This protocol addresses patients with attenuated familial adenomatous polyposis (AFAP) who have developed up to 100 colorectal adenomas and are aged 25 years or older. AFAP carries a meaningful cumulative risk of colorectal cancer, making structured clinical decision-making essential at this stage.
AFAP is defined by the presence of up to 100 colorectal adenomas in patients aged 25 or older — distinguishing it from classic FAP. Despite the attenuated polyp burden, cancer risk remains sufficiently elevated to warrant a proactive surgical strategy rather than ongoing endoscopic surveillance alone.
Prophylactic surgical intervention is the strongly recommended approach for AFAP in this setting. The type of procedure and extent of resection are determined by individual clinical factors specific to AFAP — the complete operative decision algorithm is available in the full protocol.
AFAP is defined as the presence of up to 100 colorectal adenomas in subjects aged 25 years or older [111].
Prophylactic proctocolectomy is recommended for AFAP because it complicates colorectal cancer (recommendation strong [agreement rate 100%], level of evidence C).
View source ↗