COLORECTAL CANCER SCREENING AND FAMILIAL RISK IN PEDIATRIC PATIENTS: A SURVEY OF RESIDENTS’ PRACTICE & KNOWLEDGE Tanya Tajouri , Thomas M. Attard, Rose Young, Henry T. Lynch, Creighton University, Omaha, NE. INTRODUCTION AND BACKGROUND: Colorectal cancer, the second-leading cause of cancer-related deaths and exerts a staggering socioeconomic toll on the US population every year. Up to 25% of CRC occur in individuals with a family history of CRC or adenomatous polyps. In 5-10% familial CRC occurs within the context of a clearly defined genetic syndrome including Hereditary Nonpolyposis Colon Cancer (HNPCC), Familial Adenomatous Polyposis (FAP), Peutz-Jeghers Syndrome (PJS) and Juvenile Polyposis (JP). Polyposis syndromes entail a risk of CRC from the second decade of life as well as an increased risk of extraintestinal tumors necessitating awareness, patient education and screening procedures (Table 1), and potentially surgery, including colectomy in affected children. Efforts to improve survival have increasingly focused on directed screening of at risk populations. Access to adequate screening facilities and physician knowledge base and correct practice are therefore the principal determinants of the adequacy of CRC preventive efforts. Studies in internal medicine physicians-in-training and faculty have repeatedly shown that awareness of CRC screening in both average and high-risk populations is inadequate and potentially impacts management decisions and clinical outcome; this in turn has prompted the development of novel, evidence-based approaches to physician education. Colorectal cancer, although rare in the pediatric population entails a worse prognosis than adult-onset CRC as a whole, in part because of the delay in diagnosis. Increased awareness of hereditary CRC syndromes in pediatricians may impact the outcome of pediatric CRC as would early recognition of extraintestinal malignancies associated with syndromic CRC including hepatoblastoma, thyroid (FAP), and genitourinary cancer (PJS). However, although discussed in the standard pediatric text books, pediatric resident knowledge and practice relevant to hereditary CRC and polyposis syndromes has hitherto fore not been studied. The primary aim of this study is to describe the knowledge level of pediatric residents in the treatment of children with gastrointestinal polyposis syndromes overall, and to compare the responses across the level of training and between pediatric residents and internal medicine-pediatric residents.