S0425 Predictors of Esophageal Cancer in Young Adults in the U.S.

Abstract

INTRODUCTION: Esophageal cancer (EC) is one of the most fatal malignancies worldwide, with a dramatic increase in incidence in the Western world occurring over the past few decades. Prognosis remains poor with increased mortality related to this cancer that is often diagnosed during its advanced stages, the main reason being the lack of early clinical symptoms. Epidemiologically, EC has been predominantly a disease affecting adults older than 50 years. However, recent reports have disclosed an increased incidence of EC in younger adults aged less than 50. Our aim is to describe the prevalence and the predictors of EC in young adults less than 50 year old. METHODS: We conducted a retrospective study using Explorys database, an aggregate of electronic health record data from major US healthcare systems. After excluding patients younger than 20 years and those older than 50, a cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of “Primary malignant neoplasm of esophagus” between 1999–2020 was recruited and prevalence of EC was calculated. Statistical analysis for multivariable model was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). We adjusted for the following factors: gender, race, smoking, alcohol abuse, Diabetes Mellitus (DM), obesity, and gastroesophageal reflux disease (GERD). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant. RESULTS: Among 23,353,210 individuals in the database between ages 20 and 50, 1,300 were diagnosed with EC. Baseline characteristics of patients with EC and control group are presented in Table 1. The prevalence of EC among young adults in our study approximated 5.7 in 100.000. When stratified into subgroups based on age, the prevalence was higher with increasing age (Figure 1). Table 2 shows the prevalence among ethnicities with Caucasians being most affected subjects. Using Multivariate analysis model, GERD was a major predictor of EC in young adults {OR 8.623, CI 95% 7.671–9.693}. Other significant predictors included Male gender, Caucasian race, smoking, alcohol, obesity and DM (Table 3). CONCLUSION: Our study disclosed that modifiable risk factors such as social habits (smoking, alcohol abuse) and co-morbidities like GERD, Obesity and DM were major risk factors associated with EC in young adults. Interventions to control those modifiable factors in patients as well as cancer awareness education are warranted to mitigate this increasing trend of EC in young adultsTable 1Table 2Table 3