Esophageal Cancer Mortality Research Articles

20-Year Comparative Survival and Mortality of Cancer of the Esophagus by Age, Sex, Race, Stage, Grade, Cohort Entry Time-Period, Disease Duration & Selected ICD-O-3 Oncologic Phenotypes: A Systematic Review of 83,658 Cases for Diagnosis Years 1973-2014: (SEER*Stat 8.3.4)

Objective.— To update trends in incidence, prevalence, short- and long-term survival and mortality of esophageal cancer using the statistical database of SEER*Stat 8.3.4 for diagnosis years 1973-2014 employing multiple case selection variables. Methods.— A retrospective, population-based study using nationally representative data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program to evaluate 83,658 cases of esophageal cancer for diagnosis years 1973-2014 comparing multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration, and, two histologic oncotypes. Relative survival statistics were analyzed in two cohorts: 1973-1994 and 1995-2014. Survival statistics were derived from: SEER*Stat Database: Incidence – SEER 9 Regs Research Data, November 2016 Submission (1973-2014) <Katrina/Rita Population Adjustment> Released April 2017 (Ref. 9). Case frequency and incidence data, derived from the SEER program, were used to design the table format and number of pages for this report. Results.— In a total of 83,658 cases of esophageal cancer in the United States for diagnosis years 1973-2014, multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration, and, two histologic oncotypes were compared. Mean age in males was 66.5 years, females 70.1 years, both male and female 67.2 years. Greater than 85% of incidence cases occurred between ages 55-85+ years with the zenith in males at 65-69 years (59.4%) and 70-74 years (60.5%) in females. The overall annual US death rate from 1975-2014 has slightly increased from 3.69 to 3.99 per 100,000 per year, and excess mortality remains exceedingly high. Of the 83,658 invasive cases, 82.6% were clinically staged and 79.4% were histologically graded. Conclusions.— Relative frequency, incidence and time-trends, and the clinical, demographic and secular variables of age, sex, race, stage, grade, cohort-entry time-periods, and predominant clinical oncotypes were comparatively analyzed to provide a comprehensive medical-actuarial assessment of esophageal cancer survival and mortality in the 1973-2014 time-frame.

Ornithine decarboxylase inhibition downregulates multiple pathways involved in the formation of precancerous lesions of esophageal squamous cell cancer.

The high incidence and mortality of esophageal squamous cell cancer (ESCC) is a major health problem worldwide. Precancerous lesions of ESCC may either progress to cancer or revert to normal epithelium with appropriate interventions; the bidirectional instability of the precancerous lesions of ESCC provides opportunities for intervention. Reports suggest that the upregulation of ornithine decarboxylase (ODC) is closely related to carcinogenesis. In this study, we investigated whether ODC may act as a target for chemoprevention in ESCC. Immunohistochemistry (IHC) assays indicate that ODC expression is higher in esophageal precancerous lesions compared with normal tissue controls. Its overexpression promotes cell proliferation and transformation of normal esophageal epithelial cells, and its activity is increased after N-nitrosomethylbenzylamine (NMBA) induction in Shantou human embryonic esophageal cell line (SHEE) and human immortalized cells (Het1A) cells. In addition, p38 α, extracellular regulated kinase (ERK1/2) in the mitogen-activated protein kinase pathway and protein kinase B (AKT)/mammalian target of rapamycin (mTOR)/ribosomal protein S6 kinase (p70S6K) pathways are activated in response to NMBA treatment. Difluoromethylornithine (DFMO) is an ODC inhibitor, which inhibits NMBA-induced activation of p38 α, ERK1/2 and AKT/mTOR/p70S6K pathways; this has been verified by Western blotting. DFMO was also found to suppress the development of esophageal precancerous lesions in an NMBA-induced rat model; IHC demonstrated p38 α, ERK1/2, and AKT/mTOR/p70S6K pathways to be downregulated in these rats. These findings indicate the mechanisms by which ODC inhibition suppresses the development of esophageal precancerous lesions by downregulating p38 α, ERK1/2, and AKT/mTOR/p70S6k signaling pathways, ODC may be a potential target for chemoprevention in ESCC.

