Poor compliance with germline testing recommendations in colorectal cancer patients undergoing molecular residual disease testing

Approximately 15% of colorectal cancers (CRCs) are associated with germline mutations. There is increasing adoption of DNA-based assays for molecular residual disease (MRD) and growing evidence supporting its clinical utility, particularly for CRC by oncologists in the U.S. We assessed the uptake of germline multi-gene panel testing (MGPT) for hereditary cancer in CRC patients receiving MRD analyses in community oncology settings. This retrospective study included 80 patients receiving care for CRC through community oncology practices who were referred for MRD testing at a commercial laboratory (January–March 2022). Clinical data, including test requisition forms, pathology reports, and clinical notes were reviewed. Documentation of tumor microsatellite instability and/or immunohistochemical (IHC) testing for mismatch repair (MMR) deficiency, age of CRC diagnosis, family history of cancer, and any order or recommendation for MGPT were assessed. Overall, 5/80 (6.3%) patients in the study have documented germline MGPT; 65/80 (81.3%) patients have documented MMR testing of their colorectal tumor. Among the 5 cases with abnormal MMR IHC, 2 have MGPT. Of the 33 patients meeting the 2021 National Comprehensive Cancer Network (NCCN) criteria for genetic/familial high-risk assessment, only 2 have MGPT. Our real-world data suggest that many CRC patients receiving MRD testing and meeting NCCN (v. 2021) criteria for germline MGPT may not be receiving evaluation beyond routine MMR status. Process and educational improvements are needed in community health settings to increase access and uptake of germline testing among CRC patients regardless of age at diagnosis or MMR status. Colorectal cancer is a major health concern worldwide. Identifying patients with hereditary cancer syndromes is important to patient care as well as their family members. We reviewed health records of 80 colorectal cancer patients undergoing different laboratory testing. Only 6.3% had specific genetic testing for inherited cancer risks, even though many patients met national guidelines for this testing. This points to a gap in clinical care. Enhancing access to genetic testing in community clinics could help more people and their families understand and manage their cancer risks. Schrock-Kelley et al. investigate the compliance with germline testing recommendations among colorectal cancer (CRC) patients who received molecular residual disease testing. Despite NCCN guidelines recommending consideration of multi-gene panel testing (MGPT) for all CRC patients, only 6.3% of this cohort received this, highlighting a gap in precision medicine.