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AIM: To compare the gastric cancer (GC) patients by their family history with gastric and non-GC.METHODS: Positive family histories within seconddegree relatives and clinicopathological features were obtained for 256 patients.RESULTS: Of the 256 probands, 112 (76 male, 36 female) were incorporated into familial GC (FGC) group: at least two GC members; 144 (98 male, 46 female) were included in the non-FGC group (relatives only affected with non-GCs). Of 399 tumors in relatives (181 from FGC against 212 from non-FGC), GC was the most frequent, followed by esophageal, hepatocellular,and colorectal cancer. Nasopharyngeal cancer was next to lung cancer but prior to breast and urogenital cancers. Most affected members aggregated with in first-degree relatives (FGC: 66 siblings, 48 fathers,31 mothers, four offspring; non-FGC: 56 fathers, 55 siblings, 43 mothers, and 15 offspring). The ratio of males to females in affected first-degree relatives was usually higher in male probands. Paternal history of GC was a slight risk for GC in males (OR = 1.19, 95% CI:0.53-2.69), while risk of GC by maternal history of non-GCs was increased in females (OR = 0.46, 95% CI:0.22-0.97). Diffuse-GC was the major histological type in all subgroups. Difference in tumor sites between the two groups was derived from an excess of upper sites in non-FGC female probands.CONCLUSION: Distribution of associated non-GCs in a family history of GC may vary with geographic areas.GC may have different genetic and/or environmental etiology in different families, and a certain subtype may be inherited in a female-influenced fashion.