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Usually patients at risk of Familial Adenomatous Polyposis Coli (FAP) undergo the screening and management recommended by Clinical Geneticists, and other medical professionals involved in their care. Professionals find it difficult when patients do not follow these recommendations, particularly when there is good evidence that doing so improves their clinical outcome. Beliefs regarding the safety, accuracy and benefits of undergoing screening, previous experience and cultural and religious beliefs may all influence uptake of screening. We present a case which raises important questions about how far we should explore patients' beliefs prior to predictive genetic testing. The proband had a colonoscopy which showed a few adenomatous polyps. When repeated he had greater than 100 polyps, was diagnosed with FAP and had a colectomy. 3 of his siblings requested predictive genetic testing. For two this was performed using our standard protocol (home visit by Genetic Nurse followed by clinic appointment). They received their positive results but then refused colonoscopy screening as they are convinced that the colonoscopy their brother had caused his polyposis. The third sibling was seen directly in clinic and tested but refused to return for his results. Exploring patients' belief systems and attitudes towards screening may extend the pre-test counselling process but lead to a better outcome. [ABSTRACT FROM AUTHOR]