Analysis of incidence and mortality of esophageal cancer in China, 2015

Objective: To estimate the incidence and mortality rates of esophageal cancer in China in 2015. Methods: Based on the data quality review and assessment, the esophageal cancer data from 368 cancer registries in 31 provinces (autonomous regions and municipalities) in China were included in this study. According to the national population data in 2015, the nationwide incidence and mortality of the esophageal cancer were estimated. Chinese standard population in 2000 and world Segi's population were used to calculate the age-standardized (ASR) incidence and mortality rates (ASR China and world, respectively). Results: The 368 cancer registries covered a total of 309 553 499 populations in China, accounting for 22.52% of the national population. There were 245 651 new esophageal cancer cases estimated in China in 2015, with a crude incidence rate of 17.87/100 000. The ASR China and ASR world were 11.14/100 000 and 11.28/100 000, respectively. The estimated number of esophageal cancer death was 188 044 in China in 2015, with a crude mortality rate of 13.68/100 000; The ASR China and ASR world mortality rates were 8.33/100 000 and 8.36/100 000, respectively. The ASR China incidence and mortality of esophageal cancer in males were higher in males (16.50/100 000 and 12.66/100 000) than those in females (5.92/100 000 and 4.17/100 000), and they were higher in rural areas (15.95/1100 000 and 11.67/100 000) than those in urban areas (7.59/100 000 and 5.87/100 000). Conclusion: The incidence and mortality of esophageal cancer in China are higher than the global average. The disparity of the incidence and mortality rates of esophageal cancer significantly differed in genders and areas.

EP1.17-02 Artificial Intelligence in the Qualitative Study of Pulmonary Nodules by Analyzing the Genetic Map and Imaging Data of Lung Adenocarcinoma

Artificial intelligence is the most influential technology for the future and the hottest research and technology at present. Lung cancer is the most common malignant tumor with the highest morbidity and mortality. By analyzing the genetic characteristics and imaging of patients with lung adenocarcinoma, this study aims to analyze the pulmonary nodules in the susceptible population to find the most characteristic. Gansu province is an economically backward province in northwest China, with a poor environment, poor living conditions, low level of medical and health services, mainly rural population, per capita income less than 5,000 yuan, and a high incidence and mortality of lung cancer and esophageal cancer. Most patients come to the hospital for treatment are in the middle and late stage of lung cancer, and often miss the best time for treatment. Even if they come to the hospital for treatment, there is no good effect, and bring huge economic burden and family burden. The early diagnosis and treatment of lung cancer is particularly important. Artificial intelligence for lung cancer and population census is an economical, convenient and accurate technology, which will bring huge benefits to people”s health. In this study, the imaging data of diagnosed lung adenocarcinoma patients with pulmonary nodules and the gene sequencing and mutation point of pathological specimens were studied by artificial intelligence, and the lung cancer genes identified by NICC were compared with deep learning to produce relatively complete learning software. The software was used to select the selected sample population of people with high risk of lung cancer regions, and then the postoperative pathology of pulmonary nodules highly suspected of lung cancer was input into the database, and the preoperative diagnosis of AI was compared and studied to optimize the software. It is hoped that this study can develop a set of artificial intelligence software with high accuracy and sensitivity, and then carry out early diagnosis and treatment of lung cancer in high-risk groups. Provide research basis for the genetics of lung adenocarcinoma and the early invasion characteristics of lung adenocarcinoma. This study could develop a set of artificial intelligence software with high accuracy and sensitivity, and then carry out early diagnosis and treatment of lung cancer in high-risk groups. Provide research basis for the genetics of lung adenocarcinoma and the early invasion characteristics of lung adenocarcinoma.

The lag effect of water pollution on the mortality rate for esophageal cancer in a rapidly industrialized region in China.

