Incidence Rates Of Esophageal Adenocarcinoma Research Articles

Trends in prevalence of esophageal adenocarcinoma: Findings from a statewide database of over 6 million patients.

Esophageal cancer (EC) is a leading cause of cancer-related death in the west 1 . Esophageal squamous cell carcinoma (SCC) is the most common type of EC worldwide. However, in Western countries, including the United States, esophageal adenocarcinoma (EAC) is the most common 2 . EAC is most common in the lower esophagus whereas SCC is most common in the middle and upper esophagus 3 . The incidence of EAC has increased dramatically in western countries over the past few decades. 2 3 The exact reason for this rise in EAC has not been clearly understood. However, an increase in the prevalence of EAC risk factors is postulated as a potential explanation 4 . Although there are many identifiable EAC risk factors, including gastroesophageal reflux disease (GERD), obesity, male sex, White race, and smoking 5 6 7 , Barrett's esophagus (BE) remains the major precursor lesion of esophageal adenocarcinoma. BE develops when there is a change in the normal squamous lining of the esophageal mucosa into intestinal metaplasia 8 9 . The incidence has also increased in the population over the past few decades 10 11 . There is a well-described progression within BE from non-dysplastic BE (NDBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), intramucosal carcinoma (IMC), to invasive EAC 12 13 . Recent data suggest that the increased incidence of EAC may have plateaued 1 . However, we questioned whether the prevalence of EAC is still increasing, especially at younger ages in lieu of recent trends showing an increase in the prevalence of colorectal cancer in younger patients. These findings resulted in a lowering of the colorectal cancer screening age cutoff to 45 years from 50 years 14 15 16 . Therefore, we aimed to assess the time trends in the prevalence and incidence of EAC and some of its risk factors in a large population of patients in Florida and to assess these trends based on age categories. We hypothesized that the prevalence of EAC and BE has increased over time at younger age groups.

Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma

Background: Barrett’s esophagus (BE) can progress to esophageal adenocarcinoma (EAC), a tumor characterized by rapidly increasing incidence and poor survival. We describe patterns of occurrence and risk factors for BE and EAC and how they may influence healthcare. Methods: We searched PubMed and Cochrane databases for English-language publications using the search terms Barrett’s esophagus and esophageal adenocarcinoma. We mainly considered systematic reviews with meta-analysis, randomized clinical trials, population-based observational studies, and international clinical guidelines. The results were synthesized into a narrative review. Results: The prevalence of BE (currently approximately 1% among adults) and incidence of EAC (current global age-standardized incidence rate of 0.9/100 000 person-years) have increased in many regions during the last 5 decades, particularly in North America, Northwestern Europe, and Australia. The increasing incidence is likely attributed to the increasing prevalence of the main risk factors, that is, gastroesophageal reflux disease (GERD) and obesity, combined with a decreasing prevalence of the protective exposure Helicobacter pylori-infection. GERD and obesity are now increasingly prevalent also in Asia, indicating that the incidence of EAC will continue to increase globally. Dysplastic BE and early EAC are readily endoscopically treated, and represent ideal conditions for screening because of their strong association with more advanced EAC. But such screening requires targeting of high-risk individuals, who remain to be better delineated. Conclusions: The changing prevalence rates of GERD, obesity, and Helicobacter pylori-infection might drive continued increasing EAC incidence rates worldwide. Targeted screening programs incorporating combinations of risk factors for BE and EAC may reduce mortality in EAC.

Human Microbiota in Esophageal Adenocarcinoma: Pathogenesis, Diagnosis, Prognosis and Therapeutic Implications.

Esophageal adenocarcinoma (EAC) is one of the main subtypes of esophageal cancer. The incidence rate of EAC increased progressively while the 5-year relative survival rates were poor in the past two decades. The mechanism of EAC has been studied extensively in relation to genetic factors, but less so with respect to human microbiota. Currently, researches about the relationship between EAC and the human microbiota is a newly emerging field of study. Herein, we present the current state of knowledge linking human microbiota to esophageal adenocarcinoma and its precursor lesion—gastroesophageal reflux disease and Barrett’s esophagus. There are specific human bacterial alternations in the process of esophageal carcinogenesis. And bacterial dysbiosis plays an important role in the process of esophageal carcinogenesis via inflammation, microbial metabolism and genotoxicity. Based on the human microbiota alternation in the EAC cascade, it provides potential microbiome-based clinical application. This review is focused on novel targets in prevention, diagnosis, prognosis, and therapy for esophageal adenocarcinoma.

