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Keywords:

  • family history;
  • stomach cancer;
  • gender difference;
  • cohort study;
  • JACC study

Abstract

  1. Top of page
  2. Abstract
  3. MATERIAL AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. Acknowledgements
  7. APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY
  8. APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY
  9. REFERENCES

Familial aggregation of stomach cancer has long been observed. The effect on disease risk of family history and its magnitude according to the type of affected relatives, however, is not well known. We conducted a prospective analysis using the JACC study (Japan Collaborative Cohort Study For Evaluation of Cancer Risk, sponsored by Monbusho) data. During the follow-up period, 662 stomach cancer deaths were documented. A positive history of stomach cancer in one or more first-degree relatives was associated with a significantly increased risk of death from the disease in both men (RR 1.60; 95% CI 1.11–2.31) and women (RR 2.47; 95% CI 1.50–4.06). In the subanalysis stratified by age, the association between positive family history and stomach cancer was stronger in the age group from 40–59 (RR 2.62; 95% CI 1.34–5.11 for men and RR 5.88; 95% CI 2.70–12.82 for women) than in the age group from 60–79 (RR 1.31; 95% CI 0.84–2.05 for men and RR 1.44; 95% CI 0.72–2.88 for women). In the age group from 40–59, men with father's history and women with mother's and sister's history of the disease had a significantly increased risk (RR 3.14; 95% CI 1.51–6.55, RR 10.46; 95% CI 4.54–24.12, RR 13.39; 95% CI 3.89–46.12, respectively). When 2 or more family members were affected, the increment in the risk was prominent especially in women (RR 9.45; 95% CI 4.46–20.05). These results suggest the existence of a certain subtype of stomach cancer that is inherited more often by women from one generation to the next in gender-influenced fashion. Any preventive strategy should take into account the degree of individual susceptibility. © 2001 Wiley-Liss, Inc.

Despite dramatic declines, stomach cancer remains the leading cause of cancer death among women and is second among men in Japan.1, 2 A number of environmental factors are now known to be related to the development of the disease.3–7 At the same time, familial aggregation of this neoplasm has long been observed.8 Many studies so far have revealed that presence of a family history of stomach cancer is associated with increased risk of developing the disease in both men and women.9–16 But the magnitude of which familial factor influences the disease risk and the pattern of increase in risk with reference to the type of the affected relatives differs among studies. In addition, prospective studies on this topic in a general population are few. Studying the disease in a population with a high mortality and incidence will produce a more accurate estimate of the risk. Using national representative large-scale cohort study data, we examined whether a positive history of stomach cancer in a first-degree relative increases the risk of death from the disease by controlling for the size of family and other environmental factors. We also examined to see if there is any pattern in the effect of family history according to the type of affected relatives.

MATERIAL AND METHODS

  1. Top of page
  2. Abstract
  3. MATERIAL AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. Acknowledgements
  7. APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY
  8. APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY
  9. REFERENCES

JACC study

The JACC Study, the Japan Collaborative Cohort Study For Evaluation of Cancer Risk (sponsored by the Ministry of Education, Science, Sports and Culture of Japan), is a nation-wide multicenter collaborative study to prospectively evaluate various risk or protective factors on cancer mortality and incidence. Study methods and ethical issues have been described in detail elsewhere.17–19 Briefly, our study was initiated in 1988 and enrollment was continued until the end of 1990. Subjects were followed until the end of 1997 unless they had moved out or developed one of the prospectively defined endpoints (described below). The total of 45 municipalities were involved in this prospective study. They include 6 cities (35% of the cohort population), 34 towns and 5 villages (65%). These municipalities were selected from 7 out of 8 districts in Japan, thus covering almost all of Japan. Enrollment was based on the participants of general health checkup that is periodically provided by these municipalities. We enrolled 127,477 apparently healthy inhabitants in these areas with completion of the questionnaire, because one million person-years of follow-up were estimated to be necessary for the detection of an association between mortality for cancer of several sites common in Japan and various risk factors. Two strategies were applied to obtain informed consent for participation; in the majority of study areas, it was obtained through signing the cover page of the questionnaire. In some study areas, it was obtained at the group level by explaining the aim of the study and confidentiality of the data to the leader of the community. Of 127,477 enrolled, 12,925 were under 40 and 3,760 were 80 or over and excluded from the present analysis. From 110,792 participant who were 40–79 years old (46,465 men and 64,327 women) at the time of enrollment, we excluded those with a history of stomach cancer (n = 219) and the remaining 110,573 (46,318 men and 64,255 women) were used for the present analysis. We included participants with a history of other cancer sites because we considered metastatic stomach cancer to be rare and results excluding those with a history of cancer at any site (n = 1,098) were same. None of the participants were hospital-based.

