This HTA pertains to universal testing for deficient mismatch repair (dMMR) in colorectal cancer (CRC) patients. Tumour dMMR testing can serve two purposes: optimizing chemotherapy treatment in CRC patients and diagnosing Lynch syndrome (LS), a hereditary disorder that increases the risk of certain types of cancers. Universal testing is being considered because it is hypothesized that providing this testing on a broad scale will result in better chemotherapy outcomes for CRC patients and identification of potentially high-risk family members, which will amount to an overall reduction of cancer-related morbidity and mortality in the population. The intent is to initiate a process that could ultimately lead to fewer cancer-related harms in relatives of CRC patients who have LS. This inquiry analyzes and summarizes the ethical issues involved in the implementation of universal dMMR testing in CRC patients.

Contents

• Reviewers
• Authorship
• Conflicts of Interest
• Background
• Summary of Relevant Ethical Issues
  • Whether universal dMMR testing should be implemented
  • How dMMR testing should be provided for the purpose of LS diagnosis in CRC patients and relatives
• Inquiry
• Methods
• Results
• Analysis
  • Should we implement universal dMMR testing in CRC patients?
  • How should universal dMMR testing or LS testing be provided in CRC patients and their relatives?
  • Policy implications of ethics considerations for universal dMMR tumour testing
  • Contextualizing Questions
• References
• Appendix 1 Ethics Literature Search (Combined With Search Strings Used for Condition and Technology for Clinical Search)
• Appendix 2 PRISMA Flow Diagram of Literature Search and Selection Process
• Appendix 3 Excluded Reports
• Appendix 4 Characteristics of Included Studies Examining Ethical Issues With Universal dMMR Testing

Suggested citation:

DNA mismatch repair deficiency tumour testing for patients with colorectal cancer: ethical issues. Ottawa: CADTH; 2016 Aug. (CADTH optimal use report; vol.5, no.3c).

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