The Huai River basin (located in eastern China) has a population of 180 million and has the highest risk of esophageal cancer (EC) mortality in China. Some studies found that contaminants in drinking water are a major risk factor for cancers of the digestive system. However, the effect of water pollution in the historical period on the current EC mortality remains unclear. Data were collected on the EC mortality rate in 2004 in the Huai River basin in 11 counties, and data on the surface water quality in the region from 1987 to 2004 were used. The Pearson correlation and the GeoDetector q-statistic were employed to explore the association between water pollution and the EC mortality rate in different lag periods, from linear and nonlinear perspectives, respectively. The study showed apparently spatial heterogeneity of the EC mortality rate in the region. The EC mortality rate downstream is significantly higher than that in other regions; in the midstream, the region north of the mainstream has a lower average mortality rate than that south of the area. Upstream, the region north of the mainstream has a higher mortality rate than that in the southern area. The spatial pattern was formed under the influence of water pollution in the historical period. 1996, 1997, and 1998 have the strongest linear or nonlinear effect on the EC mortality rate in 2004, in which the Pearson correlation coefficient and the q-statistic were the highest, 0.79 and 0.89, respectively. Rapid industrialization in the past 20 years has caused environmental problems and poses related health risks. The study indicated that the current EC mortality rate was mainly caused by water pollution from the previous 8 years. The findings provide knowledge about the lag time for pollution effects on the EC mortality rate, and can contribute to the controlling and preventing esophageal cancer.

Competing Risk Nomogram to Predict Cancer-Specific Survival in Esophageal Cancer Patients During the Intensity-Modulated Radiation Therapy Era: A Single Institute Analysis

Recently, competing risk method based on the subdistribution hazard model is recommended to accurately determine the effects of risk factors on specific events, because it takes into account the informative nature of censoring. The aim of present study was to investigate the probability of cancer-specific mortality of esophageal cancer (ESC) patients undergoing intensity-modulated radiation therapy (IMRT) and establish a competing risk nomogram to predict esophageal cancer-specific survival (ESC-SS) of these patients. A total of 213 ESC patients undergoing IMRT were identified to establish nomograms based on Fine and Gray’s competing risk analysis. Predictive accuracy and discriminative ability of the model were performed using concordance index(C-index),calibration curve and the area under receiver operating characteristic (ROC) curve. Decision tree analysis was performed for patients grouping. With a median 19 month (range:3-50) follow-up, the 2-year ESC-specific mortality (ESC-SM) and non-cancer specific mortality (NC-SM) of the cohorts were 35.4% and 3.51% respectively, and elevated 2-year ESC-SM were observed in patients with tumor length≥4.5cm (45.8% vs. 21.4%, p<0.001), non-squamous cell carcinoma(non-SCC, 49.9% vs. 33.7%, p=0.025), and N3 stage (43.2%, p=0.005). The 2-year NC-SM was observed in tumor length≥4.5cm cohorts (6% vs. 0%, p=0.016). All validated factors including tumor length, histology type and N stage, were integrated into the competing nomograms into the ES-SCC model [concordance (c)-index=0.72, 95%CI: 0.66-0.77]. In addition, the nomograms displayed better discrimination power than 7th edition Tumor-Node-Metastasis (TNM) stage systems for predicting ESC-SS (the AUC value 0.707 vs. 0.634).The classification tree analysis also showed that N stage is the initial node, tumor length is also determinants for ESC-SM of this patients population. NC-SM represents a significant competing event for esophageal cancer with tumor length ≥4.5cm. The competing risk nomograms could be considered as convenient individualized predictive tools for cancer specific survival in esophageal cancer undergoing IMRT treatment.Abstract 2449; Table 1VariableUnivariateMultivariateSHR95%CIpSHR95%CIpGenderMale1---Female0.680.34-1.370.29---Age<601-≥600.840.54-1.330.47---Histologic TypesSCC11Non-SCC2.031.06-3.910.0342.711.48-4.930.001GradeHigh11Moderate/poor1.441.01-2.080.0461.140.75-1.740.61SurgeryYes11No0.620.40-0.960.0331.520.85-2.720.15Tumor length≤4.511＞4.5cm2.431.48-3.99《0.0011.801.03-3.160.04MetastasisYes11No2.121.08-4.130.0281.410.66-3.000.37 Open table in a new tab

