This report reviews the state of the art in cancer prevention by endoscopic polypectomy of familial adenomatous polyposis (FAP). FAP is a hereditary disease characterized by the development of multiple adenomatous polyps in the gastrointestinal tract. The timing of colectomy depends on the size and number of adenomatous polyps. This trial evaluates the usefulness and safety of thorough endoscopic polypectomy in patients with FAP. The main endpoint is whether or not a patient needs surgery on the large intestine during the intervention period. Colorectal polyps will be thoroughly removed by periodic colonoscopy. Patients who have (or had) 100 or more adenomas in the large intestine and who refused to undergo surgery despite of being advised to do so, and who are 16 years or older. Intervention period is 5 years.
The history and future perspectives of study of the Japanese Society for Carcinoma of the Colon, Rectum, and Anus (JSCCR) are presented with regard to the topic of hereditary colorectal cancer. A registry of intestinal polyposis and familial colorectal cancer was started in 1976 with the establishment of the Polyposis Center at the Tokyo Medical and Dental University. Thereafter, the work of registry was moved to the Polyposis Committee of the JSCCR, and many important findings focusing mainly on familial adenomatous polyposis have been reported in Japan and worldwide. In 2006, the Familial Colorectal Cancer Committee was established by uniting the Polyposis Committee and the Project Committee for the Second Study of Hereditary Non-Polyposis Colorectal Cancer (HNPCC). Since the publication of the Clinical Guidelines for Hereditary Colorectal Cancer in 2012, the concept of this new committee has been to build a nationwide system for studying hereditary colorectal cancer. At the time of writing (January 2014), a multicenter retrospective study investigating familial adenomatous polyposis is ongoing, and the publication of the HNPCC study is in preparation. Close relationships are needed between the Society of Familial Tumor and the JSCCR, as the Clinical Guidelines for Hereditary Colorectal Cancer were published with the collaboration of both committees.