The study protocol was approved by the Ethics Committee of Medical Care and Research, University of Occupational and Environmental Health, Kitakyushu, Japan.

Family history and other exposure data

A self-administered questionnaire was used to assess baseline characteristics of the participants. It covered medical history and included lifestyle-related items such as diet, physical activity, drinking and smoking, occupation, level of education, reproductive history (women only) and family history of several medical conditions including cancer. Mean time spent in responding was 25.7 and 27.3 min for men and women, respectively.

Subjects were asked to specify the site of cancer in their first-degree relatives (parents or siblings), if any. We could not, however, distinguish from the data whether the affected relative died from the disease or not. We did not verify these reports by other information sources and the relative's age at cancer diagnosis was not obtained. Information was gathered on the number of siblings.

We defined a positive family history of stomach cancer as when the subject had at least 1 first-degree relative with a history of stomach cancer. In addition, we counted the number of affected first-degree relatives to see if there was any increment in risk by the aggregation (i.e., 2 or more affected relatives).

Follow-up and identification of stomach cancer cases

Our primary endpoints were death from any cause or December 31, 1997 (censored). Those who had moved out (n = 3,242) were also treated as censored. The mean follow-up period was 8.0 years and 8.2 years for men and women, respectively.

Vital statuses of the participants were checked annually by each regional research center with permission to review their population-register sheets from the Ministry of Public Management, Home Affairs, Post and Telecommunications. For the deceased, causes of death were inquired through death certificates and these data were collected at the central office of the Research Committee. Underlying causes of death were determined by the Ministry of Health, Labour and Welfare and coded according to the ninth revision of International Classification of Diseases (ICD-9) by the end of 1994 and to ICD-10 from 1995. Stomach cancer cases were defined by 151.0–151.9 (ICD-9) or C16.0–C16.9 (ICD-10). Because information on the location of cancer within the stomach or the histological type was not available in all cases, we did not use it to classify cases.

Statistical analysis

For primary analysis, we calculated age-adjusted mortality rates according to the presence or absence of a family history and for a specific type of family member affected. Person-year for each participant was calculated from the date of enrollment to the primary endpoint, death, move-out or December 31, 1997. We used Cox proportional-hazards models to compute relative risks (RRs), adjusting for 10-year-interval age categories at enrollment and the number of siblings. In another multivariate-model, consumption of vegetables, citrus fruits and green tea, preference for salty foods, drinking habit, smoking status, educational level and place of residence were further adjusted. These variables were assessed by the baseline questionnaire and were selected as covariates because they were known or suspected to modify the risk of stomach cancer.3–7

In the present analysis, salty-food preference was categorized into 3 levels (dislike, neutral, like). Frequency of food and green tea consumption was categorized into 5 levels (everyday, 3–4 times a week, 1–2 times a week, 1–2 times a month and seldom). A drinking habit was first categorized into 3 statuses (none, past, present). If present, it was further categorized into 2 levels by weekly consumption (light, heavy), i.e., daily alcohol consumption times days of drinking per week. Smoking status was classified into 3 levels (never, past, current). Information on educational level was measured as the age of formal schooling completed and was classified into 2 categories: <15 years old (corresponds to <9 years of schooling) and >16 years old (corresponds to >10 years of schooling). In the analysis, all variables were entered as dummy variables except for food frequency items. These variables were entered as equally-spaced ordinal variables (1–5).

We conducted additional analyses stratified by age to evaluate the influence of age of the study participants on the risk associated with a family history of stomach cancer.

