From the Guidelines
Patients with serrated polyposis syndrome (SPS) who are younger than 50 often present with more aggressive disease and require earlier screening and more intensive surveillance. According to the guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG) 1, a diagnosis of SPS should be made in accordance with the new WHO 2019 criteria for SPS. The guidelines also suggest that other polyposis syndromes should be excluded by gene panel testing before making a definitive diagnosis of SPS, especially if the patient is under 50 or has a family history of colorectal cancer 1.
The guidelines recommend that patients with SPS should have colonoscopic surveillance yearly once the colon has been cleared of all lesions >5 mm in size, and the interval can be extended to 2 yearly if no polyps ≥10 mm in size are identified at subsequent surveillance examinations 1. Additionally, the guidelines suggest that first-degree relatives (FDRs) of patients with SPS should be offered an index colonoscopic screening examination at age 40 years or 10 years before the diagnosis of the index case, and have a surveillance examination every 5 years unless polyp burden indicates an examination is required earlier 1.
Although the provided evidence does not specifically examine the demographic characteristics of patients with SPS who are younger than 50, the guidelines suggest that younger patients may require more intensive surveillance due to the potential for more aggressive disease. Therefore, clinicians should consider initiating colonoscopy screening before age 40 in individuals with a family history of SPS or colorectal cancer, with follow-up intervals of 1-2 years depending on polyp burden. This approach is supported by the guidelines for the management of hereditary colorectal cancer 1 and the practice guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors 1.
Key points to consider when managing patients with SPS who are younger than 50 include:
- Earlier screening and more intensive surveillance may be necessary due to the potential for more aggressive disease
- Gene panel testing should be considered to exclude other polyposis syndromes, especially if the patient has a family history of colorectal cancer
- Colonoscopic surveillance should be performed yearly or every 2 years, depending on polyp burden
- FDRs of patients with SPS should be offered an index colonoscopic screening examination at age 40 years or 10 years before the diagnosis of the index case.
From the Research
Demographic Characteristics of Patients with Serrated Polyposis Syndrome
- The provided studies do not specifically focus on the demographic characteristics of patients with serrated polyposis syndrome who are younger than 50 2, 3, 4, 5, 6.
- However, some studies provide information on the age of patients with serrated polyposis syndrome:
- A study published in 2016 found that the mean age of patients with serrated polyposis syndrome who developed colorectal cancer was 53.9 ± 12.8 years 2.
- A study published in 2015 found that the median age of first-degree relatives of patients with serrated polyposis syndrome who underwent colonoscopy was 52 years (interquartile range, 41 to 60) 4.
- A study published in 2012 found that the age range of patients with serrated polyposis syndrome was not specified, but the study included 100 patients recruited from genetics clinics between 2000 and 2010 6.
- There is limited information available on the demographic characteristics of patients with serrated polyposis syndrome who are younger than 50, and further research is needed to understand this population.
Risk of Colorectal Cancer in Younger Patients with Serrated Polyposis Syndrome
- A systematic review and meta-analysis published in 2022 found that the overall risk of colorectal cancer in patients with serrated polyposis syndrome was 19.9% (95% confidence interval, 15.3%-24.5%) 5.
- However, the study did not provide specific information on the risk of colorectal cancer in younger patients with serrated polyposis syndrome.
- Further research is needed to understand the risk of colorectal cancer in younger patients with serrated polyposis syndrome and to develop effective screening and surveillance strategies for this population.