Abstract
BackgroundFamily history (FH) by different relative types and risk of upper gastrointestinal (UGI) cancers has been only rarely reported; the data on UGI cancer survival are sparse.Methods600 esophageal squamous cell carcinoma (ESCC) cases, 598 gastric cardia adenocarcinoma cases, and 316 gastric non-cardia adenocarcinoma cases, and 1514 age-, gender-, and neighborhood-matched controls were asked for FH in first degree relatives and non-blood relatives. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regressions, and hazard ratios (HRs) from Cox proportional hazard regressions were estimated.ResultsIncreased ESCC risk was associated with FH of any cancer (OR = 1.72, 95% CI = 1.39–2.12), FH of any UGI cancer (OR = 2.28, 95%CI = 1.77–2.95) and FH of esophageal cancer (OR = 2.84, 95%CI = 2.09–3.86), but not FH of non-UGI cancer. Individuals with two or more affected first-degree relatives had 10-fold increased ESCC risk. FH of gastric cardia cancer was associated with an increased risk of all three cancers. Cancer in non-blood relatives was not associated with risk of any UGI cancer. FH of UGI cancer was associated with a poorer survival rate among younger ESCC cases (HR = 1.82, 95%CI = 1.01–3.29).ConclusionThese data provide strong evidence that shared susceptibility is involved in esophageal carcinogenesis and also suggest a role in prognosis.
Highlights
History (FH) by different relative types and risk of upper gastrointestinal (UGI) cancers has been only rarely reported; the data on UGI cancer survival are sparse
Family history (FH) of non-UGI cancer was not associated with esophageal squamous cell carcinoma (ESCC) risk, suggesting that the increased risk for FH of any malignant tumor was due to UGI cancer
Limitations of this study are: potential recall bias due to the nature of the case-control study design, under-ascertainment of FH, limited confirmation of cancer reports from relatives, potential misclassification of cancer types in relatives, and limited number of families with multiple esophageal cancer-affected members in ESCC controls, as well as small number of nonblood relatives with cancers. In this large study focused on FH and UGI cancer, we observed an increased ESCC risk among individuals with a FH of malignant tumors
Summary
History (FH) by different relative types and risk of upper gastrointestinal (UGI) cancers has been only rarely reported; the data on UGI cancer survival are sparse. Shanxi Province in north central China has among the highest esophageal cancer rates in the world [2]. Studies have implicated a number of environmental exposures and predisposing conditions, predominantly tobacco smoking and alcohol drinking as risk factors of esophageal cancer in the Western world [3,4,5], risk from these factors is either small or null in the especially high-risk populations of China and Iran [6,7,8]. Co-occurrence of esophageal cancer among family members does not necessarily reflect shared genetic susceptibility; it could be due to shared environmental exposures. Systematic exploration for the role of FH by relative type in esophageal cancer development has rarely been reported [16]
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