Gastrointestinal cancer risk in patients with a family history of gastrointestinal cancer

Joo Won Chung; Jae Jun Park; Yun Jeong Lim; Jun Lee; Sun Moon Kim; Joung-Ho Han; Seong Ran Jeon; Hong Sub Lee; Yong Sung Kim; Si Young Song

doi:10.4166/kjg.2018.71.6.338

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Chung, Park, Lim, Lee, Kim, Han, Jeon, Lee, Kim, Song, and Committee of Education and Ethics of the Korean Society of Gastrointestinal Cancer: Gastrointestinal cancer risk in patients with a family history of gastrointestinal cancer

Original Article

Korean J Gastroenterol 2018;71(6):338-348.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.6.338

Gastrointestinal cancer risk in patients with a family history of gastrointestinal cancer

Joo Won Chung^1,^*, Jae Jun Park^2,^*, Yun Jeong Lim³, Jun Lee⁴, Sun Moon Kim⁵, Joung-Ho Han⁶, Seong Ran Jeon⁷, Hong Sub Lee⁸, Yong Sung Kim⁹, Si Young Song²; Committee of Education and Ethics of the Korean Society of Gastrointestinal Cancer

¹Division of Gastroenterology, National Medical Center, Yonsei University, Seoul, Korea

²Department of Medicine, The Graduate School, Yonsei University, Seoul, Korea

³Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea

⁴Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea

⁵Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea

⁶Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea

⁷Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea

⁸Department of Gastroenterology, Myongji Hospital, Goyang, Korea

⁹Department of Gastroenterology, Wonkwang University Hospital, Iksan, Korea

Correspondence to: Yun Jeong Lim, Department of Internal Medicine, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea. Tel: +82-31-961-7133, Fax: +82-31-961-7141, E-mail: drlimyj@gmail.com

^* The first two authors equally contributed to this article.

Received 4 February 2018 Revised 27 March 2018 Accepted 13 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

This study was performed to evaluate the relationship between family history of gastrointestinal (GI) cancers and incidence of any GI cancer in the Korean population.

Methods

Between January 2015 and July 2016, 711 GI cancer patients and 849 controls in 16 hospitals in Korea were enrolled. Personal medical histories, life styles, and family history of GI cancers were collected via questionnaire.

Results

There was a significant difference in the incidence of family history of GI cancer between GI cancer patients and controls (p=0.002). Patients with family history of GI cancer tended to be diagnosed as GI cancer at younger age than those without family history (p=0.016). The family members of GI cancer patients who were diagnosed before 50 years of age were more frequently diagnosed as GI cancer before the age of 50 years (p=0.017). After adjusting for major confounding factors, age (adjusted odds ratio [AOR] 1.065, 95% confidence interval [CI]; 1.053–1.076), male gender (AOR 2.270, 95% CI; 1.618–3.184), smoking (AOR 1.570, 95% CI; 1.130–2.182), and sibling's history of GI cancer (AOR 1.973, 95% CI; 1.246–3.126) remained independently associated with GI cancers.

Conclusions

GI cancer patients tended to have a first relative with a history of concordant GI cancer. Personal factors (old age and male) and lifestyle (smoking) contribute to the development of GI cancer, independently. Individuals with high risk for GI cancers may be advised to undergo screening at an earlier age.

Keywords: Gastrointestinal neoplasm, Medical history taking, Risk factors

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Table 1.

Demographics of the Study Subjects

	Controls (n=849)	GI cancer patients (n=711)	p-value
Age (years)	53.06±15.64	64.87±10.64	<0.001
Sex
Male	392 (46.2%)	503 (70.7%)	<0.001
Female	457 (53.8%)	208 (29.3%)
BMI (kg/m²)	23.18±3.44	22.77±3.24	0.015
Marital status
Never married	163 (19.2%)	35 (4.9%)	<0.001
Ever married	686 (80.8%)	676 (95.1%)
Life style
Alcohol consumption
Less than 1/week	567 (66.9%)	463 (65.8%)	0.582
More than 1/week	281 (33.1%)	241 (34.2%)
Smoking
Never-smoker	532 (62.7%)	269 (37.9%)	<0.001
Current or Ex-smoker	316 (37.3%)	440 (62.1%)
Physical activity
More than 1/week	456 (53.8%)	385 (54.2%)	0.434
Less than 1/week	392 (46.2%)	325 (45.8%)
Diet habit
Salty diet	353 (41.6%)	311 (43.8%)	0.376
Meat rich diet	363 (42.8%)	315 (44.4%)	0.523
Vegetable poor diet	224 (26.4%)	210 (29.6%)	0.165
Medical history
Hypertension	209 (24.6%)	259 (36.4%)	<0.001
Diabetes mellitus	100 (11.8%)	141 (19.8%)	<0.001
Chronic liver disease	133 (15.7%)	123 (17.3%)	0.386
B-viral	50 (5.9%)	68 (9.6%)	0.006
C-viral	13 (1.5%)	17 (2.4%)	0.218
Fatty liver	26 (3.1%)	13 (1.8%)	0.12
Alcoholic hepatitis	42 (4.9%)	24 (3.4%)	0.125

GI, gastrointestinal; BMI, body mass index; B-viral, viral hepatitis B; C-viral, viral hepatitis C.

