Medical Oncologist
CION Cancer Clinics
When screening should start in a family with FAP | CION Cancer Clinics
In classic FAP, a child who carries the family fault usually starts bowel checks in late childhood or the early teens. A child who does not carry it needs no FAP checks at all. This page explains who should be tested, when colonoscopy begins, which checks are added in adult life, and when symptoms mean you should not wait. At CION Cancer Clinics, our oncologists plan screening and care for families with an inherited cancer syndrome, explained in plain words.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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On this page
- When should a child in an FAP family first be checked?
- Which relatives need screening, and which do not?
- What does the screening timetable look like in classic FAP?
- What do the screening terms mean?
- What changes once a child's test result is known?
- What this page cannot tell you
- Four things parents tell us, and what is actually true
- Common questions about when FAP screening starts
The short answer
When should a child in an FAP family first be checked?
In classic FAP, bowel checks for a child who carries the family fault usually start in late childhood or the early teens. International guidelines place the first colonoscopy somewhere between about ten and fifteen years of age. The gene test that decides who needs those checks is usually done around the same time, or a little before.
Why childhood, when most gene tests wait
For most inherited cancer conditions, testing waits until a child is an adult and can decide for themselves. FAP is one of the exceptions. Polyps start young, checks genuinely help, and a child who does not carry the fault can be spared years of colonoscopy.
What decides the exact age
The age is not fixed for every family. The team weighs the form of FAP in your family, the age at which relatives first had polyps, and any symptoms the child has. In the milder attenuated form, checks usually start later, in the late teens or early adult life.
When not to wait for the planned age
If a child from an FAP family has bleeding from the back passage, loose stools that do not settle, or unexplained tiredness, they should be seen sooner. Symptoms move the timetable forward.
A child who tests negative for the family fault does not need FAP checks at all.Who needs what
Which relatives need screening, and which do not?
The answer depends on whether the family fault has been found, and on each person's own test result.
Relatives who carry the fault
They follow the full FAP schedule. Bowel checks begin in late childhood or the teens, and other checks are added through adult life.
Usually includes
- Regular colonoscopy until surgery is planned
- Upper gut camera checks from early adult life
- Thyroid ultrasound as your team advises
Relatives who do not carry it
Once the family fault is known and a relative tests negative, they return to the same bowel screening advice as anyone else of their age. Their children cannot inherit FAP from them.
When no fault was found
Sometimes a family clearly has FAP, but the gene test does not find the fault. Then every child of an affected parent is screened by colonoscopy anyway, because a negative test cannot rule them out.
Babies and very young children
A rare liver tumour of early childhood is more common in FAP families. Some teams offer checks for it in the first years of life. The evidence is debated, so this is a shared decision with your team.
Not sure whether this applies to you?
Ask an oncologistA lifetime of checks
What does the screening timetable look like in classic FAP?
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Early childhood
Parents who carry the fault talk with the team about liver checks in the first years of life. Most families also start thinking about when to test their children.
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Late childhood
The child is tested for the known family fault, with a counsellor who explains it in words they can follow. Those who carry it are booked for their first colonoscopy.
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The teenage years
Colonoscopy is repeated regularly, often every year or two, and more often as polyps increase. Timing is planned around school and exams.
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Late teens to early twenties
Thyroid ultrasound is often added. Preventive bowel surgery is discussed when the polyps become too many to watch safely.
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Adult life
Upper gut camera checks begin, and continue for life alongside checks of any remaining bowel. New children in the family are offered testing when their time comes.
Words you will hear
What do the screening terms mean?
- Predictive test
- A gene test in a well person, looking for the fault already found in a relative. It predicts risk. It does not diagnose illness.
- Cascade testing
- Testing relatives one step at a time, starting with the closest, once the family fault is known.
- Colonoscopy
- A thin camera passed through the back passage to look along the whole large bowel. It is done under sedation in most children.
- Flexible sigmoidoscopy
- A shorter camera test of the lower bowel only. It is sometimes used in younger teenagers before full colonoscopy.
- Attenuated FAP
- A milder form with fewer polyps appearing later. Checks usually start later too.
- Surveillance
- Checks repeated on a schedule in someone known to be at risk, to find changes early.
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Side by side
What changes once a child's test result is known?
