Current Policy Priority
FORCE Requests Guidelines to Identify High-Risk, Lynch Syndrome Patients
Comments on New Colorectal Cancer Screening Recommendations
February 3, 2021 – Today, FORCE asked the U.S. Preventive Services Task Force (USPSTF) to develop Lynch syndrome screening recommendations to help identify individuals at increased risk of hereditary colorectal (CRC) and related cancers; we encouraged partner cancer and healthcare professional organizations to join us in this effort. The USPSTF is a panel of experts in prevention and evidence-based medicine that reviews and develops guidelines on a broad range of preventive services. These recommendations are published to guide healthcare providers in determining appropriate screening and preventive care—and to inform insurance coverage of specific preventive services.
Affecting one in 300 Americans, Lynch syndrome is more common than BRCA mutations. The USPSTF developed BRCA mutation screening recommendations in 2013 (updated in 2019) but hasn't provided guidance on screening for other inherited genetic mutations associated with an increased risk of cancer. Colorectal cancer is the third most common cancer and the second leading cause of cancer death in the U.S. Earlier, more intensive screening with colonoscopy may reduce CRC incidence by over 65% among individuals with Lynch syndrome.
USPSTF recommendations will aid in the diagnosis of Lynch syndrome in people without cancer and allow for potentially life-saving cancer screening and prevention options. In addition, a favorable recommendation would facilitate insurance coverage of genetic testing for Lynch syndrome. The Affordable Care Act stipulates that any preventive service receiving a USPSTF rating of "A" or "B" must be covered by most health plans with no copay or cost-sharing for the patient. Consequently, these guidelines impact access to care for many Americans.
In late November, FORCE submitted comments on the USPSTF Draft Recommendation Statement for Colorectal Cancer Screening. Previous guidelines recommended that people at average risk of CRC start screening for the disease at age 50. The updated guidelines endorse beginning CRC screening five years earlier—at age 45—for individuals at average risk of the disease.
FORCE agrees with the new recommendation but expressed concern that the Task Force does not provide sufficient guidance on identifying men and women who may be at increased risk of CRC due to hereditary/genetic factors. The USPSTF mentions that rates of colorectal cancer are higher in certain populations including, “Black adults and persons with a family history of colorectal cancer (even in the absence of any known inherited syndrome such as Lynch syndrome or familial adenomatous polyposis).” However, it does not provide information on how to identify people with Lynch or other CRC syndromes; and, it fails to acknowledge that endometrial, ovarian, pancreatic, urothelial and gastric cancers are associated with hereditary CRC syndromes.
We asked that the Task Force expand its recommendation by providing information to assist primary care providers in assessing potential hereditary CRC risk in their patients, and referring them for genetic counseling and testing if appropriate. This was followed by our more recent request that the USPSTF develop guidelines specifically aimed at screening and identifying people who may carry an inherited Lynch syndrome gene mutation.
Read our full comments on the USPSTF Draft Recommendation Statement for Colorectal Cancer Screening.
7/1/2021 - Effective today, North Carolina's Medicaid program will cover genetic counseling and BRCA mutation testing for those who have "higher than average risk" for the development of certain cancers based on specific personal and/or family history of the disease.
6/30/2021 - FORCE added its support to a letter sent to Senate HELP Committee leadership urging the prioritization of diagnostics reform on behalf of the In-vitro Diagnostics (IVD) Reform Coalition and the communities it represents.
5/21/2021 - Joined the Defense Health Research Consortium in a letter asking House and Senate leadership to continue support for the defense health research programs funded through the Department of Defense (DoD) Congressionally Directed Medical Research Programs (CDMRP).