Abstract
Upper gastrointestinal (UGI) cancers, comprised of malignancies of the esophagus, stomach, duodenum, pancreas, liver, biliary tract, and gallbladder, are the second leading cause of cancer-related mortality in the US and is associated with significant comorbidities. Recent studies show a disproportionate rise in pancreatic and stomach cancer among young adults. This study aims to use a nationwide, population-based cohort to (1) evaluate the trend of al UGI cancer as an aggregate and (2) examine the role of demographics, histology, and tumor stage in UGI cancer incidence among young adults. Individuals diagnosed with UGI cancer in the US from 2001-2019 were identified and obtained from the SEER-NPCR database. The primary outcomes were incidence rates of UGI cancer (calculated per 100,000, age-adjusted to the year 2000 US population), stratified by sex and age (< 55 years for young adults, and ≥55 years for older adults). Trends, annual percentage change (APC) and average APC (AAPC) were calculated using the parametric method. Sensitivity analysis was performed according to primary site and histology; further analysis examining race and cancer stage was performed in the young adult subgroup. A total of 2,333,161 patients with UGI cancer were identified. The majority of cases were male and 14.3% were <55 years of age. Incidence of UGI cancer increased most in women < 55 years of age, driven primarily by pancreatic and stomach cancers, as well as neuroendocrine tumor and gastrointestinal stromal tumor histology. African American race and localized tumors, and malignancy with distant spread are also contributing to the disparate increase among young women. UGI mortality rates have not changed significantly in young adults. The overall incidence rate of upper GI cancer is increasing significantly in young women compared to men. Increased endoscopic procedures and disparate exposure to risk factors are likely contributing to these trends.
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