SEGMENTATION OF TERRITORIES OF THE REPUBLIC OF BASHKORTOSTAN ON THE LEVEL OF MORTALITY FROM MALIGNANT NEOPLASMS

Malignant neoplasms are an actual problem due to their high prevalence, high level of disability, tendency to increase. The purpose of the study is the segmentation of the territories of the Republic of Bashkortostan (RB) by the level of mortality from malignant neoplasms (MN) as a whole by municipalities, as well as by gender and by localizations of malignant neoplasms. Material and methods. The data of official statistics of the Territorial body of the Federal State Statistics Service of the Republic of Belarus (Table C 51), Rosstat were analyzed. The study was conducted using k-means cluster analysis and rating, implemented in the Statistica system. Results. There is a significant increase in the death rate of the entire population of ZN in 41 municipalities. Analysis of standardized mortality rates shows that the mortality rate per 100 thousand of the population in the Republic of Belarus is lower than similar indicators in the Russian Federation. The exception is mortality in esophageal cancer, which is higher in both men and women than in the Russian Federation. It has been established that the regions of the fourth and fifth clusters are unfavorable in terms of mortality from MN. Discussion. Revealed a pronounced uneven distribution of the territory of the Republic of Belarus with a tendency to an increase in mortality from MN in many territories. It is possible that the main reasons for the increase in mortality rates are worsening socio-economic conditions, lower living standards, increased chemical stress in urbanized areas (air pollution), as well as insufficient promotion of healthy lifestyles among the population, preventive knowledge, and health problems. care, its poor quality. Conclusion. As a result of the analysis, it was possible to establish that cluster analysis allows us to identify areas that have similar problems related to the level and trends of mortality from malignant tumors.

Racial Disparities with Esophageal Cancer Mortality at a High-Volume University Affiliated Center: An All ACCESS Invitation

BackgroundEsophageal cancer (EC) has a dismal prognosis with 5-year survival < 19%. Black patients with EC have higher mortality than white patients, but the cause of this disparity is unclear. We sought to investigate the impact of race upon overall mortality (OM) among EC patients at our institution. MethodsWe performed a single-center retrospective review of all patients diagnosed with EC between January 2010 through December 2016 with follow-up through October 2017. We compared the difference among categorical variables and mortality using Fisher's exact test. Odds ratios (OR) and hazard regression (HR) were constructed to analyze treatment options by race. The Kaplan-Meier method was used to plot OM curves by race. We also used a logistic regression analysis to construct a predictive model for mortality based on histology and race. ResultsWe identified 77 patients (62% male) diagnosed with EC. There was no difference in treatments offered based on race. After adjusting for age, histology and stage, we found mortality was significantly higher in blacks when compared to whites (HR 14.07, 95% CI [2.33–129.70] p < 0.008). Our predictive model revealed that blacks had a higher probability of mortality at all stages of EC. ConclusionsWe found race to be an independent risk factor for OM in EC patients. This likely reflects differences in healthcare utilization or access, as evidenced by higher prevalence of Stage IV EC in black patients. Continued investigation is needed to address this disparity locally and nationally.

Mo1242 – Mortality of Esophageal Cancer in Brazil: Geographic and Temporal Analysis of the Last 17 Years

Mo1242 – Mortality of Esophageal Cancer in Brazil: Geographic and Temporal Analysis of the Last 17 Years

Area socioeconomic status is independently associated with esophageal cancer mortality in Shandong, China

Esophageal cancer (EC) is a leading cause of cancer death in China. Within Shandong Province, a geographic cluster with high EC mortality has been identified, however little is known about how area-level socioeconomic status (SES) is associated with EC mortality in this province. Multilevel models were applied to EC mortality data in 2011–13 among Shandong residents aged 40+ years. Area-level SES factors consisted of residential type (urban/rural) of the sub-county-level units (n = 262) and SES index (range: 0–10) of the county-level units (n = 142). After adjustment for age and sex, residents living in rural areas had a 22% (95% CI: 13–32%) higher risk of dying from EC than those in urban areas. With each unit increase in the SES index, the average risk of dying from EC reduced by 10% (95% CI: 3–18%). The adjustment of area-level SES variables had little impact on the risk ratio of EC mortality between the high-mortality cluster and the rest of Shandong. In conclusion, rural residence and lower SES index are strongly associated with elevated risks of EC death. However, these factors are independent of the high mortality in the cluster area of Shandong. The underlying causes for this geographic disparity need to be further investigated.

