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Table 9. Clinical Practice Guidelines for Colon Surveillance of Attenuated Familial Adenomatous Polyposis (AFAP)

Organization Condition Screening Method Screening Frequency Age Screening Initiated Comment 
Europe Mallorca Group (2008) [185]AFAPColonoscopyEvery 2 y; every 1 y if adenomas are detected18–20 y
NCCN (2014) [92]Personal history of AFAP with small adenoma burdenaColonoscopyEvery 1–2 yIf patient had colectomy with IRA due to significant polyposis not manageable with polypectomy, endoscopic evaluation every 6–12 mo depending on polyp burden.
Colectomy and IRA may be considered in patients aged ≥21 y
NCCN (2014) [92]Personal history of AFAP with significant polyposisNot applicableNot applicableNot applicableColectomy with IRA preferred. Consider proctocolectomy with IPAA if dense rectal polyposis.
NCCN (2014) [92]Unaffected, at-risk family member; family mutation unknown; APC mutation status unknown or positiveColonoscopyEvery 2–3 yLate teens

IPPA = ileal pouch–anal anastomosis; IRA = ileorectal anastomosis; NCCN = National Comprehensive Cancer Network.
aFewer than 20 adenomas that are each <1 cm in diameter and without advanced histology so that colonoscopy with polypectomy can be used to effectively eliminate the polyps.


  1. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Colorectal. Version 2.2014. Rockledge, PA: National Comprehensive Cancer Network, 2014. Available online with free registration. Last accessed June 17, 2014. 

  2. Vasen HF, Möslein G, Alonso A, et al.: Guidelines for the clinical management of familial adenomatous polyposis (FAP). Gut 57 (5): 704-13, 2008.  [PUBMED Abstract]