As a result of these challenges inherent with universal tumor screening for Lynch syndrome, not to mention the sequence of several screening tests which it entails (IHC followed in some cases by BRAF mutation analysis and/or MLH1 hypermethylation), in addition to the well-known challenges with family history collection, some have advocated for changing the paradigm to include upfront tumor sequencing [25] or universal germline genetic testing in colorectal cancer [26, 27]. The gene discussed is MLH1; the disease is colorectal cancer.