Table 2.

Distributions of GI Cancer Patients and Controls According to a Family History of GI Cancer

	Controls (n=849)	GI cancer patients (n=711)	p-value	Odds ratio	95% CI
A family history of GI cancer	187 (22.0%)	206 (29.0%)	0.002	1.444	1.148–1.816
Parent	144 (17.0%)	102 (14.3%)	0.159	0.82	0.622–1.080
Sibling	55 (6.5%)	110 (15.5%)	<0.001	2.642	1.880–3.714
Child	2 (0.2%)	9 (1.3%)	0.031	5.429	1.169–25.211
Diagnosed age of family members
<50 years old	23 (12.8%)	36 (18.1%)	0.156	0.663	0.376–1.170
≥50 years old	157 (87.2%)	163 (81.9%)	0.156	0.663	0.376–1.170
Number of affected family members
One or none	830 (97.8%)	684 (96.2%)	0.073	1.724	0.951–3.128
Two or more	19 (2.2%)	27 (3.8%)	0.073	1.724	0.951–3.128
Types of GI cancer of family members
Esophagogastric cancer	93 (11.0%)	122 (17.2%)	<0.01	1.684	1.259–2.251
Colorectal cancer	42 (4.9%)	38 (5.3%)	0.723	1.085	0.691–1.702
Hepatocellular carcinoma	41 (4.8%)	47 (6.6%)	0.13	1.395	0.906–2.147
Pancreatobiliary cancer	25 (2.9%)	17 (2.4%)	0.502	0.807	0.432–1.507

GI, gastrointestinal; CI, confidence interval.

Table 3.

Demographics and Family Histories of GI Cancer Patients Aged < or ≥50 Years at Diagnosis

	Group I ^a (n=62)	Group II ^b (n=645)	p-value
Personal factors
Diagnosed age (years)	43.84±4.90	65.3±9.3	<0.001
Sex
Male	40 (64.5%)	460 (71.3%)	0.261
Female	22 (35.5%)	185 (28.7%)	0.261
BMI (kg/m²)	22.81±3.20	22.76±3.24	0.908
Marital status
Never married	16 (25.8%)	19 (2.9%)	<0.001
Ever married	46 (74.2%)	626 (97.1%)
Lifestyle
Frequent alcohol consumption^c	32 (52.5%)	207 (32.4%)	0.002
Current or Ex-smoker	37 (59.7%)	399 (62.1%)	0.713
Low physical activity ^d	25 (40.3%)	297 (46.1%)	0.382
Dietary habits
Salty diet	17 (27.4%)	292 (45.3%)	0.007
Meat rich diet	33 (53.2%)	280 (43.5%)	0.14
Vegetable poor diet	15 (24.6%)	193 (30.0%)	0.379
Medical history
Hypertension	4 (6.5%)	252 (39.1%)	<0.001
Diabetes mellitus	3 (4.8%)	136 (21.1%)	0.002
Chronic liver disease	13 (21.0%)	110 (17.1%)	0.603
B-viral	11 (17.7%)	57 (8.8%)	0.023
C-viral	2 (3.2%)	15 (2.3%)	0.655
Fatty liver	0 (0%)	13 (2.0%)	0.618
Alcoholic hepatitis	1 (1.6%)	23 (3.6%)	0.714
Familial factors
Family History of GI cancer	21 (33.9%)	183 (28.4%)	0.361
Parental	16 (25.8%)	86 (13.3%)	0.008
Sibling	5 (8.1%)	103 (16.0%)	0.098
Child	0 (0.0%)	9 (1.4%)	>0.999
Diagnosed age of family members
<50 years old	8 (38.1%)	28 (15.9%)	0.017
≥50 years old	13 (61.9%)	148 (84.1%)
Number of affected family member
One or none	59 (95.2%)	621 (96.3%)	0.724
Two or more	3 (4.8%)	24 (3.7%)
Types of GI cancer of family members
Esophagogastric cancer	12 (19.4%)	108 (16.7%)	0.274
Colorectal cancer	5 (8.1%)	33 (5.1%)	0.368
Hepatocellular carcinoma	5 (8.1%)	42 (6.5%)	0.594
Pancreatobiliary cancer	2 (3.2%)	15 (2.3%)	0.655

GI, gastrointestinal; BMI, body mass index.