Mo1247 RISK OF NEOPLASTIC PROGRESSION IN PATIENTS WITH LONG-SEGMENT BARRETT'S ESOPHAGUS-JAPAN MULTICENTER PROSPECTIVE COHORT STUDY

The incidence of esophageal adenocarcinoma (EAC) in patients with long-segment Barrett’s esophagus (LSBE) in Japan remains to be fully elucidated. To address this issue, a nationwide multicenter prospective cohort study was designed to investigate EAC incidence rate in patients with BE with a length of at least 3 cm and started in 2011. We previously reported interim analysis findings of follow-up results obtained during the first 4-year period (June 2011 through August 2015), which indicated that the annual incidence rate of EAC in LSBE cases in Japan was 1.2% (Matsuhashi N, et al., J Gastroenterol Hepatol 32: 409-414, 2017). Here, we report findings from the second interim analysis of follow-up results obtained from June 2011 through August 2019. This is an ongoing multicenter prospective cohort study led by the National LSBE Research Group of the Japan Gastroenterological Endoscopy Society involving 13 university medical center and 22 regional hospitals throughout Japan. Based on the Prague criteria, the circumferential (C) and maximum (M) length of BE was noted, then affected patients with a length of 3 cm or longer (M ≥3 cm) were prospectively enrolled. Enrolled BE cases are scheduled for annual esophagogastroduodenoscopy (EGD) examinations for progression to dysplasia or EAC over a 10-year period. Patients with EAC diagnosed from endoscopic examination results undergo subsequent treatment, with their prognosis noted. The registry currently includes 337 participants (males 82.8%; mean age 63.4±12.8 years, range 30-103 years), with a mean follow-up period of 45.3 months (1-8 years). Of those, 12 (3.6%) were initially diagnosed with EAC at enrollment and two-thirds (8/12) were found to be in an advanced clinical stage. Among the remaining 325 with nondysplastic BE, 230 underwent at least 1 follow-up EGD examination, which revealed development of EAC in 6 over a total of 869 patient-years for an annual incidence rate of 0.69%. Five of 6 patients with EAC were male, and the follow-up period until EAC detection varied from 2.6 to 7.0 years. Subgroup analysis found 133 with a long circumferential (C ≥3 cm) BE length and 97 with a short (C <3 cm) BE length, with annual EAC incidence rates of 0.81% and 0.53%, respectively. Most of the EAC cases detected in follow-up annual EGD examinations (5/6, 83.3%) were identified as early stage cancer and those patients underwent curative resection. During follow-up periods ranging from 1-8 years (mean 45.1 months), the annual incidence rate of novel EAC in patients with BE with a length of 3 cm or longer according to the Prague M criteria was estimated to be 0.69%, similar to values reported in Western countries. Most of the EAC cases detected during the follow-up period were early cancer, suggesting the importance of annual surveillance endoscopy.

Low Risk of Progression of Barrett's Esophagus to Neoplasia in Women.

Men are at a higher risk for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), but little is known about BE progression to dysplasia and EAC in women. We performed a retrospective, multicenter cohort study to assess risk of BE progression to dysplasia and EAC in women compared with men. We also investigated comorbidities, medication use, and endoscopic features that contribute to sex differences in risk of BE progression. We collected data from large cohort of patients with BE seen at 6 centers in the United States and Europe, followed for a median 5.7 years. We obtained demographic information (age, sex, ethnicity), clinical history (tobacco use, body mass index, comorbidities), endoscopy results (procedure date, BE segment length), and histopathology findings. Neoplasia was graded as low-grade dysplasia, high-grade dysplasia (HGD), or EAC. Rates of disease progression between women and men were compared using χ2 analysis and the Student t test. Multivariable logistic regression was used to assess the association between sex and disease progression after adjusting for possible confounding variables. Of the total 4263 patients in the cohort, 2145 met the inclusion criteria, including 324 (15%) women. There was a total of 34 (1.6%) incident EACs, with an overall annual incidence of 0.3% (95% confidence interval: 0.2%-0.4%). We found significant differences between women and men in annual incidence rates of EAC (0.05% for women vs. 0.3% in men; P=0.04) and in the combined endpoint of HGD or EAC (0.1% for women vs. 1.1% for men; P<0.001). Female gender was an independent predictor for reduced progression to HGD or EAC when rates of progression were adjusted for body mass index, smoking history, race, use of aspirin, nonsteroidal anti-inflammatory drugs, proton-pump inhibitors, or statins, hypertriglyceridemia, BE length, and histology findings at baseline (hazard ratio: 0.11; 95% confidence interval: 0.03-0.45; P=0.002). In a multicenter study of men versus women with BE, we found a significantly lower risk of disease progression to cancer and HGD in women. The extremely low risk of EAC in women with BE (0.05%/y) indicates that surveillance endoscopy may not be necessary for this subgroup of patients with BE.

