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We welcome the joint work of the British Society of Gastroenterology and the Association of Coloproctology of Great Britain and Ireland in commissioning guidelines for colorectal cancer screening in high risk groups (Gut 2002;51(suppl 5):V13–14). In the absence of direct evidence from randomised trials for most of the groups, the various authors have balanced a wealth of recent genetic and epidemiological evidence estimating an individual’s levels of elevated risk against the risks associated with screening. The end result is the recognition that within the label “high risk” there is a spectrum of risks such that colonoscopic screening and surveillance must be tailored accordingly. This avoids the ineffective, costly, and potentially harmful “blanket-type” approach, which formerly prevailed.
However, within the guideline series, there is one exception—screening and surveillance in patients with acromegaly. We and other researchers1–3 have repeatedly stated that the studies undertaken by the authors of these guidelines have overestimated the risk of colorectal cancer in this patient group. They report a 13–14-fold increase in risk based on colorectal cancer detection rates among acromegalics undergoing colonoscopy at Barts compared with …