Impact of EGAPP Recommendations for Colorectal Cancer Genetic Testing On Genetic Counseling Sessions. By Emily Walsh
Background: The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group (2009) suggests that there is sufficient evidence to warrant genetic testing for Lynch syndrome for all individuals newly diagnosed with colorectal cancer (CRC). This study assessed the impact of these EGAPP recommendations by examining 1) cancer genetic counselors’ familiarity with current EGAPP recommendations, 2) the proportion of institutions that have altered their policies to conform to EGAPP recommendations, and 3) the impact of changes in protocol on genetic counseling services these recommendations have had. Methods: Data was collected using an online survey sent to cancer genetic counselors through the National Society of Genetic Counselors main listserve and the Cancer Special Interest Group listserve. Results: The overall response rate for the survey was 17%. Of the sample population, 91% was familiar with EGAPP guidelines regarding colon cancer tumor testing, and approximately 35% of institutions at which participants practice have implemented these guidelines. The most commonly reported protocol for colon cancer tumor testing was ordering IHC and MSI together, followed by gene testing if indicated. This was also the most preferred protocol among participants who were dissatisfied with their institution’s protocol. In comparison to 2008, participants whose institutions follow EGAPP guidelines reported significantly more colon cancer patient referrals per week than those whose institutions do not follow EGAPP guidelines (p=0.015), and these institutions have not added additional genetic counselors to accommodate the increased patient load. Participants reported that they had sufficient time for genetic counseling sessions, and generally reported positive attitudes towards EGAPP guidelines.