360 Gender and Racial Disparities in Incidence Rates of Esophageal Adenocarcinoma

INTRODUCTION: Adenocarcinoma is more common in the US than squamous cell cancer of the esophagus. The purpose of this study is to investigate the impact of gender, and race/ethnicity on the incidence of esophageal adenocarcinoma cancer from 2000-2016 using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: Patients diagnosed with esophageal adenocarcinoma from 2000-2016 were identified from the SEER Registry. We retrospectively evaluated gender-specific, and race/ethnicity variations in age-adjusted annual percent changes in incidence rates during 2000-2016 for people above the age above 20. A secondary analysis was also done in regards to stage distribution for disease from 2007-2016. RESULTS: Based on the SEER 21 areas data sets, the annual percent change of incidence for esophageal adenocarcinoma was 2.3% from 2000-2007 and -0.8% from 2007-2016 for both males and females. The annual percent change for females was 2.0% from 2000-2008, -5.7% from 2008-2011, and 3.5% from 2011-2016. For males, the annual percent change was 2.3 from 2000-2007 and -1.1 from 2007-2016. There was an increase in the annual percent change incidence for females from 2011-2016. Annual percentage of incidence rates by race/ethnicity can be seen in Table 1. Percent of incidence of cases of esophageal adenocarcinoma from 2007-2016 by stage distribution was evaluated by gender. Males had the highest percent of incidence cases for distant spread at 39.4, and regional spread at 32.5. Females had the highest percent of incidence cases for localized spread at 23.8. Percent of incidence of cases of esophageal adenocarcinoma from 2007-2016 by stage distribution for race/ethnicity can be seen in Table 2. For distant spread, the highest percent of cases was seen with American Indian/Alaska Natives at 46.5. CONCLUSION: Esophageal adenocarcinoma can be prevented. Our study shows that there has been an increase in the annual percent change of incidence for females in the last decade. In addition, males had the highest incidence cases for distant spread and regional spread. This study shows that American Indian/Alaskan Native and Non-Hispanic White and White (including Hispanics) had the highest percentage of cases for distant and regional spread, respectively. This may support interventions to inform certain gender and race/ethnic populations about the importance of screening for esophageal adenocarcinoma.

2861 Importance of Barrett's Surveillance in the Senior Population

INTRODUCTION: It is estimated that 5.6% of adults in the United States have Barrett’s esophagus (1). The annual cancer incidence in patients with Barrett’s esophagus is 0.1-0.4% per year, with it being higher among men, older patients, and patients with long segment Barrett’s mucosa. In patients with Barrett’s esophagus with low grade dysplasia (LGD), the annual incidence rates of esophageal adenocarcinoma (EAC) is 0.54% and of high-grade dysplasia (HGD) and/or EAC is 1.73%. Although the benefit of surveillance endoscopy remains unclear, current guidelines recommend surveillance endoscopy to detect dysplasia or EAC early enough to provide effective treatment. Currently there is no consensus on the age limit for Barrett’s surveillance, nor is there a recommended duration of surveillance. This may lead to endoscopic surveillance being performed without clear benefit. (2,3) Our aim was to assess the role of Barrett’s surveillance in detecting dysplasia and malignancy in all age groups; and evaluate the incidence and progression of Barrett's dysplasia to determine an age or duration limit to endoscopic surveillance. METHODS: A retrospective single center, longitudinal study was done by Sierra Nevada Gastroenterology Medical Associates, Inc., a community based gastroenterology group in Grass Valley, California. All outpatient upper endoscopies for Barrett’s screening and surveillance were included in the study. 300 electronic medical records were randomly selected and reviewed from Jan 2005 to Oct 2018. Data was collected on age, gender, race, ASA class, procedure findings, complications, pathology, and dysplasia status. RESULTS: See attached tables. CONCLUSION: In this study LGD was found in 10%, HGD in 0.3% and EAC in 0.3% of patients. In the subgroup of patients with LGD: 27% were detected in patients over 80 years old, 87% detected in patients with short Barrett's, 97% regressed to no dysplasia, and 3% progressed to HGD requiring ablation therapy. 16% of patients over 80 years old maintained or had dysplasia progress. Overall, 1 patient presented with EAC at index endoscopy. 91% of our study population had short Barrett's. There was no dysplasia before age 50 and dysplasia incidence increased with age. There were no endoscopy related complications. In patients over 80 years old, the incidence and progression of dysplasia remains significant. When evaluating endoscopy in this population, risks and benefits need to be considered, but age alone should not exclude a patient from surveillance.