^a Group I contained GI cancer patients diagnosed at <50 years old

^b Group II contained GI cancer patients diagnosed at ≥50 years old

^c Frequent alcohol consumption means alcohol consumption more than one per week

^d Low physical activity means physical activity less than one per week.

Table 4.

Independent Risk Factors Associated with GI Cancer as Determined by Multivariate Analysis

	p-value	AOR	95% CI
Age	<0.001	1.065	1.053–1.076
Sex (male)	<0.001	2.270	1.618–3.184
Ever-smoker	0.007	1.570	1.130–2.182
GI cancer history of sibling	0.004	1.973	1.246–3.126
Hypertension	0.396	1.119	0.863–1.453
Diabetes	0.378	1.153	0.841–1.580
Ever-married	0.203	1.342	0.853–2.114
GI cancer history of children	0.176	3.072	0.604–15.623
GI cancer history of family	0.665	1.075	0.774–1.494

Four factors (family history of GI cancer, marital status, hypertension, and diabetes) did not show any significance.

GI, gastrointestinal; AOR, adjusted odds ratio; CI, confidence interval.

Table 5.

The Family History and the Risk of Each Type of Gl Cancer

	Control (n=849)	EG ca (n=311)			CRC (n=188)			HCC (n=89)			PB ca (n=130)
	Control (n=849)		AOR	95% CI		AOR	95% CI		AOR	95% CI		AOR	95% CI
Personal factors
Age (years)	53.06±15.64	64.55±10.29	1.062	1.050–1.074	64.11±11.10	1.056	1.043–1.069	63.18±10.38	1.05	1.032–1.067	67.96±10.40	1.082	1.064–1.10
Sex Male	392 (46.2%)	237 (76.2%)	3.734	2.783–5.009	130 (69.1%)	2.613	1.864–3.662	68 (76.4%)	3.775	2.272–6.271	74 (56.9%)	1.541	1.062–2.236
Female	457 (53.8%)	74 (23.8%)			58 (30.9%)			21 (23.6%)			56 (43.1%)
BMI (kg/m2)	23.18±3.44	22.78±3.2	0.965	0.927–1.003	23.39±3.12	1.018	0.972–1.066	23.12±3.55	0.995	0.933–1.060	21.50±3.00	0.85	0.799–0.905
Marital status
Ever married	686 (80.8%)	300 (96.5%)	6.48	3.467–12.112	182 (96.8%)	7.207	3.140–16.545	78 (87.6%)	1.685	0.876–3.240	123 (94.6%)	4.175	1.913–9.112
Never married	163 (19.2%)	11 (3.5%)			6 (3.2%)			11 (12.4%)			7 (5.4%)
Lifestyle
Frequent alcohola consumption	281 (33.1%)	124 (40.1%)	1.361	1.042–1.778	67 (36.6%)	1.175	0.844–1.635	29 (32.6%)	0.986	0.622–1.564	23 (17.7%)	0.45	0.284–0.714
Current or Ex-smoker	316 (37.3%)	201 (64.8%)	3.105	2.366–4.073	121 (64.7%)	3.086	2.218–4.296	61 (68.5%)	3.668	2.296–5.860	62 (47.7%)	1.535	1.059–2.225
Low physical activity^b	392 (46.2%)	140 (45.0%)	0.931	0.757–1.144	76 (40.6%)	0.796	0.577–1.099	37 (41.6%)	0.829	0.536–1.281	75 (57.7%)	1.586	1.092–2.304
Diet habit
Salty diet	353 (41.6%)	154 (49.5%)	1.378	1.062–1.789	86 (46.0%)	1.196	0.870–1.645	30 (33.7%)	0.714	0.451–1.132	43 (33.1%)	0.694	0.470–1.026
Meat rich diet	363 (42.8%)	147 (47.3%)	1.2	0.925–1.558	79 (42.2%)	0.979	0.711–1.349	40 (44.9%)	1.093	0.704–1.696	51 (39.2%)	0.864	0.593–1.261
Vegetable poor diet	224 (26.4%)	88 (28.3%)	1.098	0.821–1.467	49 (26.2%)	0.988	0.689–1.415	28 (31.8%)	1.298	0.808–2.085	45 (34.6%)	1.472	0.995–2.180
Medical history
Hypertension	209 (24.6%)	123 (39.5%)	1.978	1.503–2.602	63 (33.5%)	1.526	1.088–2.141	19 (21.3%)	0.828	0.488–1.403	55 (42.3%)	2.207	1.512–3.221