Esophagus cancer geographical distribution, incidence, mortality and their world Human Development Index (HDI) relationship: an ecology study in 2018

Objective: Esophageal cancer is the eighth most common cancer in the world. About 80 of cases occur in less developed regions. The study purposed to investigate the epidemiology of esophageal cancer incidence and mortality in 185 countries and its relation with HDI in 2018. Materials and Methods: A descriptive-analytical study was developed based on cancer incidence and mortality data extraction from the World Bank for Cancer in 2018. The incidence and mortality rates and esophagus cancer distribution maps were drawn for World countries. To analyze data, correlation and regression tests were used to evaluate the relationship between the incidence and mortality with HDI. The statistical analysis was carried out by Stata-14, and the significance level was estimated at 0.05 level. Results: The highest and the lowest esophageal cancer incidences were in the Asian continent (N=444597; 77.7) and the Oceania continent (N=2315; 0.4). The most esophageal cancer incidence and mortality was in high HDI regions. A negative and significant correlation was observed between incidence (R = -0.143, p <0.05) and mortality (R = 0.234, p <0.05) of esophagus cancer and HDI. Furthermore, there was a negative and significant correlation between incidence rate and LEB (r = -0.16, p <0.05). Also, the results showed a negative and significant correlation between mortality rate and GNI (r = 0.1, p <0.05), MYS (r = -0.17, p <0.05), LEB (r = -0.23, p <0.05) and EYS (r = -0.15, p <0.05). Conclusions: There is a negative correlation between esophageal cancer incidence and mortality as well as the HDI index, improving the HDI can be effective in reducing of the cancer incidence and mortality.

Time Trends of Gastrointestinal Cancers Incidence and Mortality in Yangzhong From 1991 to 2015: An Updated Age-Period-Cohort Analysis.

Background: Gastrointestinal (GI) cancers are the common cause of morbidity and mortality in China which seriously threaten people's health and lives. The aim of this study was to describe the temporal trend in the epidemiology of GI cancers from 1991 to 2015, with an emphasis on the effects of age, period and cohort in Yangzhong City, Jiangsu province, a high-risk area of GI cancers in China.Methods: Our study extracted cases of gastric cancer, esophageal cancer and colorectal cancer diagnosed from 1991 to 2015 from Yangzhong Cancer Registry. Age-standardized rates (ASRs) were calculated and joinpoint regression was used to compute the estimated annual percent changes. Age-period-cohort (APC) model was performed to investigate the independent effects of age, calendar period, and birth cohort.Results: Between 1991 and 2015, 18,006 new cases and 10,262 deaths were registered with GI cancers in Yangzhong. The age-standardized incidence rates (ASIRs) of gastric cancer decreased in both sexes during the study period. And the incidence rates of esophageal cancer stabilized at first then continued to decline, the turning point was in 2005 for men and 2001 for women. Changes in the mortality rates of gastric cancer and esophageal cancer showed significant declined trends around 2000–2010 in both genders. The incidence rates of colorectal cancer increased steadily during the entire study period, and the increase was more pronounced in the mortality rates of men. The results of APC analysis suggest that general decreases in incidence and mortality of esophageal cancer and gastric cancer might be caused by the downward trend of the period and cohort effects, while the increases in colorectal cancer might be caused by the uptrend of the period effects.Conclusions: The incidence and mortality rates of esophageal and gastric cancers showed a downward trend and colorectal cancer was on the rise as a whole in Yangzhong City. The different burden of gastrointestinal cancer indicating heterogeneous risk factors exist and may have contributed to these temporal variations.

Temporal Changes in Esophageal Cancer Mortality by Geographic Region: A Population-based Analysis.

