patients With Young-Onset Colorectal Cancer","volume":"20","author":"Dharwadkar","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jss.2022.08.024","article-title":"Barriers to Colorectal Cancer Screening in US Immigrants: A Scoping Review","volume":"282","author":"Puli","year":"2023","journal-title":"J. Surg. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13053-018-0090-4","article-title":"Patient and provider perspectives on adherence to and care coordination of lynch syndrome surveillance recommendations: Findings from qualitative interviews","volume":"16","author":"Schneider","year":"2018","journal-title":"Hered. Cancer Clin. Pract."},{"key":"ref_28","first-page":"e2300024","article-title":"Development of an Electronic Health Record-Based Clinical Decision Support Tool for Patients With Lynch Syndrome","volume":"7","author":"Bleznuck","year":"2023","journal-title":"JCO Clin. Cancer Inform."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"AuBuchon, K.E., Schubel, L.C., Rivera, J.N.R., Garner, D., Tran, J., Urdinola, S., and Arem, H. (2025). Patient and provider perspectives on implementing patient navigation for colorectal cancer screening for Black and Latine patients: A qualitative study. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-025-13185-8"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"645","DOI":"10.7326\/ANNALS-24-01885","article-title":"Patient Navigation to Improve Colonoscopy Completion After an Abnormal Stool Test Result: A Randomized Controlled Trial","volume":"178","author":"Coronado","year":"2025","journal-title":"Ann. Intern. Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/12\/2010\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:40:51Z","timestamp":1782196851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/12\/2010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["cancers18122010"],"URL":"https:\/\/doi.org\/10.3390\/cancers18122010","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]}}}