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We read with great interest the article by ten Kate et al (Gut 2007;56:1198–201) from the Dutch HNPCC group regarding the risk of small bowel cancer (SBC) in patients with hereditary non-polyposis colorectal cancer (HNPCC). The study confirms our data from 20051 regarding the localisation of tumours and the absence of identifiable risk factors for SBC in patients with HNPCC (ie, gender, mutation, family history, personal cancer history). The authors additionally calculated a lifetime risk of 4.2% for SBC using Kaplan–Meier statistics. Ten Kate et al recommend a non-invasive surveillance strategy. However, the authors argue that the lifetime risk for gastric cancer (GC) may influence a surveillance strategy for SBC regarding upper intestinal endoscopy.
In our previous studies1 2 cumulative cancer risks were not provided. We …