The 95% CIs are presented for all relative risks. All reported p-values are 2-sided. All analysis was performed separately for men and women with SAS statistical package release 6.12.20 The age-adjusted mortality rate were standardized on the age distribution of the world standard population.21

RESULTS

  1. Top of page
  2. Abstract
  3. MATERIAL AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. Acknowledgements
  7. APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY
  8. APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY
  9. REFERENCES

A history of stomach cancer in a first-degree relative was reported by 4,416 (9.5%) of the men and 6,770 (10.5%) of the women. During the follow-up period, we documented 662 stomach cancer deaths (445 among men and 217 among women) per 897,405 person-years of follow-up (372,250 for men and 525,155 for women). Crude mortality rates for men and women were 119.5 (per 100,000 person-years) and 41.3, respectively and the age-adjusted mortality rates were 99.5 and 33.7, respectively. Both the crude and age-adjusted mortality rates of men were almost 3 times as high as those of women. These figures, however, did not differ substantially from the whole Japanese population, considering that the age-adjusted mortality rates (of the same age-group) of stomach cancer in 1990 were 89.6 and 36.8 for men and women, respectively.1

In Table I, baseline characteristics of the participants are given according to the presence or absence of a family history of stomach cancer. Participants with a family history of stomach cancer were older than those without a family history (p < 0.05). There were no substantial differences between participants with and without a family history in terms of salty-food preference, consumption of citrus fruits or smoking status. In those with a family history of stomach cancer, the proportion of participants who consumed tomatoes, carrots and green tea everyday, had higher level of education and lived in cities was higher in both men and women (p < 0.05).

Table I. Characteristics of the Study Participants According to the Presence or Absence of a Family History of Stomach Cancer
 Men (n = 46,318)Women (n = 64,255)
FH (+) (n = 4,380)FH (−) (n = 41,938)FH (+) (n = 6,743)FH (−) (n = 57,512)
  • 1

    p < 0.05 by Student's t-test.

  • 2

    p < 0.05 by chi-square test.

Age-category (%)
 40–4919.426.1219.824.62
 50–5931.130.132.330.8
 60–6933.929.634.030.2
 70–7915.614.213.914.4
Age (years): mean58.957.4158.657.81
Number of siblings: mean5.04.64.94.6
Salty-food preference (%)
 Dislike12.512.318.418.8
 Neutral45.545.754.754.8
 Like41.942.026.926.4
Tomatoes (%)
 Seldom13.112.3211.910.22
 1–2/Month26.329.520.623.9
 1–2/Week30.830.529.129.8
 3–4/Week18.217.320.420.2
 Everyday11.710.318.015.8
Citrus fruits (%)
 Seldom6.97.54.23.9
 1–2/Month15.516.28.69.3
 1–2/Week26.726.321.720.5
 3–4/Week23.022.822.223.1
 Everyday27.927.243.243.3
Spinach and green vegetables (%)
 Seldom1.41.420.90.9
 1–2/Month9.69.46.27.1
 1–2/Week28.829.727.326.8
 3–4/Week27.830.030.731.2
 Everyday32.429.535.034.0
Carrots and pumpkins (%)
 Seldom4.44.721.41.52
 1–2/Month19.119.69.911.5
 1–2/Week37.138.434.635.2
 3–4/Week24.224.531.630.9
 Everyday15.212.922.520.9
Green tea (%)
 Seldom6.36.628.27.82
 1–2/Month1.52.51.92.9
 1–2/Week2.96.73.37.0
 3–4/Week5.37.65.37.6
 Everyday84.076.681.474.8
Alcohol drinking habit (%)
 None21.422.380.582.42
 Past7.67.82.12.0
 Light drinker41.240.114.112.3
 Heavy drinker29.829.83.43.3
Smoking status (%)
 Never21.020.593.392.7
 Past27.926.72.01.8
 Current51.152.84.85.5
Educational level (%)
 ≤9 years of schooling35.337.7236.840.62
 ≥10 years of schooling64.762.363.259.4
Place of residence (%)
 City41.132.2241.833.62
 Town/village58.967.858.266.4

Participants of either gender with a family history of stomach cancer had increased risk of death from the disease after controlling for age and the number of siblings (Table II). These increases in risk became even stronger after controlling for other known or suspected risk factors for the disease. The RR differed according to the type of affected family member. Among men, the multivariate-adjusted RR was significantly increased only in those with a father's history of stomach cancer. On the other hand, women with a family history of stomach cancer in a father, mother or sister had a significantly increased risk of the disease. Among the men with two or more affected family members, the multivariate-adjusted RR was 2.34 (95% CI, 1.03–5.32), against 9.45 (95% CI, 4.46–20.05) among the women. In women both of whose parents were affected the multivariate-adjusted RR was 16.90 (95% CI, 6.10–46.82).

