Current status of knowledge, diagnosis and management of hereditary colorectal cancer among physicians in China: a national questionnaire survey of 81 doctors from different hospitals.

Abstract

Hereditary colorectal cancer (HCRC), including Lynch syndrome (LS) and familial adenomatous polyposis (FAP), accounts for 5-10% of colorectal cancers (CRC); however, little is known about physicians' awareness and management of these conditions in China. We conducted a nationwide cross-sectional survey of 81 physicians from 81 Chinese hospitals using a 74-item questionnaire assessing genetic testing, pedigree management, and LS/FAP protocols. The mean annual CRC caseload was 1093 per hospital, in stark contrast to only 32 HCRC cases. The LS diagnosis rate was alarmingly low (0.83% vs. expected 2-3%). Although 95.1% of hospitals offered dMMR immunohistochemistry, only 85.3% of CRC patients received it. Genetic testing completion rates were poor: 74.1% and 76.5% of hospitals reported 0-25% completion for suspected HCRC patients and first-degree relatives, respectively. Major barriers included high costs (93.8%), lack of insurance coverage (75.3%), and patient refusal (51.9%). Fewer than one-third of centers adhered to National Comprehensive Cancer Network (NCCN) guidelines. Only 8.6% incorporated risk-reducing hysterectomy and bilateral salpingo-oophorectomy into standard practice. Merely 13.6% maintained family management systems, 23.5% employed genetic counselors, and 46.9% had received HCRC training. HCRC diagnosis and management in China are inadequate, with substantial guideline-practice gaps. Urgent interventions are needed to improve physician education, reduce financial barriers, and implement standardized protocols.