Diabetes mellitus	100 (11.8%)	50 (16.1%)	1.435	0.994–2.072	31 (16.5%)	1.479	0.954–2.292	25 (28.1%)	2.926	1.762–4.859	37 (28.5%)	2.98	1.930–4.601
Chronic liver disease	133 (15.7%)	29 (9.3%)	0.554	0.362–0.847	19 (10.1%)	0.605	0.364–1.007	64 (71.9%)	13.782	8.376–22.675	12 (9.2%)	0.547	0.294–1.020
B-viral	50 (5.9%)	10 (3.2%)	0.531	0.266–1.060	6 (3.2%)	0.527	0.222–1.247	45 (50.6%)	16.343	9.870–27.061	7 (5.4%)	0.909	0.403–2.051
C-viral	13 (1.5%)	4 (1.3%)	0.838	0.271–2.589	0 (0%)			12 (13.5%)	10.022	4.420–22.723	1 (0.8%)	0.499	0.065–3.843
Fatty liver	26 (3.1%)	4 (1.3%)	0.412	0.143–1.191	7 (3.7%)	1.224	0.523–2.864	0 (0%)	−	−	2 (1.5%)	0.495	0.116–2.109
Alcoholic hepatitis	42 (4.9%)	11 (3.5%)	0.705	0.358–1.386	3 (1.6%)	0.312	0.096–1.016	9 (10.1%)	2.162	1.015–4.602	2 (1.5%)	0.3	0.072–1.255
Familial factors
Family History of Gl cancer	187 (22.0%)	96 (30.9%)	1.581	1.183–2.113	58 (30.9%)	1.579	1.114–2.240	27 (30.3%)	1.542	0.954–2.492	27 (20.8%)	0.928	0.589–1.461
Parental	144 (17.0%)	49 (15.8%)	0.916	0.643–1.304	31 (16.5%)	0.967	0.632–1.478	9 (10.1%)	0.551	0.270–1.123	14 (10.8%)	0.591	0.330–1.058
Sibling	55 (6.5%)	52 (16.7%)	2.898	1.935–4.342	27 (14.4%)	2.421	1.482–3.955	20 (22.5%)	4.184	2.372–7.383	12 (9.2%)	1.468	0.764–2.823
Child	2 (0.2%)	4 (1.3%)	5.518	1.006–30.277	1 (0.5%)	2.265		1 (1.1%)	4.812	0.432–53.607	3 (2.3%)	10.004	1.655–60.453
							0.204–25.106
Age of diagnosis, affected family member
<50 years old	23 (12.8%)	16 (17.2%)	0.705	0.352–1.411	8 (14.3%)	0.879	0.369–2.092	10 (37.0%)	0.238	0.100–0.567	2 (8.0%)	1.685	0.372–7.624
≥50 years old	157 (87.2%)	77 (82.8%)			48 (85.7%)			17 (63.0%)			23 (92.0%)
Number of affected family member
Two or more	19 (2.2%)	15 (4.8%)	2.214	1.111–4.413	5 (2.7%)	1.194	0,440–3.238	4 (4.5%)	2.056	0.684–6.182	3 (2.3%)	1.032	0.301–3.537
One or none	830 (97.8%)	296 (95.2%)			183 (97.3%)			85 (95.5%)			127 (97.7%)
Type of Gl cancer of family member
EG ca	93 (11.0%)	70 (22.5%)	2.361	1.677–3.325	28 (14.9%)	1.423	0.902–2.244	7 (7.9%)	0.694	0.311–1.546	19 (14.6%)	1.391	0.817–2.369
CRC	42 (4.9%)	14 (4.5%)	0.906	0.488–1.683	21 (11.2%)	2.416	1.394–4.187	1 (1.1%)	0.218	0.030–1.606	2 (1.5%)	0.3	0.072–1.255
HCC	41 (4.8%)	10 (3.2%)	0.655	0.324–1.324	14 (7.4%)	1.586	0.846–2.973	20 (22.5%)	5.712	3.172–10.288	3 (2.3%)	0.466	0.142–1.526
PB ca	25 (2.9%)	6 (1.9%)	0.648	0.263–1.596	3 (1.6%)	0.534	0.160–1.789	2 (2.2%)	0.758	0.176–3.253	6 (4.6%)	1.595	0.641–3.965

Gl, gastrointestinal; EG ca, esophagogastric cancer; CRC, colorectal cancer; HCC, hepatocellular carcinoma; PB ca, pancreatobiliary cancer; OR, odds ratio; CI, confidential interval; BMI, body mass index; B-viral, viral hepatitis B; C-viral, viral hepatitis C.

^a Frequent alcohol consumption means alcohol consumption more than once per week; bLow physical activity means physical activity less than once per week.

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