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The role of heredity in the etiology of large bowel cancer: Data from the Melbourne colorectal cancer study

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Abstract

Family history data of colorectal cancer, heart disease, and stroke were obtained on near relatives (parents, siblings, and children) in 702 colorectal cancer cases and 710 age-/sex-matched community controls as part of a large, comprehensive, population-based epidemiological and clinicopathological study of colorectal cancer conducted in Melbourne (the Melbourne Colorectal Cancer Study). There was a statistically significant higher family history rate of colorectal cancer in cases than in controls (relative risk=2.13; 95% confidence interval=1.53–2.96; p < 0.001). This family history effect was more pronounced for colon cancer than for rectal cancer and there was an earlier age of detection of colorectal cancer in those with a family history of this cancer when compared with those without such a history. Dietary risk factors for colorectal cancer, which were previously described in the Melbourne study, were separate and independent from the family history effects. It is concluded that a family history of colorectal cancer is an important indication to screen individuals for this cancer, and also that while heredity has a definite role in the etiology of colorectal cancer, this hereditary effect is either likely to be small, or else likely to be important in only a proportion (perhaps 20%) of cases.

Résumé

Les antécédents de cancers familiaux colorectaux, maladie cardiaque, et accidents vasculaires cérébraux ont été recueillis des proches parents (parents, fratrie, et enfants) chez 702 patients ayant présenté un cancer colorectal et chez 710 sujets témoins comparables en ce qui concerne l'âge et le sexe, dans une étude à grande échelle, épidémiologique, et anatomoclinique sur le cancer colorectal, menée à Melbourne, Australie (Melbourne Colorectal Cancer Study). Il y avait plus d'antécédents familiaux de cancer colorectal chez ceux qui avaient un cancer que chez les témoins (risque relatif=2.13; intervalle de confiance à 95%=1.53–2.96;p<0.001). Ceci était plus net pour les patients ayant un cancer colique que pour ceux qui avaient un cancer rectal. Le cancer était détecté plus tôt chez les patients ayant des antécédents familiaux de cancer que chez ceux qui n'en avaient pas. Les risques alimentaires du cancer colorectal déjà décrits n'étaient pas liés aux antécédents familiaux. Les antécédents familiaux de cancer colorectal sont un facteur important dans le dépistage de ces cancers. L'hérédité joue un rôle important dans l'édologie du cancer colorectal chez 20% des patients.

Resumen

La predisposición hereditaria y la dieta representan las 2 principales hipótesis sobre etiología del cáncer colorrectal. La información contenida en este artículo proviene de un amplio estudio comprensivo, clinicopatológico, y epidemiológico sobre la incidencia, etiología, y sobrevida (el Estudio de Melbourne sobre Cáncer Colorrectal), y los datos de historia familiar provienen de casos controlados del estudio. Los datos de historia familiar de cáncer colorrectal, enfermedad cardiaca, y accidente cerebrovascular fueron obtenidos en familiares cercanos (padres, hermanos, e hijos) de 702 pacientes con cáncer colorrectal y de 710 personas control de similar edad y sexo, en la misma comunidad de Melbourne. Se encontró una estadísticamente significativa mayor tasa de historia familiar de cáncer colorrectal en los pacientes que en los controles (riesgo relativo=2.13; 95%, intervalo confidencial=1.53–2.96;p<0.001). Tal efecto de historia familiar apareció más pronunciado en el cáncer del colon que en el cáncer del recto, y se observó una edad de detección más temprana del cáncer colorrectal en los pacientes con historia familiar de este tipo de cáncer, en comparación con aquellos sin la historia familiar. Los factores dietéticos en el cáncer colorrectal, los cuales fueron previamente descritos en el estudio de Melbourne, aparecieron aislados e independientes de los efectos de la historia familiar. Se présenta la conclusión de que la historia familiar de cáncer colorrectal es una importante indicación para el tamizaje individual, y también de que si bien es cierto que la herencia posee una influencia definitiva en la etiología del cáncer colorrectal, este efecto hereditario aparentemente es menor o sólo llegar a ser de importancia en apenas una parte (tal vez 20%) de los casos.

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Authors and Affiliations

  1. Department of Surgery, University of Melbourne, Repatriation General Hospital, 3081, Heidelberg, Victoria, Australia

    Gabriel A. Kune M.D., Susan Kune M.A., Ph.D. & Lyndsey F. Watson B.Sc.

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  1. Gabriel A. Kune M.D.
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  2. Susan Kune M.A., Ph.D.
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  3. Lyndsey F. Watson B.Sc.
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Kune, G.A., Kune, S. & Watson, L.F. The role of heredity in the etiology of large bowel cancer: Data from the Melbourne colorectal cancer study. World J. Surg. 13, 124–129 (1989). https://doi.org/10.1007/BF01671173

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