ENDOSCOPIC SCREENING AND SURGERY FOR FAMILIAL ADENOMATOUS POLYPOSIS -DANGEROUS DELAYS

Background Registries for patients with familial adenomatous polyposis (FAP) can improve patient management. However, in relation to colorec tal cancer, a critical review has not previously been undertaken of th e effectiveness of screening and surgical protocols within a registry. Methods A review was undertaken of 63 gene carriers who received prim ary treatment for FAP between 1987, when the Northern Region Polyposis Registry was formed, and 1995. Results In some gene carriers with col orectal cancer, surgery was delayed because of social factors or unple asant surgical experiences in the family. Colonoscopy failed to detect five colorectal cancers. Conclusions Delays in treatment still occur in patients with FAP and colorectal cancer, often because of complex s ocial problems and patients' fear of surgery. If multiple colorectal p olyps are present, colonoscopy is not a reliable screening test for ma lignancy and prophylactic surgery is indicated, preferably before the patient is 20 years old.