{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T12:58:31Z","timestamp":1789131511643,"version":"build-2803163510"},"reference-count":40,"publisher":"Harborside Press, LLC","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The incidence of early-onset colorectal cancer (EOCRC) is rapidly increasing. Pathogenic germline variants (PGVs) are detected in 16% to 20% of patients who have EOCRC, highlighting a need for genetic counseling (GC) and multigene panel testing in these patients. We aimed to determine the rate of referral to GC and uptake and outcomes of germline testing in patients with EOCRC. <jats:bold>Methods:<\/jats:bold> We conducted a retrospective cohort study of patients aged &lt;50 years diagnosed with colorectal cancer (CRC) from 2010 to 2019 at Cleveland Clinic. Demographic data were extracted, including age, sex, self-reported race, and family history of CRC. The proportions of patients with GC referral and completion of GC and genetic testing were investigated, and genetic testing results were analyzed. Multivariable logistic regression analysis was conducted to identify factors independently associated with GC referral and uptake. <jats:bold>Results:<\/jats:bold> A total of 791 patients with EOCRC (57% male and 43% female) were included; 62% were referred for GC, and of those who were referred, 79% completed a GC appointment and 77% underwent genetic testing. Of those who underwent testing, 21% had a PGV detected; 82% were in known CRC-associated genes, with those associated with Lynch syndrome and familial adenomatous polyposis the most common, and 11% were in other actionable genes. Referral to GC was positively associated with family history of CRC (odds ratio [OR], 2.11; 95% CI, 1.51\u20132.96) and more recent year of diagnosis (2010\u20132013 vs 2017\u20132019; OR, 5.36; 95% CI, 3.59\u20138.01) but negatively associated with older age at diagnosis (OR, 0.89; 95% CI, 0.86\u20130.92). <jats:bold>Conclusions:<\/jats:bold> Referral to GC for patients with EOCRC is increasing over time; however, even in recent years, almost 25% of patients were not referred for GC. We found that 1 in 5 patients with EOCRC carry actionable PGVs, highlighting the need for health systems to implement care pathways to optimize GC referral and testing in all patients with EOCRC.<\/jats:p>","DOI":"10.6004\/jnccn.2023.7057","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T20:31:10Z","timestamp":1699389070000},"page":"1156-1163.e5","source":"Crossref","is-referenced-by-count":14,"title":["Referral, Uptake, and Outcome of Genetic Counseling and Testing in Patients With Early-Onset Colorectal Cancer"],"prefix":"10.6004","volume":"21","author":[{"given":"Hareem","family":"Syed","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Sommovilla","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio"},{"name":"Sanford R. 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Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio"},{"name":"DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio"},{"name":"Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Macaron","sequence":"additional","affiliation":[{"name":"Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio"},{"name":"DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio"},{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandie","family":"Heald","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio"},{"name":"Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruishen","family":"Lyu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Schmit","sequence":"additional","affiliation":[{"name":"Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio"},{"name":"DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio"},{"name":"Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio"},{"name":"Population and Cancer Prevention Program, Case Comprehensive Cancer Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanika","family":"Nair","sequence":"additional","affiliation":[{"name":"DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio"},{"name":"Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneel","family":"Kamath","sequence":"additional","affiliation":[{"name":"DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio"},{"name":"Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smitha","family":"Krishnamurthi","sequence":"additional","affiliation":[{"name":"DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio"},{"name":"Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alok A.","family":"Khorana","sequence":"additional","affiliation":[{"name":"DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio"},{"name":"Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Liska","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio"},{"name":"Sanford R. 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