PurposeTo analyze differences in esophageal cancer survival by geographic region of the U.S. from the 1970s to the 2000s, and attribute the causes of these discrepancies.MethodsRaw data were obtained from the Surveillance Epidemiology and End Results (SEER) program of the National Cancer Institute. Patients were stratified by decade of diagnosis and by geographic region (East, Hawaii/Alaska, Midwest, Southwest, and West), containing SEER registries. The Kaplan-Meier method with the log-rank test was used to compare the overall survival (OS) among these geographic groups. A multivariate Cox Proportional Hazard analysis was conducted to evaluate the impact of the following factors on differences in survival: patient age, gender, race, tumor stage, site, histology, treatment method, and metropolitan size.ResultsA total of 87,834 patients were identified. OS has increased significantly since 1973, with five-year OS improving from 4.9% (the 1970s) to 15.3% (2000s) (P<0.001). Residence in the East was prognostic for higher OS compared to all the other regions, with a median OS of six months in the 1970s and 12 months in the 2000s (P<0.001). The multivariate analysis revealed increased age, African American race, distant disease, non-distal tumor location, squamous cell histology, and no radiation therapy were associated with worse OS. The West and East had the highest amount of cancer centers (12 and seven, respectively). And the East had the highest number of cancer centers per person (5.7E-07) while the South had the lowest (1.6E-07).ConclusionsThere are disparities in esophageal cancer survival and quality of care through different geographic regions of the U.S., which may be attributed to a combination of the unbalanced distribution of medical resources, the regional differences in cancer biology, and other lifestyle and socioeconomic factors. More research should be conducted to further characterize regional differences and guide the implementation of improvements in survival.

Spatial Analysis of Esophageal Cancer Mortality in a High-risk Population in China: Consistent Clustering Pattern in 1970-74 and 2011-13

Purpose:Almost half of the global esophageal cancer (EC) deaths occurred in China. This study aims to examine the geographic spread of EC mortality in two periods in a large Chinese population.Methods:Age-standardized mortality rates (ASMRs) for 140 county-level units in Shandong Province during the periods 1970-74 and 2011-13 were derived using data from the First National Cause-of-Death Survey and the Shandong Death Registration System, respectively. ASMRs were smoothed using Area-to-Area Poisson kriging technique. Spatial scan statistics were used to detect spatial clusters with higher EC mortality and clusters with greater temporal changes in EC mortality.Results:The provincial average ASMR decreased from 13.0 per 100,000 in 1970-74 to 5.8 in 2010-13. Almost all counties or districts have experienced a decrease in EC mortality, while the reduction was particularly pronounced in the mid-west region. This study has identified a geographical cluster with much higher EC mortality rates and the clustering pattern has largely unchanged over the past 40 years. Residents living in the cluster during 1970-74 were 2.7 (95%CI: 2.2-3.4) times more likely to die from EC than the rest of the province. The corresponding risk ratio for the 2011-13 cluster was 3.7 (95%CI: 2.8-5.0).Conclusions:This study detected a geographically defined subpopulation in Shandong, China with much higher risk of dying from EC. This spatial pattern has been consistent over the past few decades. The results suggest the key drives for geographic variations in esophageal cancer may not have changed.

Gender and Race Disparities in Prevalence and In-Hospital Mortality of Esophageal Cancer

Gender and Race Disparities in Prevalence and In-Hospital Mortality of Esophageal Cancer

Esophageal cancer in the world: incidence, mortality and risk factors

There is little about the incidence, mortality and risk factors of Esophageal cancer (EC) in the world. Therefore, the purpose of this study was to determine the incidence rate, mortality and EC risk factors in the world. This review study was conducted on published English research by January 2017 with the search in by March 2018 by searching in the databases of PubMed, Scopus, and Science Direct with the keywords "esophagus cancer," "epidemiology," "incidence," "mortality," "risk factor," " world." Based on the findings of this study, the geographical distribution of the EC differs according to subtitles, as AC is more prevalent in developed countries, while SCC is more prevalent in countries in Africa and East Asia. The most important risk factors for EC are the low intake of vegetables and fruits, drinking drinks and hot liquids, reducing the intake of nutritional supplements such as selenium and zinc, smoking, excessive consumption of alcohol, past medical history, obesity and exposure to some environmental factors. According to the findings, it seems that the main cause of EC- is an undesirable lifestyle. Therefore, it is possible to improve the lifestyle and inform the community about EC risk factors and healthy lifestyle education.