Clustering of esophageal cancer among white men in the United States.

Studies of the geographic distribution of esophageal cancer in the United States have been limited. We aimed to examine geographic clustering of esophageal cancer in the United States and assess whether that clustering is explained by the distribution of known risk factors for esophageal cancer. We conducted cluster analyses derived from county mortality rates of esophageal cancer, using publicly available datasets. State incidence rates of esophageal adenocarcinoma were from the National Program of Cancer Registries, and county esophageal-cancer mortality rates were from the Vital Statistics Cooperative Program. County prevalences of cigarette use, alcohol use, obesity, education, and income were published estimates derived from the Behavioral Risk Factor Surveillance System and the American Community Survey. The primary outcomes were clusters of high and low esophageal-cancer mortality rates among non-Hispanic white men, both unadjusted and adjusted for risk factors. Age-standardized county rates of esophageal-cancer mortality among non-Hispanic white men ranged from 4.8 to 21.2 per 100,000/year. There was a cluster of high mortality in the Great Lakes states and New England and a cluster of low mortality in the Southeastern United States. State incidence rates of esophageal adenocarcinoma were consistent with this pattern. Adjusting for risk factors did little to change the pattern of observed rates or the clusters derived from them. Among non-Hispanic white men, there are clusters of high and low mortality rates with esophageal cancer within the United States, likely representing esophageal adenocarcinoma; but those clusters were not explained by several known risk factors. Focusing future efforts in the high-cluster areas might improve the efficiency of cancer screening and control.

Incidence Trends of Esophageal and Gastric Cancer Subtypes by Race, Ethnicity, and Age in the United States, 1997–2014

There is limited information on contemporary incidence rates and trends, by race, ethnicity, and age, for major subtypes of esophageal and gastric cancer in the United States. We examined the most recent nationwide incidence data for esophageal squamous cell carcinoma, esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric non-cardia adenocarcinoma (GNCA) by race, ethnicity, and age in the United States. Average contemporary incidence rates (2010-2014) and annual percent changes in rates (from1997 through 2014) by race, ethnicity, and age were calculated for each cancer subtype using nationwide data compiled by the North American Association of Central Cancer Registries. From 1997 through 2014, overall esophageal squamous cell carcinoma incidence rates continuously decreased in both sexes and all racial and ethnic groups, although rates remained stable among younger non-Hispanic white women. Overall, EAC incidence rates decreased or stabilized during the most recent time period (2006-2007 through 2014) in men and women, after increasing from 1997 through 2006 and 2007. However, EAC incidence rates continued to increase from 1997 through 2014 in several subpopulations, including non-Hispanic white men younger than 50 years, non-Hispanic white women younger than 70 years, and Asian/Pacific Islander men (all ages combined). Overall GCA incidence rates increased among non-Hispanic whites, but decreased among Hispanics (men only) and Asian/Pacific Islanders. Although overall GNCA rates decreased in both sexes and all racial and ethnic groups, rates increased in younger age groups among men (all races and ethnicities combined) and non-Hispanic white, non-Hispanic black, and Hispanic women. Using high-quality nationwide population-based data, we found increasing incidence trends for EAC, GCA, and GNCA in several subpopulations in the United States.

Low Incidence of Esophageal Adenocarcinoma After Eradication of Helicobacter pylori in Japan

Low Incidence of Esophageal Adenocarcinoma After Eradication of Helicobacter pylori in Japan

Esophageal Adenocarcinoma: Opportunities for Targeted Prevention in Ohio.