Table II. Risk of Stomach Cancer Death According to the Presence or Absence of a Family History and the Type and Number of Family Members Affected
 No. of casesAge-adjusted mortality rate1 (/100,000 person-year)RR295% CIRR395% CI
  • 1

    Age-adjusted mortality rate standardized on the age distribution of the world standard population.

  • 2

    RR and 95% CI adjusted for 10-year interval age categories (40–49, 50–59, 60–69, 70–79) and the number of siblings.

  • 3

    RR and 95% CI adjusted for 10-year interval age categories (40–49, 50–59, 60–69, 70–79), the number of siblings, self-rated preference of salty foods (dislike, neutral, like), consumption of green-yellow vegetables, citrus fruits and green tea (everyday, 3–4 times a week, 1–2 times a week, 1–2 times a month and seldom), drinking habit (none, past, light, heavy), smoking status (never, past, current), educational level (≤9 years of schooling, ≥10 years of schooling) and place of residence (city, town/village).

Men
 Family history (−)39397.311
 Family history (+)52122.41.280.95–1.721.601.11–2.31
 Type of family member affected
  Father29135.61.390.95–2.032.061.33–3.19
  Mother12111.01.040.59–1.841.160.57–2.37
  Brother1093.01.130.60–2.121.000.94–1.07
  Sister12177.12.181.22–3.881.780.79–4.05
  Both parents3211.92.140.70–6.762.350.58–9.51
  ≥2 family members10209.62.291.22–4.312.341.03–5.32
Women
 Family history (−)18031.011
 Family history (+)3756.81.921.33–2.772.471.50–4.06
 Type of family member affected
  Father2168.62.151.37–3.372.041.05–3.97
  Mother17105.13.001.83–4.925.373.01–9.58
  Brother732.01.330.62–2.841.180.37–3.77
  Sister787.42.621.23–5.602.901.05–8.01
  Both parents6452.510.894.83–24.5816.906.10–46.82
  ≥2 family members13294.26.553.70–11.599.454.46–20.05

We divided the participants into 2 groups (i.e., 40–59 and 60–79) and conducted the same analyses (Tables III, IV). Of the participants aged 40–59, the age-adjusted mortality rates of men and women associated with a family history of stomach cancer were 68.2 and 39.9 per 100,000 person-years of follow-up, respectively. Among participants aged 60–79, the age-adjusted mortality rates of men and women associated with a family history of the disease were 236.2 and 92.3 per 100,000 person-years of follow-up, respectively.

Table III. Risk of Stomach Cancer Death According to the Presence or Absence of a Family History and the Type and Number of Family Members Affected (Participants' Age at Enrollment 40–59)
 No. of casesMortality rate (/100,000 person-year)RR195% CIRR295% CI
  • 1

    RR and 95% CI adjusted for 10-year interval age categories (40–49, 50–59) and the number of siblings.

  • 2

    RR and 95% CI adjusted for 10-year interval age categories (40–49, 50–59), the number of siblings, self-rated preference of salty foods (dislike, neutral, like), consumption of green-yellow vegetables, citrus fruits and green tea (every day, 3–4 times a week, 1–2 times a week, 1–2 times a month and seldom), drinking habit (none, past, light, heavy), smoking status (never, past, current), educational level (≤9 years of schooling, ≥10 years of schooling) and place of residence (city, town/village).

Men
 Family history (−)9749.311
 Family history (+)1478.81.901.07–3.382.621.34–5.11
 Type of family member affected
  Father11102.02.211.18–4.123.141.51–6.55
  Mother358.51.200.38–3.781.260.30–5.21
  Brother156.91.250.17–9.041.760.24–12.89
  Sister185.61.890.26–13.632.540.35–18.79
  Both parents1248.35.360.75–38.49
  ≥2 family members2192.44.551.11–18.633.400.46–25.10
Women
 Family history (−)3814.311
 Family history (+)1449.54.022.07–7.815.882.70–12.82
 Type of family member affected
  Father636.52.300.98–5.412.821.07–7.48
  Mother10122.68.784.38–17.5810.464.54–24.12
  Brother0
  Sister3133.511.113.36–36.8113.393.89–46.12
  Both parents3389.228.498.77–92.5229.986.73–133.54
  ≥2 family members5251.124.989.47–65.9030.309.71–94.57
Table IV. Risk of Stomach Cancer Death According to the Presence or Absence of a Family History and the Type and Number of Family Members Affected (Participants' Age at Enrollment 60–79)
 No. of casesMortality rate (/100,000 person-year)RR195% CIRR295% CI
  • 1

