Dan Li, MD

Gastroenterology, KP Santa Clara

Dr. Li’s passion for supporting patients with Lynch syndrome (LS) spans an entire career. Patients who have LS, a hereditary condition that greatly increases the risk of colorectal cancer (CRC) and other cancers, carry a lifetime risk of up to 80% for CRC, compared to a risk of about 6% in the general population. But when LS is diagnosed early and proactively managed, mortality is decreased for patients and their at-risk relatives.

Dr. Li developed a universal LS screening program in 2011 for all patients newly diagnosed with CRC in KP Northern California. The program, now one of the largest in the country, has since screened more than 9,000 patients and identified more than 100 with LS. However, because patients with LS tend to develop CRC at a young age, Dr. Li became interested in investigating the diagnostic yield and efficiency of screening elderly patients, and whether it is reasonable to stop screening above a certain age.

“It’s not common for patients with Lynch to develop their first cancer in their 70s or 80s,” Dr. Li explains. “While several studies support the efficiency and cost-effectiveness of universal screening for those 70 or younger, the same type of data on older patients has been sparse.”

Dr. Li conducted a retrospective cohort study of 3,891 patients in KP Northern California with newly diagnosed CRC who had LS screening between 2011 and 2016. His findings, published in Annals of Internal Medicine in 2019, demonstrate a substantial decline in diagnosis of Lynch in elderly patients. Of the 63 Lynch cases in the cohort, only 5 were detected after age 70, and just 1 after age 80.

“We found that discontinuing reflex screening for LS after age 80 might be reasonable, particularly in resource-limited settings,” says Dr. Li. “Although further studies in other health care settings are still needed, our study has the potential to inform clinical care providers and health policy makers, and may help national guideline committees refine future screening recommendations.”