The Singapore Polyposis Registry was established in 1989 in Singapore General Hospital. The aim is to provide a central registry service to all doctors in Singapore to facilitate in identification, surveillance and management of families and individuals at high risk of getting colorectal cancer from FAP (Familial Adenomatous Polyposis) and HNPCC (Hereditary Non-polyposis Colorectal Cancer). Both have an autosomal dominant inheritance that gives rise to colorectal cancer at any early age if untreated. They account for 5-6% of all colorectal cancers. Sixteen FAP families with 139 members have been evaluated. Fifty-eight members are affected and 81 are at risk or unaffected. Those who have been screened positive have a much lower risk of cancer (13%) compared with those who presented with the disease (89%) and death from colorectal cancer in the corresponding groups were nil and 58%. Eight HNPCC families with 36 affected and 170 at-risk members have been registered. Colonoscopic surveillance have just started: one case of Dukes' A cancer in a 26 year-old patient, and two cases with polyps have been diagnosed. Advances in molecular genetics and the identification of APC (Adenomatous Polyposis Coli) gene in the FAP locus of Chromosome 5 have made it possible to diagnose FAP genetically. This has important impact on management in terms of prenatal diagnosis and dietary and chemoprevention programmes in addition to surgical intervention.