Objective:The incidence of esophageal adenocarcinoma, one of the most lethal gastroenterological diseases, has been increasing since the 1960s. Prevention of esophageal adenocarcinoma is important because no early detection screening programs have been shown to reduce mortality. Obesity, gastroesophageal reflux disease, and tobacco smoking are risk factors for esophageal adenocarcinoma. Due to the high prevalence in Ohio of obesity (32.6%) and cigarette smoking (21.0%), this study sought to identify trends and patterns of these risk factors and esophageal adenocarcinoma in Ohio as compared with the United States.Methods:Data from the Ohio Cancer Incidence Surveillance System, Surveillance Epidemiology and End Results Program (SEER), and Behavioral Risk Factor Surveillance System were used. Incidence rates overall, by demographics and by county, as well as trends in incidence of esophageal adenocarcinoma and the percent of esophageal adenocarcinoma among esophageal cancers were examined. Trends in obesity and cigarette smoking in Ohio, and the prevalence of each by county, were reported.Results:There was an increasing trend in esophageal adenocarcinoma incidence in Ohio. Ohio’s average annual esophageal adenocarcinoma incidence rate was higher than the SEER rate overall and for each sex, race, and age group in 2009 to 2013. There was also an increasing prevalence of obesity in Ohio. Although the prevalence of cigarette smoking has been stable, it was high in Ohio compared with the United States.Conclusions:Health care providers and researchers should be aware of the esophageal adenocarcinoma incidence rates and risk factor patterns and tailor interventions for areas and populations at higher risk.

Quality of Life After Endoscopic Mucosal Resection of Early Stage Esophageal Adenocarcinoma: 2017 Presidential Poster Award

Incidence rates of esophageal adenocarcinoma (EA) arising from esophageal dysplasia have continued to increase over the last few decades. Historically patients with EA have had a poor prognosis, often due late stage of disease at time of diagnosis. Recent changes in National Comprehensive Cancer Network guidelines for the management of early EA now recommend endoscopic rather than surgical interventions for T1aN0M0 disease. Our goal was to assess the quality of life (QOL) for patients that have undergone endoscopic therapy for their early EA. All patients included in the study were previously diagnosed with T1aN0M0 EA, and underwent management with endoscopic mucosal resection (ER). Using the validated disease specific Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) instrument, we surveyed our cohort to assess for their current quality of life after therapeutic intervention. The mean time from procedure to survey completion for our cohort was 27 months. The response rate for our survey was one hundred percent (Table 1). All patients reported being on proton pump inhibitors at time of survey. The total scores ranged from zero to fourteen, with a mean score of 3.6, consistent with excellent symptom control. The heartburn scores ranged from zero to nine with a mean score of 1.8. The regurgitation scores ranged from zero to four with a mean score of 1.2. All five patients reported being satisfied with their present condition. On average all patients had well controlled symptoms at time of survey administration, nearly two years after initial intervention. Three of the five patients had a total score of zero, indicating no reported symptoms, while two of the five patients had perceived symptoms. Of those reporting presence of both heartburn and regurgitation, their survey scores were still below the threshold to be considered significant. The two patients that reported symptoms had more distal EA (37 cm - 43 cm from the incisors) near or including the lower esophageal sphincter (LES). These two patients also required more interventions to achieve disease clearance (cryoablations and balloon dilatations). We believe involvement of the LES and need for repeat interventions is the driving factors of ongoing mild symptoms in our patients. Our study demonstrates that patients treated with ER for early EA have an excellent quality of life, with minimal symptoms, which may occur more frequently with disease involving the LES.Table: Table. Results of GERD-HRQL for our cohort

The Annual Risk of Esophageal Adenocarcinoma Does Not Decrease Over Time in Patients With Barrett's Esophagus.

Endoscopic surveillance is recommended for patients with Barrett's esophagus (BE). However, it remains unclear if all BE patients benefit from long-term surveillance. We investigated the risk of esophageal adenocarcinoma (EAC) in BE patients in relation to number of successive endoscopies, years of follow-up, and calendar year. We conducted a retrospective cohort study of male veterans with newly diagnosed BE during 2004-2009 with follow-up until 30 September 2011. EAC was verified using detailed structured electronic medical records reviews. We used Poisson regression to determine incidence rates, rate ratios (RR), and corresponding 95% confidence intervals (CI) for EAC according to number of successive endoscopies, years of follow-up independent of number of follow-up endoscopies, and calendar year of BE diagnosis. Among 28,561 male patients with BE, 406 developed EAC during 140,499 person-years of follow-up (median 4.9 years). EAC incidence rates increased with each additional endoscopy following a previous negative endoscopy (RR per additional endoscopy, 1.43; 95% CI, 1.25-1.64). Compared to the EAC incidence rate at the 1st follow-up EGD, the EAC incidence rate at the 5th follow-up EGD was ninefold higher (adjusted RR, 8.82; 95% CI, 4.90-15.9). EAC incidence was highest at the first year of follow-up (5.34 per 1,000 person-years); however, EAC rates starting from the second follow-up year increased during successive years of follow up. Compared to the EAC incidence rate in the 2nd year of follow-up, the EAC incidence rate was 1.5-fold higher in EGDs conducted ≥5 years after the index BE date (adjusted RR, 1.49; 95% CI, 1.07-2.10). In contrast, we found no significant change in EAC incidence rates by calendar year. Persistence of non-neoplastic BE on multiple consecutive endoscopies was not associated with lower EAC risk. These findings argue against discontinuation of endoscopic surveillance in patients with persistent nondysplastic BE after multiple negative endoscopies.

