Microsatellite Instability and its Significance to Hereditary and Sporadic Cancer

Up to one million people within the United States may have Lynch syndrome (LS), but only 10% have been diagnosed. Early identification of these individuals is critical because they are predisposed to the development of colorectal and several other cancers at a relatively young age. Individuals with LS carry a germline mutation in one of four DNA mismatch repair genes, which leads to hypermutability in simple repetitive DNA sequences. This hallmark molecular phenotype called microsatellite instability (MSI) is now widely used to screen individuals needing germline sequencing to confirm diagnosis of LS. Standardized markers for MSI testing and other improvements in methodology have greatly improved the accuracy and cost-effectiveness of MSI testing. The current trend toward universal MSI screening of all colorectal and endometrial cancers will save lives by identifying LS prior to the development of deadly cancer. New technologies for MSI detection, such as next generation sequencing, open the possibility of a single test for LS that determines both tumor MSI status and germline mutations. Moreover, MSI detection is poised to take on an even greater role in prediction of responses to the new immunotherapies targeted at MSI-positive tumors