Background Screening of patients with familial adenomatous polyposis (FAP) have led to a substantial reduction in mortality due to colorectal cancer (CRC). Recent guidelines suggest that surveillance of non-intestinal malignancies should also be considered in those patients. However, the value of these surveillance programmes is unknown. The aims of this study were (1) to assess the occurrence of extracolonic malignancies in a large series of adenomatous polyposis coli (APC) mutation carriers and (2) to evaluate the causes of death.
Methods All APC mutation carriers were selected from the Dutch polyposis registry. Data on causes of death were collected. Pathology reports were retrieved from the Dutch Pathology Registry.
Results A total of 85 extracolonic malignancies were diagnosed in 74 of 582 APC mutation carriers. Duodenal and skin cancers were the most prevalent cancers. Thyroid cancer was observed in only 1.5% of the cases. The main cause of death was cancer (59% of all deaths), with 42% due to CRC and 21% due to duodenal cancer. One patient died from thyroid cancer. The second and third most common causes of death were cardiovascular disease (13% of all deaths) and desmoid tumours (11% of all deaths), respectively.
Conclusion Extending surveillance programmes to other cancers will not contribute significantly to the survival of patients with FAP.
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Contributors Conception and design: ZG, HFAV.
Provision of study materials or patients: BAJB, AMJL, FN, J-WP, JCHH, JJK, SS, WHVNC, BJMW, HM, ED.
Collection and assembly of data: ZG, HFAV.
Data analysis and interpretation: ZG, HFAV.
Manuscript writing: All authors.
Final approval of manuscript: All authors.
Funding Study supported by the Netherlands Foundation of Detection of Hereditary Tumours (NFDHT).
Competing interests None declared.
Patient consent Patients registered at the Netherlands Foundation for the Detection of Hereditary Tumors (StOET) sign a consent form approving the use of their medical data for research purposes upon registration.
Ethics approval Approved by boards of the Netherlands Foundation for the Detection of Hereditary Tumors (StOET) and the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA).
Provenance and peer review Not commissioned; externally peer reviewed.
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