The Epidemiology of Esophageal Adenocarcinoma in the United States: Presidential Poster Award

Abstract

Introduction: While endoscopic resection followed by ablation has become the preferred approach for select superficial esophageal adenocarcinomas, the epidemiology of early stage disease has not been examined. This was evaluated in the context of the overall incidence and the rate of change relative to the other major epithelial cancers. Methods: The Surveillance Epidemiology and End Results (SEER) data from 1973 to 2014 were analyzed to compare age-adjusted incidence rates among major epithelial carcinomas including esophageal adenocarcinoma (EAC), esophageal squamous cell carcinoma, breast, prostate, pancreatic, lung, colorectal, and gastric cancer. The percent change in incidence over time was compared by tumor subtype. The fraction of early T-stage, node-negative EAC without metastasis was examined from 2004 to 2014, when precise T-stage data was available. Results: There were 17,026 patients with esophageal adenocarcinoma, 85% of whom were men, 92.0% non-Hispanic White, and 73.3% above the age of 60. Of these, 745 patients were in the early stage analysis cohort. The change in the annual incidence from 1973 to 2014 was 733% for EAC. By Joinpoint analysis, the average annual percent change (AAPC) of esophageal adenocarcinoma during this time period was 5.4% (95% CI 4.8, 6.1). The increase in EAC incidence was significantly higher than for other epithelial malignancies over the same time period (p-value < 0.05). The next most rapidly increasing malignancy examined was breast cancer, which had an AAPC of 0.9% (95% CI 0.4, 1.3). The annual percent change plateaued between 2004 and 2014, and the fraction of cases of early stage disease remained stably high at 21%. Conclusion: Over the past four decades, there has been a 7-fold increase in the incidence of esophageal adenocarcinoma, significantly greater than that observed in other major epithelial malignancies. Approximately one in five patients appear to have potentially resectable early stage disease and may be eligible for organ-sparing, minimally invasive management. Further studies may clarify the cause of the disproportionate increase in esophageal adenocarcinoma relative to stable or decreasing rates in the other tumor subtypes, but overall, this study supports the proliferation of treatment options and increasing focus on the prevention, detection, and treatment for early stage esophageal adenocarcinomas.333_A Figure 1. Percent Change in Annual Incidence of Major Epithelial Cancers from 1973- 2014 Relative to the Index Year, by Cancer Type333_B Figure 2. Annual Incidence Rate of Early Stage Esophageal Adenocarcinoma 2004- 2014333_C Figure 3. Cases of Esophageal Adenocarcinoma 2010-2014, by Tumor Stage