Racial, Ethnic, and Sex Differences in Incidence-Based Mortality of Aggregate Upper Gastrointestinal Cancers.

Abstract

Current strategies for upper gastrointestinal (UGI) cancer screening primarily target cancer-specific risk, with the strongest focus on esophageal adenocarcinoma (EAC). However, all UGI cancers are amendable to screening and early detection with an upper endoscopic exam. This study assesses and explores incidence-based mortality (IBM) for cumulative UGI cancers, aiming to identify race or sex-based disparities. We used Surveillance, Epidemiology, and End Results Research data to analyze patients diagnosed with EAC, esophageal squamous cell carcinoma (ESCC), cardia gastric cancer (CGC), non-cardia gastric cancer (NCGC), or colorectal adenocarcinoma from 2000 to 2019. Age-adjusted IBM was calculated as a rate per 100,000 population and stratified by sex and race/ethnicity. We also compared UGI cancer IBM with that of colorectal cancer, a cancer with established population-wide endoscopic screening guidelines. Cumulative IBM for UGI cancers was 8.40 (95% CI 8.34-8.46). The highest cancer-specific IBM rates were for EAC (2.26, 95% CI 2.23-2.29), followed by NCGC (2.07, 95% CI 2.04-2.10), CGC (1.60, 95% CI 1.57-1.62), ESCC (1.21, 95% CI 1.19-1.23), and miscellaneous UGI cancer (1.27, 95% CI 1.13-1.40). UGI cancer IBM was highest among Black males (16.43, 95% CI 15.97-16.89), American Indian/Alaska Native males (15.23, 95% CI 13.75-16.82), and Hispanic males (13.76, 95% CI 13.42-14.11). These rates are significantly greater than among White males (12.81, 95% CI 12.68-12.95). UGI cancers impose a significantly higher mortality burden on non-White population subgroups that are not currently targeted by any systematic screening approach.