    RR and 95% CI adjusted for 10-year interval age categories (60–69, 70–79) and the number of siblings.

  • 2

    RR and 95% CI adjusted for 10-year interval age categories (60–69, 70–79), the number of siblings, self-rated preference of salty foods (dislike, neutral, like), consumption of green-yellow vegetables, citrus fruits and green tea (every day, 3–4 times a week, 1–2 times a week, 1–2 times a month and seldom), drinking habit (none, past, light, heavy), smoking status (never, past, current), educational level (≤9 years of schooling, ≥10 years of schooling) and place of residence (city, town/village).

Men
 Family history (−)296209.311
 Family history (+)38235.11.150.81–1.631.310.84–2.05
 Type of family member affected
  Father18233.21.120.70–1.801.650.95–2.87
  Mother9208.31.000.51–1.941.150.51–2.61
  Brother9238.81.190.61–2.311.210.53–2.76
  Sister11472.02.401.31–4.381.630.66–4.00
  Both parents2358.81.730.43–6.942.790.69–11.34
  ≥2 family members8433.92.161.07–4.372.140.87–5.28
Women
 Family history (−)14269.111
 Family history (+)2391.41.470.94–2.301.440.72–2.88
 Type of family member affected
  Father15136.51.991.17–3.381.620.64–4.09
  Mother7104.71.480.70–3.173.311.41–7.76
  Brother7100.91.600.75–3.431.420.44–4.58
  Sister4110.11.750.65–4.740.850.12–6.19
  Both parents3438.16.382.03–20.0212.482.99–52.06
  ≥2 family members8283.84.592.24–9.425.371.90–15.17

In general, the association between positive family history and stomach cancer proved to be stronger in the 40–59 age group than the 60–79 age group. Only in the 40–59 age group, irrespective of gender, was the multivariate-adjusted RR associated with positive family history significantly increased (Table III). Among men with a family history, the multivariate-adjusted RR was 2.62 (95% CI, 1.34–5.11), against 5.88 (95% CI, 2.70–12.82) among women. In this age group, the multivariate-adjusted RR of men associated with father's history of stomach cancer was significantly increased to 3.14 (95% CI, 1.51–6.55). In the same age group, women with a mother's and sister's history of stomach cancer had a significantly increased risk of the disease of 10.46 (95% CI, 4.54–24.12) and 13.39 (95% CI, 3.89–46.12), respectively. Women with a family history of stomach cancer in both parents had a multivariate-adjusted RR of 29.98 (95% CI, 6.73–133.54). Women with 2 or more affected first-degree relatives had a multivariate-adjusted RR of 30.30 (95% CI, 9.71–94.57).

Table IV shows that family history of stomach cancer was not significantly associated with mortality from the disease among the men in the age group from 60–79. Among the women in the same age group, those with a mother's history of the disease had a significantly increased risk of 3.31 (95% CI, 1.41–7.76). Those with 2 or more affected family members and both parents affected had a significantly increased risk of 5.37 (95% CI, 1.90–15.17) and 12.48 (95% CI, 2.99–52.06), respectively.

We excluded participants who survived less than three years in the subanalysis because we considered the possibility that the underlying illness that might have been present in these participants at the time of enrollment would have influenced their recall. We found almost identical results in both men and women (data not shown).

DISCUSSION

  1. Top of page
  2. Abstract
  3. MATERIAL AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. Acknowledgements
  7. APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY
  8. APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY
  9. REFERENCES

We found from this prospective analysis that a family history of stomach cancer in one or more first-degree relatives was associated with an increased risk of death from the disease in both men and women, but particularly in women. The increased risk was not altered after multivariate adjustment for known or suspected risk factors of the disease. This result is consistent with the previous results of case-control,11–16, 22, 23 and prospective studies.9 Our study more clearly demonstrated that the effect of family history varies in relation to the age and gender of the study participants and the type of affected relatives.

