The Western Australian Family Connections Genealogical Project: Detection of Familial Occurrences of Single Gene and Chromosomal Disorders

Outcomes of screening gastroscopy in first-degree relatives of patients fulfilling hereditary diffuse gastric cancer criteria

BACKGROUND AND AIMS

The aim of this study was to determine the yield of endoscopic screening in first-degree relatives (FDRs) of CDH1-negative hereditary diffuse-type gastric cancer (HDGC) patients.

METHODS

In this retrospective observational cohort study, in 2 expert centers in the Netherlands data were collected on FDRs from families fulfilling the international HDGC criteria that underwent endoscopic screening. Extensive inspection of the stomach was performed by gastroscopy, taking random and/or targeted stomach biopsy specimens to identify diffuse-type gastric cancer.

RESULTS

Between 2004 and 2016, 90 persons (40% men; mean age, 48 years) from 40 families were offered endoscopic screening. The mean number of endoscopies per person was 3. The mean follow-up time was 46 months and mean endoscopic interval 20 months. Signet ring cell carcinoma foci restricted to the mucosa (pT1a) were identified in 4 persons (4%) from 1 family, which afterward was diagnosed with a germline CTNNA1 mutation. Advanced poorly cohesive gastric carcinoma was diagnosed in 1 person from another family. Intestinal metaplasia was diagnosed in 38 persons (42%) and low-grade dysplasia in 4 persons (4%). Additionally, in 40 persons (44%) scar tissue was observed in the gastric mucosa, which can hinder the endoscopic detection of small white lesions typical for HDGC.

CONCLUSIONS

Endoscopic screening in HDGC families without a pathogenic CDH1 mutation may be reasonable, as we detected signet ring cell carcinomas in 6% of persons screened. However, the criteria and frequency of screening may have to be reconsidered.

Objectively Verified Parental Hip Fracture Is an Independent Risk Factor for Fracture: a Linkage Analysis of 478,792 Parents and 261,705 Offspring

Parental hip fracture (HF) is considered a major risk factor for offspring major osteoporotic fracture (MOF), but all studies to date have relied on self-reported information of uncertain accuracy. We tested the association of objectively verified parental HF with offspring MOF and HF. We used a population-based historical cohort study of 261,705 offspring (age ≥40 years) with at least one linked parent (total 478,792 parents) for the province of Manitoba, Canada. Cox proportional hazards models were developed to test hazard ratio (HR) for offspring MOF and HF for 1997 to 2014 according to prior parental HF dating back to 1970. The median age of offspring at study entry was 40 years (range, 40 to 50 years), and 48.3% were women. During 2.9 million person-years of offspring follow-up (median per offspring, 12 years), we identified 7323 incident MOF (4.4% versus 2.7% for those with and without a parental HF, p < 0.001), including 331 HF (0.3% versus 0.1%, p < 0.001). Parental HF was independently associated with increased risk of offspring MOF (HR, 1.30; 95% confidence interval [CI], 1.20 to 1.41). The strength of the association decreased with older parental age at HF (ptrend  < 0.001), and was no longer significant if parental HF occurred after age 80 years (adjusted HR, 1.07; 95% CI, 0.96 to 1.19). The relationship between parental HF and offspring HF was even stronger than for MOF (adjusted HR, 1.64; 95% CI, 1.21 to 2.23). Associations with MOF or HF were not affected by either the gender of the parent with HF or the gender of the offspring. Parental HF increased the risk for offspring MOF and HF but not when parental HF occurred after age 80 years. This suggests a more nuanced approach for clinicians trying to stratify fracture risk, and illustrates the enormous potential of parent-offspring record linkage for other familial disorders. © 2016 American Society for Bone and Mineral Research.