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High cumulative risk of colorectal cancers and desmoid tumours and fibromatosis in South Asian APC mutation carriers
  1. Shivani Ashar1,
  2. Anuja Lipsa1,2,
  3. Nikhat Khan1,2,
  4. Rajiv Sarin1,3
  1. 1 Cancer Genetics Unit, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai, Maharashtra, India
  2. 2 Homi Bhabha National Institute, Mumbai, Maharashtra, India
  3. 3 Tata Memorial Centre, Mumbai, India
  1. Correspondence to Dr Rajiv Sarin, Cancer Genetics Unit, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India; rsarin{at}


Management of familial adenomatous polyposis (FAP) is guided by the cumulative risk of colorectal cancer (CRC) and aggressive fibromatosis/desmoid (AF/D). The first non-Caucasian FAP cohort with cumulative risk estimates for CRC and AF/D shows distinct differences with the Caucasian and other Asian cohorts. The strong correlation between the adenomatous polyposis coli (APC) mutation location with the FAP phenotype and the geoethnic differences in APC mutation spectrum, genetic constitution, lifestyle and sporadic CRC rates, mandates the use of population-specific cumulative risk estimates for CRC and desmoid for counselling and risk management. On genotype–phenotype correlation in 83 individuals with classical FAP and a confirmed pathogenic/likely Pathogenic (P/LP) APC variant (n=76) or obligate carrier of the family variant (n=7), we observed a high cumulative CRC risk of 40% and 85% by 40 and 60 years, respectively. The observed 30% cumulative risk by 50 years for desmoids was higher than previous European and Asian cohorts and was significantly associated with prophylactic surgery (OR: 4.58, 95% CI 1.06 to 19.78) and APC mutation 3′ of codon 1309 (OR: 13.07, 95% CI 3.58 to 47.56) and also 3′ of codon 1444 (OR: 8.0, 95% CI 1.83 to 34.94). Global cooperation is required to establish FAP genotype–phenotype associations and population-specific risk estimates to guide genetic counselling and risk management.

  • genetic association studies
  • colorectal surgey
  • gastrointestinal diseases
  • genetic carrier screening
  • genetic testing

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  • SA, AL and NK contributed equally.

  • Contributors SA, AL and RS planned the study. SA, AL and NK performed laboratory experiments, and SA and AL carried out statistical analysis.SA, AL and RS wrote the manuscript. All authors approved the final manuscript.

  • Funding We acknowledge the Indian Council of Medical Research for funding the project and Department of Atomic Energy–ACTREC for providing fellowship to AL and NK.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.