title: Gastric cancer in FAP: a concerning rise in incidence.
abstract: The highest cancer risks in familial adenomatous polyposis (FAP) include colorectal, duodenal, and thyroid for which surveillance is recommended. Nearly all patients with FAP have gastric fundic gland polyposis (FGP), but gastric cancers are rarely reported with a similar incidence as the general population. We describe a recent, sudden increase in the incidence of gastric cancer in FAP. Seven of the ten cases were diagnosed in the last 20 months. Comparing our population to the SEER database for gastric cancer, the standardized incidence ratio is 140. All cases arose in patients with a carpeting of FGP and associated with large mounds of proximal gastric polyps. Nearly all patients were under upper endoscopic surveillance. This is a concerning observation and reflects a change in the phenotypic presentation of FAP in Western patients.
authors.affiliation: Departments of Gastroenterology and Hepatology, The Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA. mankang@ccf.org.
authors.forename: Gautam
authors.identifier: 0000-0002-4320-7322
authors.initials: G
authors.lastname: Mankaney
authors.affiliation: Department of Medicine, Cleveland, OH, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Leone
authors.affiliation: Department of Pathology and Laboratory Medicine, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cruise
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: LaGuardia
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Malley
authors.affiliation: Departments of Gastroenterology and Hepatology, The Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Bhatt
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: James
authors.initials: J
authors.lastname: Church
authors.affiliation: Departments of Gastroenterology and Hepatology, The Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA.|Department of Colorectal Surgery, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Burke
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000150:complications*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000453:epidemiology*
keywords: Endoscopic surveillance; Familial adenomatous polyposis; Gastric cancer; Screening