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Table 4　Toronto protocol: agreed surveillance recommendations for TP53 carriers13)However, in a meta-analysis of whole-body MRI surveillance, most of the cancers detected were localized and curative treatment was achieved23). Therefore, there is a high possibility of reducing complications and improving quality of life by reducing the intensity of treatment. In addition, some studies have reported that routine examina-tions can contribute to a reduction in anxiety24).Due to the rarity of the disease, the annual surveillance system recommended for LFS is not currently in place nationwide. Although some other facilities perform brain, thoracic, abdominal, and pelvic (including lower limb) imaging four times a year, surveillance that requires frequent visits lacks continuity. Therefore, we proposed a surveil-lance system that includes whole-body and brain MRI25), with collaborations between the genetics department, radiology department, breast oncology department and the family clinic.With the spread of cancer genomic medicine, the diagnosis rate of hereditary tumor syndromes is expected to increase in the future. For these diseases, extra consideration should be given when deciding on a cancer treatment plan and a lifetime surveillance system is necessary. At our hospital, which has a genetic outpatient clinic, we have established a surveillance system including whole-body MRI for LFS, which hopefully will be taken up by other hospitals in Japan.Abdominal US, every 3–4 month: birth-40 y, Biochemistry (17 OH-progesterone, total testosterone, DHEAS, androstenedione) should only be performed where there is an unsatisfactory USS.Annual dedicated MRI from age 20–70 years(woman only) Consider risk-reducing mastectomy from age 20 yearsAnnual dedicated brain MRI from birth (first MRI with contrast)Annual WB-MRI from birth, Abdominal US 3-4 monthly: from 18 yColonoscopy every 2 y: from age 25 or 10 y before earliest onset of colorectal carcinoma in familyRecommend Helicobacter pylori testing and eradication if requiredEndoscopy not indicated due to lack of evidenceAnnual dermatology review from 18 years (general practitioner or dermatology), Japanese is not common. General advice on use of high protection factor sunscreen and covering up in sun.Recommend detailed discussion of red flag symptoms in both children and adults and provide information on relevant resources. Discuss importance of making positive lifestyle choices (e.g.: not smoking, eating a healthy diet, limiting alcohol consumption, sun protection, keeping physically active and providing appropriate resources).ACC, adrenocortical carcinoma; DHEAS, dehydroepiandrosterone sulfate; MRI, magnetic resonance imaging; US, ultrasound; WB, whole-body; y years.ACCBreast cancerBrain tumorSarcomaColonGastricSkinOther 1) Sidransky D, Tokino T, Helzlsouer K: Inherited p53 gene mutations in breast cancer. Cancer Res, 1992; 52: 2984-2986. 2) Levine A: p53, the cellular gatekeeper for growth and division. Cell, 1997; 88: 323-331. 3) Zhang J, Walsh MF, Wu G, et al: Germline Mutations in Predisposition Genes in Pediatric Cancer. N Engl J Med, 2015; 373: 2336-2346.We would like to thank Dr. Masashi Ueno (the Department of Gastrointestinal Surgery, Toranomon Hospital), her family doctor, for his understanding of the patient’s follow-up. We sincerely appreciate Clear Science Pty Ltd. for language editing.The author recived no financial support for the research.RS carried out the acquisition of data and wrote the manuscript. YH and HS conducted pathological assessments. KS and SS conducted whole-body MRI test and assessments. NS and MA reviewed and revised the manuscript. MU, MS, and MA were responsible for the care of the patient. All authors read and approved the final manuscript.None declared.411ConclusionAcknowledgmentsFundingAuthor contributionsConflicts of interest statementReferences