A multivariable logistic regression model adjusted for cancer subtype, gene panel, and sex identified several genes significantly associated with PM risk, including SMAD4 [OR(95%CI) = 1.40 (1.29–1.52), FDR = 0.001], KRAS [OR(95%CI) = 1.29(1.21–1.38), FDR = 0.002], and PAX7 [OR(95%CI) = 0.54(0.44–0.66), FDR = 0.030], in addition to previously reported genes such as ESR1, TCF7L2, and FBXW7 (Supplementary Fig. 2e, Supplementary Data 6). Here, SMAD4 is linked to cancer.