One of the limitations of our study is that we did not verify independently the accuracy of the self-reports of a family history. Studies on the accuracy of the self-reported family history, however, suggest that the sensitivity and specificity of a family history of cancer is fairly good even in a case-control study setting.24 The sensitivity of a self-reported family history of colorectal cancer was reported to be 0.82 with a specificity of 0.97 in the control group and there were no substantial differences in the accuracy between cases and controls.25 Accurate reporting found in the controls of a population-based case-control study implies that the accuracy of a self-reported family history in the cohort study can be expected.24 Furthermore, inaccurate reporting of a family history in the cohort study would produce nondifferential misclassification that results in an attenuation of risk estimates.

Participants' knowledge of a family history of stomach cancer might have influenced their attitudes toward participating in gastric screening programs during follow-up. This could not be verified because we did not collect any information about the screening participation during follow-up. Participants with a family history of stomach cancer, however, might have attended more screening programs during the follow-up period. Our analysis was restricted to the fatal cases, so a detection bias caused only by closer surveillance of participants with a family history by screening programs is less likely. Furthermore, adjustment with the participation in a gastric screening program one year before enrollment, which was determined by the questionnaire, did not materially alter the association (data not shown).

Controlling for the consumption of green tea and some vegetables and other environmental factors strengthened the association between presence of a family history and death from the disease. Because participants with a family history had had consumed green tea and these vegetables more frequently (Table I), it is possible that such individuals with a family history had been able to reduce the risk of the disease. This may imply the existence of interaction between family history and environmental exposures and is important information to be confirmed by further investigation for the prevention of the disease.

Although information on some of the potential confounders was collected and adjusted for, we cannot rule out the possibility that unmeasured confounders, such as personal and family history of Helicobacter pylori infection or other factors associated with shared environment may explain the observed association.26, 27 Participants with 2 or more affected relatives had a highly increased risk, however, an effect stratified subanalysis revealed to be greater in the age-group from 40–59 and these findings are consistent with a previous report on the relation between the risk of colon cancer and family history, which concluded that the disease occurs as a result of a partially penetrant inherited susceptibility.28 There is also accumulating knowledge about the molecular mechanisms underlying familial aggregation of stomach cancer.29–31 Thus, the positive association found between family history and risk of the disease can be interpreted as partly due to the genetic factor.

In our study, the effect of family history was greater in women, especially in those with a positive family history of the same gender. This gender-specific association was also observed in men. One possible explanation may be the existence of a certain subtype of stomach cancer that is inherited from one generation to the next in gender-influenced fashion. Transmission of the gene responsible for the disease may be dependent on the gender of the parent and offspring.32

Another explanation may be related to the differences in recall of family cancer history between men and women. In the validation studies of self-reported family histories of cancer, women provided the history more accurately than men.24, 25 There are several studies describing the possibility of this gender bias in recall as an explanation of the gender-specific association found in women.16, 33 There were other studies, however, that found accuracy of family history did not vary by gender;34 hence, accuracy is not the sole explanation.

There may be environmental exposures that are common within a family of the same gender, especially females, which are associated with the development of stomach cancer.

Further investigation of the family history in consideration of molecular traits such as E-cadherin gene35 or transforming growth factor beta-130 and interaction with Helicobacter pylori infection26 are needed to solve these questions.

In conclusion, a positive family history of stomach cancer significantly increased the risk of the disease, especially in middle-aged women. This would imply that the degree of individual susceptibility should be taken into account in any preventive strategy. Measurement and improvement of diet and other lifestyles or intensive gastric screening in every persons with a family history of stomach cancer may be effective in preventing the disease.

Acknowledgements

  1. Top of page
  2. Abstract
  3. MATERIAL AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. Acknowledgements
  7. APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY
  8. APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY
  9. REFERENCES

The authors sincerely express their appreciation to Dr. K. Aoki, Professor Emeritus, Nagoya University School of Medicine and the former chairman of the Monbusho ECC (steering committee of the JACC study, i.e., the Research Committee on Evaluation of Risk Factors for Cancer by Large-scale Cohort Study) and Dr. H. Sugano, former Director, National Cancer Institute, Tokyo, who greatly contributed to the initiation of the JACC study.

APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY

  1. Top of page
  2. Abstract
  3. MATERIAL AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. Acknowledgements
  7. APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY
  8. APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY
  9. REFERENCES

Y. Ohno, (present chairman of the Monbusho ECC), A. Tamakoshi (Secretary General of the Monbusho ECC), H. Toyoshima (Nagoya University Graduate School of Medicine); M. Mori (Sapporo Medical University School of Medicine); Y. Motohashi (Akita University School of Medicine); S. Hisamichi (Tohoku University Graduate School of Medicine); Y. Nakamura (Jichi Medical School); T. Shimamoto (Institute of Community Medicine, University of Tsukuba); H. Mikami (Chiba Cancer Center); S. Hashimoto (School of Health Sciences and Nursing, University of Tokyo); Y. Inaba (Juntendo University School of Medicine); H. Tanaka (Medical Research Institute, Tokyo Medical and Dental University); Y. Hoshiyama (Showa University School of Medicine); H. Suzuki (Niigata University School of Medicine); H. Shimizu (Gifu University School of Medicine); S. Tokudome (Nagoya City University Medical School); Y. Ito (Fujita Health University School of Health Sciences); A. Koizumi (Graduate School of Medicine and Faculty of Medicine, Kyoto University); T. Kawamura (Kyoto University Center for Student Health); Y. Watanabe (Kyoto Prefectural University of Medicine, Research Institute for Neurological Diseases & Geriatrics); M. Nakao (Kyoto Prefectural University of Medicine); T. Suzuki (Research Institute, Osaka Medical Center for Cancer and Cardiovascular Diseases); T. Hashimoto (Wakayama Medical College); T. Nose, (Tottori University Faculty of Medicine); N. Hayakawa (Research Institute for Radiation Biology and Medicine, Hiroshima University); T. Yoshimura (Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan); K. Fukuda (Kurume University School of Medicine); T. Kitagawa (Cancer Institute of Japanese Foundation for Cancer Research); T. Kuroki (Gifu University); N. Okamoto (Kanagawa Cancer Center); T. Ishibashi (Asama General Hospital); H. Shio (Shiga Medical Center) and K. Tajima (Aichi Cancer Center Research Institute).

APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY*

  1. Top of page
  2. Abstract
  3. MATERIAL AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. Acknowledgements
  7. APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY
  8. APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY
  9. REFERENCES

K. Aoki, S. Tominaga (Aichi Cancer Center); S. Anzai, T. Kawaguchi, K. Nakamura, M. Masaki (Showa University School of Medicine), S. Kanamori, M. Morimoto, S. Yoshimura (Shiga Medical Center for Adults); S. Kamiyama, Y. Takizawa, N. Hachiya (Akita University School of Medicine); K. Kawai, S. Nakagawa, H. Watanabe, (Kyoto Prefectural University of Medicine); M. Kurihara, (Research Institute for Radiation Biology and Medicine, Hiroshima University); Y. Komachi, (Institute of Community Medicine, University of Tsukuba); R. Sasaki, (Aichi Medical University); M. Sugita, (Toho University School of Medicine); I. Sugimura, (Asahikawa Kosei Hospital); T. Tanaka, (Chigasaki Public Health Center); T. Hirohata, (Kyushu University School of Medicine); I. Fujimoto, (Center for Adult Diseases, Osaka); M. Matsuzaki, (Chigasaki Public Health and Welfare Center); H. Miyake, (Sapporo Medical University School of Medicine); M. Murata, (Chiba Cancer Center); S. Morio, (Kanagawa Cancer Center); H. Yanagawa, (Jichi Medical School) and S. Watanabe (Tokyo University of Agriculture).

  • *

    Investigators were affiliated with the preceding institutions when they participated in the study.

REFERENCES

  1. Top of page
  2. Abstract
  3. MATERIAL AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. Acknowledgements
  7. APPENDIX I – PRESENT INVESTIGATORS INVOLVED IN THE JACC STUDY
  8. APPENDIX II– PAST INVESTIGATORS INVOLVED IN THE JACC STUDY
  9. REFERENCES
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