Bloom's syndrome has been known as a clinical entity for 34 years. Careful records of cases diagnosed throughout the world have been maintained since its recognition as an entity, and most instances of cytologically verified Bloom's syndrome have been accessioned to what has been referred to as the Bloom's Syndrome Registry since the mid‐1960s. Presented here is the fourth in a series of progress reports from the Registry of information accumulated during this long‐term surveillance of affected families, along with mention of selected recent advances that have been made in the understanding of the syndrome. 130 persons had been accessioned to the Registry by the end of 1987; 96 of these were alive, their mean age being 18.9 years. Although a number of clinical complications occur in Bloom's syndrome, the most important is malignant neoplasia. In the 130 persons in the Registry, 57 malignant neoplasms had been detected, the mean age at diagnosis being 24.8 years. Neoplasia in Bloom's syndrome is noteworthy not only because of its frequency and exceptionally early age of emergence but for its variety of histological types and sites of ori