J Am Acad Nurse Prac
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J Am Acad Nurse Prac · Feb 2008
Review Case ReportsScoping the family history: assessment of Lynch syndrome (hereditary nonpolyposis colorectal cancer) in primary care settings--a primer for nurse practitioners.
To describe and discuss the characteristic features and red flags of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, that warrants referral for genetic cancer risk assessment (GCRA). A focus on the nurse practitioner's (NP) role in familial risk assessment, physical examination, initiation of genetic referrals, and issues related to the genetic counseling process are also discussed. ⋯ Approximately 5% of all colon cancers are because of a germ line mutation predisposing individuals and their family members to colorectal and other cancers. Although the efficacy of screening modalities is established, healthcare providers often fail to identify those at greatest risk for disease. The extended family history is the first step in recognition of individuals "suspect" for hereditary colon cancers such as Lynch syndrome. Early-age onset of Lynch syndrome-associated cancers, an autosomal-dominant pattern, multiple primary tumors in an individual or multiple family members with Lynch syndrome-associated cancers, characteristic pathological features of colon cancer, or a known germ line Lynch syndrome mutation in a family member are "red flags" that will aid NPs in identifying individuals who may benefit from GCRA. IMPLICATIONS FOR NURSE PRACTITIONER PRACTICE: The importance of enhanced surveillance for early diagnosis and prevention of disease is a critical part of primary care. Thus, it is imperative that NPs obtain a minimum of a three-generation pedigree, recognize hereditary cancer patterns, and provide referral counseling for consideration of genetic testing of individuals suspect for Lynch syndrome.