The English National Health Service (NHS) Lynch Syndrome Transformation Project was established to deliver universal testing for Lynch syndrome (LS) of newly diagnosed colorectal (CRC) and endometrial cancer (EC). A central aim was to integrate ‘mainstreamed’ genetic
testing into routine care by cancer multidisciplinary teams in England.

In June 2021 national and regional LS project teams were established to support ‘LS champions’ within local cancer multidisciplinary teams (MDTs). A comprehensive
retrospective genomic dataset and dashboard was compiled by the National Disease Registration Service (NDRS), complimented with prospective local MDT audit (2022-23). A robust national registry of people diagnosed with LS was developed to ascertain individuals for targeted interventions, including for a new national LS Bowel Cancer Screening Programme (LS-BCSP).

In total 276 LS champions were appointed and trained across 248 CRC and EC MDTs (>95% coverage nationally). Tumour Mismatch repair (MMR) tumour testing rates increased for CRC (43>94%) and EC (19>94%). MDT-led mainstreaming services were developed in 46% of all
CRC and 41% EC teams in England. In subgroup data, the time to germline genetic testing was 21 days in ‘mainstreamed’ patients, versus 180 days referred to regional clinical genetics services. New diagnoses of LS have consistently increased each year from a total of 545 in 2020 to a total of 1394 in 2024 (an increase of 255% versus a target of >50%).

The NHS England LS Transformation project has driven equitable nationwide delivery of diagnosis testing for Lynch syndrome, with integration of ‘mainstreamed’ genetic testing into routine cancer care.