International Journal of Epidemiology, Vol 26, 1159-1165, Copyright © 1997 by International Epidemiological Association
J Chang-Claude, H Becher, M Blettner, S Qiu, G Yang and J Wahrendorf
BACKGROUND: The high incidence of oesophageal cancer in northern China is
attributed predominantly to environmental factors. The role of genetic
factors has not been extensively studied. METHODS: Our aim was to study
familial aggregation of oesophageal cancer in pedigrees from a defined
population base in a high incidence area in China and to quantify the risk
associated with different first degree relatives using different analytical
approaches. Detailed data on family members of three successive generations
and the occurrence of oesophageal and other cancers in family members were
collected from a population-based series of 244 oesophageal cancer cases
which occurred between 1987 and mid-1992 in Huixian County, Henan. RESULTS:
Compared to expected rates, the standardized mortality ratio (SMR) of
oesophageal cancer among first degree relatives of oesophageal cancer
patients was 2.4 (2.2 in male and 2.7 in female relatives). The
corresponding SMR for first and second degree relatives were 1.6 and 2.2.
The null hypothesis of 'no familial aggregation' was rejected using
Tarone's one-sided score test for binomial distributions indicating some
evidence for clustering within families. To account for variance due to
between-pairs correlation and family and/or individual specific variables,
we fitted a series of regression models using a Generalized Estimation
Equations (GEE) approach. The pairwise odds ratios were 2.3 for
parent-parent, 1.9 for sib-parent and 1.1 for sib-sib, adjusted for sex,
age and sex of index case. DISCUSSION: The existence of familial
aggregation of oesophageal cancer in the study population was confirmed
using different analyses and a two- to threefold increased risk was found
for first degree relatives. The clear association of disease between parent
and sib provides some indication of a genetic component. The pairwise
association between parents but not between sibs suggests that
environmental factors have a stronger action after childhood.
ARTICLES
Familial aggregation of oesophageal cancer in a high incidence area in China
German Cancer Research Center, Division of Epidemiology, Heidelberg, Germany.
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