Surveillance of patients with long-segment Barrett's esophagus: A multicenter prospective cohort study in Japan.

The incidence of esophageal adenocarcinoma (EAC) in cases with long-segment Barrett's esophagus (BE) has not been investigated in Japan. The aim of this study is to investigate the incidence of EAC in Japanese cases with long-segment BE prospectively. This is a multicenter prospective cohort study investigating the incidence rate of EAC in patients with BE with a length of at least 3 cm. Study subjects received index esophagogastroduodenoscopy at the time of enrollment, and they were instructed to undergo yearly follow-up esophagogastroduodenoscopy. Patients in whom EAC was diagnosed in the endoscopic examinations underwent subsequent treatment, and their prognosis was observed. Of 215 enrolled patients, six (2.8%) were initially diagnosed with EAC at the enrollment. Among the remaining 209 patients, 132 received at least one follow-up esophagogastroduodenoscopy. In this follow-up, three EACs developed in 251 observed patient-years (incidence rate: 1.2% per year). Most of the EACs detected at the initial endoscopic examination (5/6, 83%) were already at advanced stages. Meanwhile, all the three lesions detected in the follow-up esophagogastroduodenoscopies were identified as early cancers and subjected to curative resection. The incidence rate of EAC in Japanese cases with long-segment BE was calculated to be 1.2% in a year.

Time trends in the incidence of oesophageal cancer in Asia: Variations across populations and histological types

ObjectiveWe aimed to assess temporal trends in incidence rates of oesophageal cancer in Asian countries. Materials and methodsUsing data from the Cancer Incidence in Five Continents series, we examined the temporal trends in incidence rates of oesophageal cancer by population and histological type in seven Asian countries in 1988–2007. Age-period-cohort analyses estimated the overall annual percentage changes (net drifts) and their 95% confidence intervals (CIs) in incidence rates. ResultsThe age-standardised incidence rate of oesophageal cancer declined in most Asian populations, but remained relatively unchanged in Japan and Israel. The rate of oesophageal squamous cell carcinoma decreased in Hong Kong, Singapore and Israel, but was stable in Japan. The net drifts were statistically significant in men in Hong Kong (−3.4%, 95% CI: −6.1%, −0.7%) and in women in Singapore (−10.1%, 95% CI: −14.4%, −5.5%). The age-standardised incidence rates of oesophageal adenocarcinoma were below 2 and 0.5 per 100 000 in men and women, respectively, across all periods in the all registers containing valid data on histological type. The age-standardised incidence rate of oesophageal adenocarcinoma slightly increased in Japan, Singapore, and Israel, although the net drift was statistically significant only in Israeli men (4.9%, 95% CI: 0.8%, 9.1%). ConclusionThe overall incidence rates of oesophageal cancer declined in most Asian countries, which is due to a decrease in oesophageal squamous cell carcinoma incidence. However, attention needs to be paid to a probable beginning of an increasing incidence of oesophageal adenocarcinoma in Asia.

Obesity and the Incidence of Upper Gastrointestinal Cancers: An Ecological Approach to Examine Differences across Age and Sex.

