As cases with apparent MMR biomarker loss without internal positive controls ranged from 230 cases (5.8%) for MSH6 to 523 (13.1%) for MLH1 (Supplemental Table B), the frequency of MMR deficiency we report could be an underestimation, although it does agree quite closely with genomic findings as described above [19, 36]. This evidence concerns the gene MSH6 and mismatch repair cancer syndrome 1.