Protecting Your Family: Risk and Screening for Relatives

One of the most important aspects of a Serrated Polyposis Syndrome (SPS) diagnosis is what it means for your family. Because there is a clear pattern of increased risk among close relatives, your diagnosis serves as an “early warning system” that can protect your loved ones ^[1][2].

Increased Risk for Loved Ones

Your first-degree relatives (FDRs)—which include your parents, siblings, and children—have a significantly higher chance of developing colorectal cancer (CRC) compared to the general population ^[1].

• Higher Probability: Research suggests that FDRs of patients with SPS may have up to a 5-fold increased risk of developing colorectal cancer ^[3][4].
• Advanced Polyps: These relatives are also more likely to develop “advanced neoplasia,” which are the types of polyps most likely to turn into cancer if not removed ^[2].
• A Shared Risk: Interestingly, this risk applies to your family members regardless of whether you met Criterion I or Criterion II for your diagnosis ^[1].

Screening Guidelines for Family Members

Because the risk is higher, the “standard” rules for colon cancer screening (which often start at age 45 for the general public) do not apply to your family. Major medical societies, such as the U.S. Multi-Society Task Force on Colorectal Cancer, recommend a more proactive approach ^[5][6]:

1. When to Start: FDRs should begin colonoscopy screening at age 40 ^[5][7].
   • Note: If you or another family member were diagnosed with colorectal cancer at a very young age, your relatives should start screening 10 years earlier than that youngest diagnosis ^[5].
2. How Often: If the initial screening is clear, FDRs should typically repeat their colonoscopy every 5 years ^[5][6].

This 5-year interval for your relatives is more frequent than the 10 years recommended for the general public, but less frequent than the 1-2 year “surveillance” interval you follow as a person with a confirmed diagnosis ^[5][8].

Questions for Relatives to Take to Their Doctor

When your family members schedule their screening, it is helpful for them to advocate for themselves. Provide them with this list of questions to take to their primary care provider or gastroenterologist:

• “My first-degree relative was diagnosed with Serrated Polyposis Syndrome (SPS). Given my 5-fold increased risk, will you authorize a colonoscopy for me now?”
• “Are you familiar with the U.S. Multi-Society Task Force guidelines that recommend I be screened every 5 years starting at age 40?”
• “Will the endoscopist performing my procedure be looking specifically for flat, sessile serrated lesions?”

Changes in the 2019 WHO Criteria

The way doctors use family history to diagnose SPS has changed recently. In the older (2010) guidelines, a person could be diagnosed with SPS simply by having a first-degree relative with the syndrome plus a small number of their own serrated polyps ^[2][9]. The 2019 WHO update simplified this by removing family history as a standalone diagnostic tool ^[9].

Today, a diagnosis is based entirely on the number, size, and location of polyps found in your colon ^[9]. However, this change was made to make the diagnosis more precise for the patient—it does not change the fact that your family members need early and regular screening ^[1][2].