This prevalence may be linked to syndromes and P/LP variants in genes such as ATM, BRCA1, BRCA2, and CHEK2, which are known to predispose individuals to GC, as noted in other studies.13, 14, 15,34,39 While we recognise the possibility that these P/LP variants may be linked to other cancers (e.g., those seen in HBOC), in the few families where we performed co-segregation analyses, there were multiple GC cases within the family carrying the P/LP variant, providing further GC causality evidence for our findings. This evidence concerns the gene ATM and gastric cancer.