Changing epidemiology of esophageal cancer: A population-based study over 43 years (1975–2018).

Abstract

247 Background: Esophageal cancer (EC) is the seventh most common cancer worldwide. Previous studies have indicated that the incidence of squamous cell carcinoma of the esophagus (SCE) in the US has declined since the 1970s. In comparison, the incidence of adenocarcinoma of the esophagus (ACE) has sharply risen in the US since the 1970s. This study aimed to examine temporal trends in incidence rates of EC, ACE, and SCE that include recent decades. Methods: Data were derived from the Surveillance, Epidemiology, and End Results (SEER) of the National Cancer Institute - a population-based cancer database. Using SEER*Stat, we calculated the age-adjusted incidence rates (AAIR) for EC, ACE, and SCE in both SEER 9 (for longest follow-up time) and SEER 21 (the largest cohort covering 36.7% of the US population). Temporal incidence trends were examined using Joinpoint analyses to estimate the annual percent change (APC). Subgroup analyses were performed for sex, age, and race/ethnicity. Results: See Table. When stratified by age, age <64 years had a significant decrease in incidence with an APC of -1.1 (2007-2018), while the incidence plateaued in the remaining age groups. The rise in incidence was highest among non-Hispanic whites (NHW) from 2000-2004 (APC 4.0), especially NHW males (APC 3.0); however, the incidence plateaued in all race/ethnicity groups after 2006. Conclusions: The AAIR of EC as a whole has been decreasing since 2004. The AAIR of ACE has, for the first time, plateaued in the most recent decade (2006-2018), after having risen for three preceding decades (1975-2006); we find this effect is mainly driven by the AAIR from NHW males, age <64 years. The incidence of SCE has continued to decline since 1975. Future studies should further explore the underlying etiology of these patterns.[Table: see text]