#8 Esophageal and gastric cancer in the united states

Abstract

PURPOSE: Historically, esophageal and gastric cancers have been considered as two cancers. Esophageal cancers were predominantly squamous cell carcinomas, stomach cancers were adenocarcinomas, tumors arose throughout each of the two organs, and rates for each were higher among blacks than whites. Recent observations suggest that there may be at least three, if not four, distinct epidemiologic and potentially etiologic entities: squamous cell carcinoma of the esophagus (SCE), adenocarcinoma of the esophagus (ACE) (arising in the distal region), proximal stomach or gastric cardia adenocarcinoma (GCA), and noncardia gastric adenocarcinoma (NGA). METHODS: We analyzed SEER incidence data for 1974–78 to 1994–98 by anatomic site and histologic type to describe these potentially different tumors, review known or suspected risk factors, and describe the trends in prevalence of these factors. RESULTS: SCE rates decreased after 1988 for all race-gender groups. In contrast, the incidence of ACE increased more than 400% among white males, and ACE rates surpassed those of SCE after 1988. ACE rates increased more than 300% among white females, rose 100% among black males, and also showed an upward trend among black women. NGA trends were generally downward. However, similar to ACE, GCA rates increased from 1974–78 to 1984–88, although to a lesser extent, and appear to have stabilized since then. With the decrease in NGA rates and the increase then stabilization in GCA rates, rates of GCA and NGA among white men were similar in 1994–98. CONCLUSIONS: Declines in the prevalence of smoking and drinking and increases in consumption of fresh fruits and vegetables may contribute to the downward trends in SCE. Increases in gastroesophageal reflux disease and obesity, and declines in Helicobactor pylori ( H. pylori ) infection may contribute to the upward trends in ACE. Reductions in NGA may be related to improved diet and reductions in smoking and H. pylori prevalence. Factors contributing to the rising incidence of GCA of the cardia during the 1970s and 1980s, but not the 1990s, are less clear.