Even in the era of multigene panel testing, these data suggest that telephone disclosure of cancer genetic test results is as an alternative to in-person disclosure for interested patients after in-person pretest counseling with a genetic counselor.

OBJECTIVES. The purpose of this study was to compare lumbar spine surgical procedures by age, gender, and number of comorbidities with respect to mortality in patients 65 years of age and older in the United States. METHODS. A 100% sample of the 1986 Medicare inpatient Health Care Financing Administration claims files databases involving lumbar spine surgical procedures was analyzed. RESULTS. Lumbar spine surgery in 34,418 patients (median age = 71 years) was associated with a significant increase in in-hospital and 1-year cumulative mortality only beyond 80 years of age. When adjusted for age, in-hospital and 1-year cumulative mortality with both decompression and excision procedures were significantly higher in men than in women. When adjusted for both age and gender, mortality increased significantly as the number of comorbidities increased. CONCLUSIONS. With lumbar spine surgery in elderly patients, mortality did not significantly increase until 80 years of age and was consistently associated with decompression and excision, with male gender, and with an increase in number of comorbidities.

In a retrospective analysis, we found that despite similar rates of colorectal tumor analysis, minority patients are less likely to be recommended for genetic evaluation or to undergo germline testing for Lynch syndrome. Improvements in institutional practices in follow up after tumor testing could reduce barriers to diagnosis of Lynch diagnosis in minorities.

Multigene panel tests for hereditary cancer syndromes are increasingly utilized in the care of colorectal cancer (CRC) and polyposis patients. However, widespread availability of panels raises a number of questions including which patients should undergo testing, which genes should be included on panels, and the settings in which panels should be ordered and interpreted. To address this knowledge gap, key questions regarding the major issues encountered in clinical evaluation of hereditary CRC and polyposis were designed by the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer Position Statement Committee and leadership. A literature search was conducted to address these questions. Recommendations were based on the best available evidence and expert opinion. This position statement addresses which genes should be included on a multigene panel for a patient with a suspected hereditary CRC or polyposis syndrome, proposes updated genetic testing criteria, discusses testing approaches for patients with mismatch repair proficient or deficient CRC, and outlines the essential elements for ordering and disclosing multigene panel test results. We acknowledge that critical gaps in access, insurance coverage, resources, and education remain barriers to high-quality, equitable care for individuals and their families at increased risk of hereditary CRC.