We are requesting the following information relating to the implementation of NICE guidance DG27: Molecular testing strategies for Lynch syndrome in people with colorectal cancer, within your trust.

The guidance, published in February 2017, recommends that ‘testing be offered to all people with colorectal cancer, when first diagnosed, using immunohistochemistry for mismatch repair proteins or microsatellite instability testing to identify tumours with deficient DNA mismatch repair, and to guide further sequential testing for Lynch syndrome.’

Please could you provide us with information on the following questions? We would appreciate it if you could select the answers to the written questions below by either highlighting the appropriate response or deleting the inapplicable.

FOI questions

1. Do you test newly diagnosed bowel cancer patients in your trust (either contracted or referred) for molecular features of Lynch syndrome using either immunohistochemistry or microsatellite instability testing?
 Yes – everyone under the age of 50
 Other – When requested by the oncologist, histology suggestive of dMMR, poorly differentiated tumour

2. If yes, at what stage does this testing take place?
 Post treatment i.e. test is carried out on the tumour resection specimen only.

3. Is this test carried out as a reflex test i.e. automatically or upon referral?
 Reflex
 Referral via MDT

4. In their published adoption support resource NICE suggest identifying a named ‘clinical champion’ within each colorectal multidisciplinary team to effectively implement testing people for molecular features for Lynch syndrome. Is this established in your trust?
 No

5. Do you audit diagnostic outcomes within your trust to ensure that every patient is tested for molecular features for Lynch syndrome?
 No

6. Have you had to submit a business case for funding in order to effectively implement this new guidance?
 Yes, but no additional funding was provided. Please provide information on why. Awaiting outcome of business case/request for additional costs associated with laboratory testing.

7. If no such testing is in place, do you have information on whether there are any plans to introduce molecular testing for Lynch syndrome as per NICE guidance? Yes

8. What are the main barriers you have faced if no molecular testing or only selected testing is performed? Please specify.
 Financial