Esophageal and gastric cancers differ in their epidemiology but have several risk factors in common. The aim of this study was to assess age and sex differences in the burden of esophageal and gastric cancers in the context of the global obesity epidemic. Data from 50 countries were obtained from Cancer Incidence in Five Continents Volume X and GLOBOCAN 2012. Age-specific and age-standardized incidence rates of esophageal adenocarcinoma and squamous cell carcinoma (ESCC), as well as cardia (CGC) and noncardia (NCGC) gastric cancer, were estimated. Countries were grouped and analyzed according to their obesity prevalence. A gradient across quartiles of obesity prevalence was found for esophageal adenocarcinoma, with the highest incidence rates in high prevalence countries (ASR 3.0 vs. 0.8 per 100,000 in highest vs. lowest obesity quartiles, males). In contrast, for ESCC as well as for CGC and NCGC the reverse was true, with the highest rates observed in countries with the lowest obesity prevalence (ESCC, 2.2 vs. 11.5; CGC, 2.8 vs. 7.8; NCGC, 3.9 vs. 17.4 in highest vs. lowest obesity quartiles, males). Although for esophageal adenocarcinoma, sex and age differences in incidence were most pronounced in countries with a high prevalence of obesity, these differences were much smaller for the other cancer sites assessed. Variation in obesity prevalence may partly explain age and sex differences in the incidence of esophageal adenocarcinomas. Ecologic studies can help assess relationships between risk factors and cancer, and generate new hypotheses that may be pursued through more directed research.

Surveillance in Patients With Barrett's Esophagus for Early Detection of Esophageal Adenocarcinoma: A Systematic Review and Meta-Analysis.

Objectives:Although endoscopic surveillance of patients with Barrett's esophagus (BE) has been widely implemented for early detection of esophageal adenocarcinoma (EAC), its justification has been debated. This systematic review aimed to evaluate benefits, safety, and cost effectiveness of surveillance for patients with BE.Methods:MEDLINE, EMBASE, EconLit, Scopus, Cochrane, and CINAHL were searched for published human studies that examined screening practices, benefits, safety, and cost effectiveness of surveillance among patients with BE. Reviewers independently reviewed eligible full-text study articles and conducted data extraction and quality assessment, with disagreements resolved by consensus. Random effects meta-analyses were performed to assess the incidence of EAC, EAC/high-grade dysplasia (HGD), and annual stage-specific transition probabilities detected among BE patients under surveillance, and relative risk of mortality among EAC patients detected during surveillance compared with those not under surveillance.Results:A total of 51 studies with 11,028 subjects were eligible; the majority were of high quality based on the Newcastle–Ottawa quality scale. Among BE patients undergoing endoscopic surveillance, pooled EAC incidence per 1,000 person-years of surveillance follow-up was 5.5 (95% confidence interval (CI): 4.2–6.8) and pooled EAC/HGD incidence was 7.7 (95% CI: 5.7–9.7). Pooled relative mortality risk among surveillance-detected EAC patients compared with nonsurveillance-detected EAC patients was 0.386 (95% CI: 0.242–0.617). Pooled annual stage-specific transition probabilities from nondysplastic BE to low-grade dysplasia, high-grade dysplasia, and EAC were 0.019, 0.003, and 0.004, respectively. There was, however, insufficient scientific evidence on safety and cost effectiveness of surveillance for BE patients.Conclusions:Our findings confirmed a low incidence rate of EAC among BE patients undergoing surveillance and a reduction in mortality by 61% among those who received regular surveillance and developed EAC. Because of knowledge gaps, it is important to assess safety of surveillance and health-care resource use and costs to supplement existing evidence and inform a future policy decision for surveillance programs.

Risk of Upper Gastrointestinal Cancers in Patients With Gastroesophageal Reflux Disease After a Negative Screening Endoscopy

Practice guidelines recommend a 1-time screening endoscopy for patients with gastroesophageal reflux disease (GERD) who are at high risk for Barrett's esophagus or malignancy. However, little is known about the risk of cancer in patients with negative findings from screening endoscopies. We conducted a retrospective cohort study using data from 121 Veterans Health Administration facilities nationwide to determine the incidence rate of esophageal adenocarcinoma (EA) separately, as well as any upper gastrointestinal cancers, in patients with an initial negative screening endoscopy (esophagogastroduodenoscopy [EGD]). We included veteran patients with GERD diagnosed between 2004 and 2009 who had a negative screening EGD within 1 year of diagnosis. We estimated the incidence rate of EA, and any upper gastrointestinal cancer, in patients with GERD who had a negative screening EGD. We examined differences in demographic, clinical, and facility factors among patients with and without cancer. We identified 68,610 patients with GERD and a negative screening EGD (mean age, 55.5 y; 90% men; 67.5% white). During a mean follow-up period of 3.2 years, 10 patients developed EA and 29 patients developed any upper gastrointestinal malignancies, including EA. The incidence of subsequent EA in this group was 4.6/100,000 patient-years of follow-up evaluation, whereas the incidence of any upper gastrointestinal cancers was 13.2/100,000 patient-years of follow-up evaluation. Patients with a subsequent cancer were significantly older and had higher comorbidity scores than patients without cancer. Other clinical and facility factors did not differ significantly between these 2 groups. The risk of cancer is low, over a mean 3-year period, for patients with GERD who had a negative screening endoscopy. These findings justify recommendations for a 1-time screening endoscopy for patients with GERD.

Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis

The natural history of low-grade dysplasia (LGD) in patients with Barrett's esophagus (BE) is unclear. We performed a systematic review and meta-analysis of studies that reported the incidence of esophageal adenocarcinoma (EAC) and/or high-grade dysplasia (HGD) among patients with BE with LGD. Systematic review and meta-analysis of cohort studies. Patients with BE-LGD, with mean cohort follow-up ≥ 2 years. Pooled incidence rates with 95% confidence intervals (CI) of EAC and/or BE-HGD. We identified 24 studies reporting on 2694 patients with BE-LGD, with 119 cases of EAC. Pooled annual incidence rates of EAC alone and EAC and/or HGD in patients with BE-LGD were 0.54% (95% CI, 0.32-0.76; 24 studies) and 1.73% (95% CI, 0.99-2.47; 17 studies). The results were stable across study setting and location and in high-quality studies. Substantial heterogeneity was observed, which could be explained by stratifying based on LGD/BE ratio as a surrogate for quality of pathology; the pooled annual incidence rates of EAC were 0.76% (95% CI, 0.44-1.09; 14 studies) for LGD/BE ratio <0.15 and 0.32% (95% CI, 0.07-0.58; 10 studies) for LGD/BE ratio >0.15. The annual rate of mortality not related to esophageal disease in patients with BE-LGD was 4.7% (95% CI, 3.2-6.2; 4 studies). Substantial heterogeneity was observed in the overall analysis. The incidence of EAC among patients with BE-LGD is 0.54% annually. The LGD/BE ratio appears to explain the variation observed in the reported incidence of EAC in different cohorts. Conditions not related to esophageal disease are a major cause of mortality in patients with BE-LGD, although additional studies are warranted.

Acid-suppressive medications and risk of esophageal adenocarcinoma in patients with Barrett’s esophagus: A systematic review and meta-analysis.

11 Background: Acid-suppressive medications, particularly proton pump inhibitors (PPI), may modify risk of esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE). We performed a systematic review and meta-analysis of studies evaluating the association between PPIs and histamine receptor antagonists (H2RA) and risk of EAC or high-grade dysplasia (BE-HGD) in patients with BE. Methods: Through a systematic search up to June 2013, we identified 7 observational studies (5 cohort studies and 2 case-control studies; 2,813 patients with BE, 317 cases of EAC and/or BE-HGD, 84.4% PPI users) reporting the association between PPIs or H2RA and EAC in patients with BE. Summary odds ratio (OR) with 95% confidence intervals (CI) was estimated using random effects model, and heterogeneity was measured using the inconsistency index (I2). Results: On meta-analysis, PPI use was associated with 71% reduction in EAC risk in patients with BE (adjusted OR, 0.29; 95% CI, 0.12-0.71). There was a trend toward a dose-response relationship with PPI use for &gt;2 years protective against EAC [3 studies; PPI use &gt;2 years vs. &lt;2 years (as compared to no use): OR, 0.45 (0.19-1.06) vs. 1.09 (0.47-2.56)]. Considerable heterogeneity was observed in the overall analysis (I2=81%). On restricting analysis to 5 cohort studies, use of PPIs was consistently associated with a lower risk of EAC and/or BE-HGD (adjusted OR, 0.33; 95% CI, 0.19-0.58; I2=9%). H2RA use was not associated with decreased risk of EAC in patients with BE based on 2 studies (adjusted OR, 1.15; 95% CI, 0.77-1.72). Using a 67% summary risk reduction (derived from cohort studies) of EAC and/or BE-HGD with PPI use in patients with BE, and observed cumulative incidence rates of EAC and/or BE-HGD in patients with BE overall as 10.2 per 1,000 patient years, we estimate the number needed to treat with PPIs to prevent 1 case of EAC or BE-HGD in BE patients at 147. Conclusions: Based on meta-analysis of observational studies, the use of PPI, but not H2RA appears to be associated with a decreased risk of EAC and/or BE-HGD in patients with BE. PPI use should be considered in BE, and chemopreventive trials of PPIs in patients with BE are warranted.