a National Cancer Institute, Bethesda, MD 20892, USA.
b Beijing Institute for Cancer Research and School of Oncology, Beijing Medical University, Beijing, China 100034.
c Linqu Public Health Bureau, Linqu, Shandong, China 262600.
d Westat, Inc., Rockville, MD 20850, USA.
Reprint requests to: Wei-Cheng You, Division of Cancer Epidemiology and Genetics, National Cancer Institute, EPS Room 8030, Bethesda, MD 20892, USA.
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Abstract |
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Aim To study the relation of family history of gastric cancer and ABO blood type with precancerous gastric lesions in a high-risk area for stomach cancer.
Subjects and setting We examined 3400 adults aged 3564 in a population-based gastric endoscopic screening in a county in China with one of the highest rates of stomach cancer in the world.
Methods In this cross-sectional study, data on family cancer history, ABO blood type and other characteristics of the participants were obtained by interview and blood test. Responses were compared between those with the most advanced gastric lesions, dysplasia (DYS) or intestinal metaplasia (IM), versus those with chronic atrophic gastritis (CAG) or superficial gastritis (SG).
Results The prevalence odds ratio (OR) for blood type A relative to other types was 1.39 (95% CI : 1.121.73) for DYS and 1.28 (95% CI : 1.061.53) for IM. The OR associated with parental history of stomach cancer was 1.88 (95% CI : 1.202.95) for DYS, but the numbers were too small to evaluate aggregation among siblings. The combined OR associated with blood type A and a parental of history of gastric cancer was 2.61 (95% CI : 1.594.30) for DYS and 1.46 (95% CI : 0.932.31) for IM.
Conclusions The findings suggest that genetic factors play a role in developing precancerous gastric lesions.
Keywords Precancerous gastric lesions, ABO blood type, family stomach cancer history
Accepted 6 October 1999
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Introduction |
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Materials and Methods |
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After health workers visited each person and obtained appropriate written informed consent, the subjects received an endoscopic examination and biopsies were taken from seven standard locations: four from the antrum, one from the angulus, and two from the body of the stomach. The presence or absence of superficial gastritis (SG), CAG, IM and DYS was recorded for each biopsy. Each site was assigned a diagnosis based on the most severe histology that was found, while each subject was assigned a global diagnosis based on the most severe diagnosis among any of the biopsies. Information on family history, diet and other potential risk factors was obtained by interview, while ABO blood type was determined by a blood test.
Prevalence odds ratios (OR) were used as the measures of association between ABO blood type and gastric lesions in this cross-sectional study. Separate logistic regressions were used to compute OR and 95% CI for DYS versus SG/CAG and for IM (without accompanying DYS) versus SG/CAG (SAS 6.08. Logistic Procedure, SAS Institute, Inc.). The logistic models included the following main effects: a history of parental gastric cancer (1 if present, 0 otherwise), blood type (1 if type A, 0 otherwise), gender (1 if male, 0 if female), and three age categories (3544, 4554, 55+).
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Results |
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Blood type was significantly associated with both IM (OR = 1.28; 95% CI : 1.061.53) and DYS (OR = 1.39; 95% CI : 1.121.73) as shown in row 2 of Table 1. A history of parental gastric cancer was significantly associated with DYS (OR = 1.88; 95% CI : 1.202.95), but not with IM. The risks associated with the combination of blood type A and a parental history of gastric cancer were estimated by multiplying the individual OR (row 4, Table 1
), yielding an overall OR of 2.61 (95% CI : 1.594.30) for DYS and 1.46 (95% CI : 0.932.31) for IM. No significant interactions between blood type and parental history were seen (P-values = 0.55 and 0.54 for IM and DYS, respectively).
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Discussion |
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There have been few epidemiological studies of genetic predisposition to precancerous gastric lesions. In a high-risk area of Colombia, people with blood type A had a higher prevalence of CAG/IM than those with other blood types.7 It has been suggested that gastric carcinomas produce antigens immunologically related to blood type A antigens that may help limit tumour growth in non-type A individuals,8 but the data from China and Colombia suggest that the influence of blood type A precedes the onset of cancer. It is noteworthy that the putative stage of transition (CAG to IM) affected by type A resembles the pattern observed for Lewis blood-group antigens. In one study, anomalies in Lewis a antigens occurred in 67% of cases with DYS, 65% with IM and only 15% with CAG.9
Familial susceptibility has been well documented for stomach cancer6 and reported also for CAG in a manner suggesting an autosomal recessive mode of inheritance.10 Although we had no information on CAG or other precursor lesions among first degree relatives, our data showed that individuals with a parental history of stomach cancer had a significantly higher prevalence of DYS, while the number of siblings with gastric cancer was too small for evaluation.
In summary, this survey of gastric precancerous lesions in a high-risk population in China revealed associations with blood type A and parental history of gastric cancer, consistent with the role of genetic predisposition. Our findings complement earlier studies in this population implicating the effects of dietary practices, cigarette smoking, Helicobacter pylori infection, and other environmental factors in the progression of precancerous lesions.1,2 Further studies are needed to elucidate genetic mechanisms and gene-environment interactions in the multi-step process of gastric carcinogenesis.
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Acknowledgments |
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References |
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