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 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

Hereditary nonpolyposis colorectal cancer

Assignment #2
Topic: Clinical criteria used to screen for hereditary nonpolyposis colorectal cancer

Why: Information on the clinical criteria commonly used to screen for hereditary nonpolyposis colorectal

cancer is either incomplete (Amsterdam Criteria) or missing (Bethesda guidelines).

Search Terms

- “Clinical criteria to screen for hereditary nonpolyposis colorectal cancer”

- “Clinical criteria to screen for lynch syndrome”

o Rationale: “Lynch Syndrome” is the more commonly used term in the medical field as

opposed to “hereditary nonpolyposis colorectal cancer”, and it is the term used in the

recently published “Classification of Tumours” textbook by the World Health Organization.

Secondary Source Literature Search Strategy:

- Searched for review articles in PubMed and applied the following filters to search: review, published

in the last 5 years, humans, and English.

o There was an overlap of 5 articles retrieved when using search terms “Clinical criteria for

lynch syndrome” (total articles retrieved: 6) and “Clinical criteria to screen for hereditary

nonpolyposis colorectal cancer” (total articles retrieved: 5)

- Searched for systematic reviews from high quality journals using the Cochrane Library

- Scanned article abstracts for relevance and looked at journal quality and author affiliation to assess

credibility and appropriateness of source:

o Eliminated articles whose focus was on a cancer other than colorectal cancer (e.g. ovarian

cancer, endometrial cancer, etc.) and those that were too broad in focus, i.e. those that failed

to explore the clinical criteria used for screening and diagnosis of lynch syndrome in-depth

Potential Sources Considered:

1. Bui, Q. M., Lin, D., &amp;amp; Ho, W. (2017). Approach to lynch syndrome for the gastroenterologist.

Digestive Diseases and Sciences, 62(2), 299-304. doi:10.1007/s10620-016-4346-4

2. Vindigni, S. M., &amp;amp; Kaz, A. M. (2016). Universal screening of colorectal cancers for lynch syndrome:

Challenges and opportunities. Digestive Diseases and Sciences, 61(4), 969-976. doi:10.1007/s10620-

015-3964-6

Selected Source: Bui, Q. M., Lin, D., &amp;amp; Ho, W. (2017). Approach to lynch syndrome for the

gastroenterologist. Digestive Diseases and Sciences, 62(2), 299-304. doi:10.1007/s10620-016-4346-4

- This article was chosen because it is a recent (within the last five years) review article published in a

reputable journal that provides a comprehensive, in-depth review of the clinical criteria used for the

screening and diagnosis of lynch syndrome (i.e. is relevant to the topic at hand).

Source Meets MEDRS Criteria:

- The review article was published within the last five years and provides up-to-date evidence

- The article is published in a high-quality, peer-reviewed journal

- The article is comprehensive, relevant to the topic, and provides thoroughly referenced coverage of

the topic with lack of bias

Using the article:

- Currently, the Wikipedia page provides incomplete information on the clinical criteria used to screen

individuals for lynch syndrome. I plan on using this source to add information on the clinical criteria

used (i.e. the Amsterdam I and II criteria and how they differ, the Bethesda guidelines, and the CRC

risk assessment tool), their significance, barriers in delivery, and their efficacy as screening tools.

Assignment #3
 Proposed Changes: 

All proposed changes are numbered and would fall under the ‘Screening’ subheading on the Wiki page.

1. Underneath ‘Amsterdam Criteria’ prior to ‘Amsterdam Criteria (all bullet points must be fulfilled)’ insert:

-       The Amsterdam I criteria were published in 1990; however, were felt to be insufficiently sensitive.

2. Between the ‘Amsterdam Criteria…’ and ‘Amsterdam Criteria II’ insert:

-       The Amsterdam II criteria were developed in 1999 and improved the diagnostic sensitivity for Lynch Syndrome by including cancers of the endometrium, small bowel, ureter and renal pelvis.

