EP901 - Implementation of an Early-Onset Colorectal Cancer Registry Improves Genetic Testing Referral and Completion Rates

ePoster Presenter(s)

• 

  Mary G. Smithson, MD

  Colorectal Fellow
  Cleveland Clinic Foundation
  Cleveland Clinic Foundation
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• JM

  Jacob G. Mansell, BS

  Clinical Research Coordinator
  Cleveland Clinic Department of Colorectal Surgery
  North Ridgeville, Ohio, United States

  Disclosure information not submitted.
• SF

  Shah Huzaifa H. Feroz, MD

  Clinical Research Fellow
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• JS

  Josh Sommovilla, MD

  Assistant Professor of Surgery
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• SM

  Sarah McGee, MS, CGC

  Genetic Counselor
  Cleveland Clinic Foundation
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• HC

  Haniee Chung, MD

  Staff Surgeon
  Cleveland Clinic Foundation
  Cleveland, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Emre Gorgun, MD, MBA. FACS, FASCRS. (he/him/his)

  Vice Chair, Department of Colorectal Surgery
  Cleveland Clinic
  Cleveland Cliinic
  Cleveland, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• 

  Michael A. Valente, DO

  Associate Professor of Surgery
  Cleveland Clinic
  cleveland, Ohio, United States

  Disclosure information not submitted.
• SK

  Smitha Krishnamurthi, MD

  Staff
  Cleveland Clinic Foundation-Main Campus
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• AK

  Alok Khorana, MD

  Staff
  Cleveland Clinic Foundation-Main Campus
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• SS

  Stephanie Schmit, PhD, MPH

  Associate Staff
  Genomic Medicine Institute, Cleveland Clinic Research
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  David Liska, MD

  Associate Professor, Chair
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic, Cleveland, Ohio
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Purpose/Background: The incidence of early-onset colorectal cancer (EOCRC) continues to rise. Up to 25% of patients harbor a pathogenic germline variant, underscoring the importance of genetic testing (GT) in this population. A prior study found only 62% of EOCRC patients were referred for GT at our institution, highlighting the need for structured care pathways. In 2021, we implemented comprehensive care paths within a new multidisciplinary EOCRC center and registry to improve coordination of care. We hypothesized that implementation of this dedicated center would increase GT referrals.

Methods/Interventions: A retrospective analysis was conducted using EOCRC registry data (2021-2025) from Cleveland Clinic, enrolling patients diagnosed before age 50. Demographic, clinical, and GT data were collected as part of the multidisciplinary EOCRC center. All eligible patients were contacted by a dedicated coordinator, and referrals to genetic counseling were initiated for those who agreed. GT referral and completion rates were compared before and after center implementation. Multivariate logistic regression identified factors associated with GT referral.

Results/Outcomes: Of the 590 EOCRC patients, 54 were excluded for inflammatory bowel disease, non-adenocarcinoma histology, or a prior known hereditary cancer syndrome. Among 536 included patients, 56.3% were male, 85.8% White, and 61.4% had colon tumors. Stage I-III disease was present in 61.4%. Family history of colorectal cancer was reported in 41.4% (9.3% first degree, 24.1% second degree). All patients were referred for counseling, with 92.9% accepting. Of those, 85.1% completed counseling and 82.1% completed testing. Pathogenic germline variants were identified in 9.0%, most commonly Lynch syndrome. Compared to pre-center data, referral (92.9% vs 62%, p< 0.001) and completion (82.1% vs 76.8%, p=0.048) rates were significantly higher (Fig. 1). Demographics were similar between groups, though non-referred patients were older and more often male. Younger age increased referral odds (OR 0.37, 95% CI 0.18-0.77; p=0.01), while male sex decreased odds (OR 0.22, 95% CI 0.09-0.56; p=0.01).

Conclusion/Discussion: Implementation of a dedicated EOCRC center significantly improved GT referral and completion rates. These findings highlight the value of structured, disease-specific pathways that combine coordinated multidisciplinary management with systematic data collection to improve adherence to GT guidelines and facilitating the identification of patients and families at increased hereditary risk.

Genetic testing referral comparing pre versus post EOCRC Center implantation