Causation of Borrmann type 4 gastric cancer: Heritable factors or environmental factors?

Background. The prognosis of Borrmann type 4 gastric cancer remains poor today. The relative contributions of genetic factors and nongenetic factors to type 4 gastric cancer are unclear. The study of family history and spousal history of cancer may play an important role in the assessment of causation of this severe gastric cancer. Methods. During the period 1995-1997, 1118 consecutive patients with histologically confirmed gastric cancer (probands), including 113 with type 4 carcinoma, were admitted to the National Cancer Center Hospital. The type of carcinoma, as well as the family history of cancer in first-degree relatives and spouses of the probands, was abstracted from medical records. Family history and spousal history of cancer were compared between type 4 and other types of gastric cancer. Results. While paternal history had no association with type 4 carcinoma compared with other types, maternal history was associated with a fourfold risk [95% confidence interval (CI), 1.6-9.3] of daughters' type 4 carcinoma, but not sons'. Among probands whose wives had a history of gastric cancer, the risks of type 4 gastric cancer were significantly increased, to as high as 13-fold (95% CI, 2.5-65.3). However, husbands' history had no relationship with wives' type 4 carcinoma. No relationship between type 4 carcinoma and family history or spousal history of other cancers was observed. Conclusion. The present study suggested that environmental factors may have a key effect in causing type 4 carcinoma. The findings may be valuable for identifying subjects at high risk of such malignant gastric cancer as Borrmann type 4.