Global Inequality in the Incidence and Mortality Rates of Esophageal Cancer: A Country-Level Analysis

Background: Esophageal cancer (EC) is among the ten most common cancers and causes-related mortality worldwide. Objectives: To determine the global inequality in the incidence and mortality rates of EC and decomposing of determinants in inequality. Methods: The rates of incidence and mortality about EC were obtained for 172 countries from the global cancer project. The World Bank database was also used to obtain the HDI and its gradient for 169 countries. Inequality in the age-specific incidence and mortality rates of EC was calculated according to the HDI by using the concentration index (CI). We were decomposing CI to determine contributors in inequality. Results: The concentration index was negative for incidence (-0.23) and mortality (-0.25) rates of EC, indicating the higher concentration of the rates among deprived countries. The important contributors in incidence and mortality inequality rates of EC were HDI and Urbanization with about 0.25 absolute contributions. Conclusions: Global inequalities exist in the EC incidence and mortality rates, which have contributed to the cancer-related health disparities worldwide. The important positive contributors in inequalities were HDI and urbanization. These findings suggest that prevention, early detection, and public health education programs and policies should be targeted to reduce global cancer disparities, particularly in low and middle-income developing countries.

Cancer mortality in an international cohort of reinforced plastics workers exposed to styrene: a reanalysis

ObjectiveTo investigate the carcinogenicity of styrene by reanalysing data from a previous international cohort study of workers in the reinforced plastics industry.MethodsMortality from cancers of prior interest was analysed with...

Inequalities in esophageal cancer mortality in Brazil: Temporal trends and projections.

The main objective of the study was to analyze the effect of age, period and birth cohort on esophageal cancer mortality in Brazil and its geographic regions, per sex. An ecological study is presented herein, which evaluated the deaths by esophageal cancer and the distribution, per geographic region. Poisson Regression was utilized to calculate the effects of age, period and birth cohort, and projections were made with the statistical software R, using the age-period-cohort model. Projection of data covered the period 2015–2029. Regarding the geographic regions of Brazil, a decrease was verified, throughout time, for the mortality rates of the South and Southeast regions, for men and women. For the North, Northeast and Midwest regions, an increase was evidenced in mortality rates, mainly for men, after the 2000's. Regarding the projections, a progressive increase of mortality rates was verified for the Northeast and North regions. Divergences evidenced for observed and projected esophageal cancer mortality rates revealed inequalities among the geographic regions of Brazil.

Epidemiological Profile of Esophageal Cancer Mortality in Rio Grande do Sul and its Health Regions.

Introduction: Malignant esophageal neoplasia is a rare tumor, but it has high morbidity and mortality. Early diagnosis and intensive treatment associated with surgical approach remains the best treatment for the disease. Its epidemiology is extremely diverse in the world, even in the same country. Methodology: This was a retrospective analysis made from 2000-2015, analyzing the mortality rates of malignant esophageal neoplasia in the state of Rio Grande do Sul (RS) in its 30 Health Regions and in Brazil. The mortality data were collected in the Mortality Information System (SIM) and the population data in the Brazilian Institute of Geography and Statistics (IBGE). Results: The esophageal cancer mortality rate was 8.61 (95% CI, 8.49-8.73) per 100,000 inhabitants in RS, while the national rate was 3.66 (95% CI, 3, 49- 3.82), with a significant difference (p <0.0001). The regional distribution was variable, and the West Border region presented the highest rate, 12.91 (95% CI, 12.05-13.77). However, even regions with lower mortality presented twice as much deaths than the national rate. Mortality increased with aging, with the oldest age groups (≥80 years) presenting 69.62 (95% CI, 64.9-74) deaths per 100,000 inhabitants. Conclusion: Esophageal neoplasia is still a very serious condition in the state of RS, being associated with an almost 3-fold higher mortality rate compared to the national rate. Even within the state different epidemiological patterns are found. Keywords : Esophageal cancer; epidemiology; mortality