3. After the ‘Amsterdam Criteria II’ insert:

-       The Bethesda criteria were developed in 1997 and later updated in 2004 by the National Cancer Institute to identify persons requiring further testing for Lynch Syndrome through MSI. In contrast to the Amsterdam Criteria, the Revised Bethesda Guidelines use pathological data in addition to clinical information to help health care providers identify persons at high-risk.

Revised Bethesda Guidelines:

If a person meets any 1 of 5 criteria the tumour(s) from the person should be tested for MSI:

1.     Colorectal cancer diagnosed before age 50

2.     Presence of synchronous or metachronous colorectal or other Lynch syndrome associated cancers (e.g. cancers of endometrium, ovary, stomach, small bowel, pancreas, biliary tract, ureter, renal pelvis, brain, sebaceous glands, keratoacanthomas)

3.     Colorectal cancer with MSI-high pathology in a person who is younger than 60 years of age

4.     Colorectal cancer diagnosed in a person with one or more first-degree relative with colorectal cancer or Lynch syndrome associated tumour diagnosed under age 50

5.     Person with colorectal cancer and two or more first- or second-degree relatives with colorectal cancer or Lynch syndrome associated cancer diagnosed at any age

It is important to note that these clinical criteria can be difficult to use in practice and clinical criteria used alone misses between 12 and 68 percent of Lynch Syndrome cases.

 Rationale for proposed change: 

1. & 2. To date, the Wiki article lists the Amsterdam I and II criteria, however, does not identify when the guidelines were published and why a second iteration of the guidelines was needed. I have added two sentences to provide an explanation as to why the Amsterdam II guidelines were developed. I believe this is important to add to the Wiki page in order to understand the evolution of clinical criteria used for Lynch Syndrome screening.

3. Currently, the Wikipedia page provides incomplete information on the clinical criteria used to screen for persons at high-risk for Lunch syndrome. Specifically, the page does not address the Bethesda Guidelines which are universally used to identify persons warranting further investigation for Lynch syndrome through microsatellite instability (MSI). Fifteen percent of all colorectal cancers are those with MSI; the National Cancer Institute developed the Bethesda Guidelines to include both the clinical and histological manifestations of Lynch syndrome. I have included a section on the Bethesda criteria which includes when they were developed, revised, and how they differ from the Amsterdam criteria, and listed the Bethesda Criteria. This addition provides readers with a more complete description of the clinical criteria in use.

Additionally, it is important to note that the Wiki page does not address how these criteria are implemented in practice. It is not only crucial to understand which criteria have been developed but their clinical significance and use in every day practice. For this reason, I have added a sentence on the application of the clinical guidelines in real practice and their limitations.

For all changes above I have used the following review articles:

1.     Bui, Q. M., Lin, D., & Ho, W. (2017). Approach to lynch syndrome for the gastroenterologist. Digestive Diseases and Sciences, 62(2), 299-304. doi:10.1007/s10620-016-4346-4

2.     Vindigni, S. M., & Kaz, A. M. (2016). Universal screening of colorectal cancers for lynch syndrome: Challenges and opportunities. Digestive Diseases and Sciences, 61(4), 969-976. doi:10.1007/s10620-015-3964-6

As the clinical criteria mentioned above have been well-established in clinical practice, the proposed changes are unambiguous and non-controversial.

 Critique of Sources: 

The two secondary sources used are both narrative reviews, broad in scope, published within the last five years and provide up-to-date evidence. The review articles are published in high-quality, peer-reviewed journals and the articles are comprehensive and relevant to the topic at hand. Both articles’ authors state no conflict of interest and provide thoroughly referenced coverage of the topic. However, the articles do not explicitly state the structure used for identifying, reviewing and evaluating studies, which could introduce bias. For instance, there could be gaps in literature searching practices that could have led to the exclusion of relevant research. Also, ideally, there would be multiple reviewers for data review and extraction; however, this was not explicitly mentioned in the review articles.

- I like all of the changes you propose to make and think it's important to outline the various clinical criteria with the chronology on when they were introduced and why. You clearly justified your proposed changes. - The sources that you chose are good secondary sources