Child carries the fault
Child does not carry it
Colonoscopy starts in late childhood or the teens
No FAP bowel checks are needed
Upper gut and thyroid checks follow later
Routine adult screening applies
Preventive surgery is planned in time
No surgery is needed for FAP
Their own children can be offered testing
Their children cannot inherit FAP from them
Being straight with you
What this page cannot tell you
It cannot set the start age for your child. That depends on the family's form of FAP, the ages at which relatives had polyps, the exact APC variant, and how your child is doing. What your specific variant means is a question for the counsellor who ordered the test.
It cannot tell you how to explain it to your child
Every child is different. Some want every detail, others want to know only what happens next. A genetic counsellor can help you find words that fit your child's age, and can sit with you when the result is shared.
Who this does not apply to
This timetable is only for families with confirmed or strongly suspected FAP. Families with one older relative who had bowel cancer, or one or two polyps removed in later life, do not follow it. Most people reading about bowel screening are in that group and need only routine advice.
Families travelling from the districts can ask for the child's counselling and first colonoscopy to be planned close together, to reduce trips to Hyderabad.Commonly believed
Four things parents tell us, and what is actually true
"Our child is healthy, so we can wait until they are grown up."
Polyps in FAP begin silently in childhood. Waiting for adult life can mean missing the window when checks help most. The gene test first tells you whether checks are needed at all.
"Colonoscopy is too much for a child."
Children are usually sedated and remember little. Teams used to working with young people plan the preparation gently. The test is far easier than facing a late diagnosis.
"Only the son who looks like his father needs checking."
Every child of an affected parent has the same chance, whoever they resemble and whether son or daughter. Only a test can tell who carries the fault.
"Testing will ruin her marriage chances, so we should keep quiet."
This fear is real and common. Skipping checks leaves the risk in place and only hides it. A counsellor can help you think through what to share, and when, without giving up her care.
Questions we are asked
Common questions about when FAP screening starts
At what age should my child have the gene test?
Usually in late childhood, around the time the first colonoscopy would be due. Testing much earlier rarely changes care, and waiting lets the child take part in the conversation. Your counsellor will help you pick a time that suits your child.
How often is colonoscopy repeated?
Often every year or two in the teenage years, and more often as polyps increase. The gap is set after each test by what the doctor sees. It is a guide, and your team may shorten it.
What if my child has symptoms before the planned age?
Get them seen promptly. Bleeding from the back passage, loose stools that do not settle or unexplained tiredness should never wait for a scheduled check. Tell the doctor that FAP runs in the family.
Do I need screening if I am an adult who was never tested?
Yes, if a parent or sibling has FAP. Ask for the gene test for the family fault first. If that is not possible, a colonoscopy is the safe option while you wait.
Does attenuated FAP need screening in childhood?
Usually not. In the milder form, colonoscopy tends to start in the late teens or early adult life, because polyps appear later. Your team will look at the family's pattern before setting a start age.
Is the liver check for babies really necessary?
Experts disagree. The liver tumour is rare, but more common in FAP families, and finding it early helps. The checks involve regular blood tests and ultrasound. Talk it through with your team and decide together.
Can screening be done outside Hyderabad?
Colonoscopy is widely available, but children with FAP are best seen by a team used to the condition. Many families travel for key tests and do simpler follow-up closer to home. Ask your team how to share the load.
Where do we start if a parent has just been diagnosed?
Ask for a copy of the parent's genetic report and colonoscopy findings. Take them to a genetic counsellor who can plan testing for each child. Call the CION helpline if you are not sure who to see.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
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Sources
- GeneReviews (NCBI) — APC-Associated Polyposis Conditions
- NCCN — Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric
- National Cancer Institute — Genetics of Colorectal Cancer (PDQ) - Health Professional Version
- NHS — Predictive genetic tests for cancer risk genes
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Telling children they may have FAPHow to have the conversation before the testHundreds of polyps: what FAP actually looks likeWhat the first colonoscopy may showDeciding the timing of preventive bowel surgeryThe next decision once polyps increaseUpper GI surveillance and duodenal polyps in FAPThe checks that begin in adult life
Talk to us
Not sure when your child's checks should begin?
Tell us about the family diagnosis and your children's ages. We will help you reach a genetic counsellor who can plan testing and the first checks. One helpline serves every CION centre.