IntroductionCholangiocarcinoma is an aggressive and rare cancer of the bile duct with a very poor prognosis. It accounts for approximately three percent of gastrointestinal cancers but nearly 20 percent of deaths are from hepatobiliary cancers. Cholangiocarcinoma is also a clinically silent disease that presents at advanced stages. In this study, we wanted to identify subpopulations at the greatest risk of developing cholangiocarcinoma such that we can improve diagnosis and ultimately reduce the cancer mortality rate.MethodsThe United States Cancer Registry (USCS) was used to obtain data for cholangiocarcinoma from 2001 to 2015. Incidence analysis was done for sex, race, stage, primary location (intrahepatic bile duct or extrahepatic bile duct), and US regional location.ResultsThe overall incidence of cholangiocarcinoma from 2001 to 2015 was 1.26 per 100,000 people per year. The overall incidence rates were greatest for each stratification in males, Asian and Pacific Islanders (API), distant disease, intrahepatic bile duct cholangiocarcinoma (ICC), and in the Northeast. Incidence rates were increasing between 2001 and 2015 in all subpopulations. Compared to extrahepatic bile duct cholangiocarcinoma (ECC), ICC increased significantly between 2001 and 2015. From 2001 to 2007, the annual percent change (APC) for ICC was 2.79, from 2007 to 2010 the APC was 17.02, and from 2010 to 2015 the APC was 9.67. Moreover, the incidence of distant disease also increased significantly with an APC of 9.22.ConclusionIn our study, we analyzed the incidence of cholangiocarcinoma in all 50 states in the USA. We found that the incidence is increasing in all subpopulations and specifically at a dramatic rate for ICC and those with distant disease at the time of diagnosis. Ultimately, our findings identified at-risk populations who need closer monitoring for cholangiocarcinoma.

IntroductionEsophageal cancer is one of the leading causes of death in males in the United States (US). Previous studies have analyzed incidence rates of esophageal cancer in the US using the data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program. However, given its limited patient population, certain groups and regions in the US are underrepresented. Our study utilizes the United States Cancer Statistics (USCS) database, which combines the SEER database with the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) to cover all 50 states to examine the incidence of esophageal cancer.MethodsThe USCS registry was used to obtain data for esophageal cancer from 2001 to 2015. Incidence analysis was stratified based on sex, race, stage, histology, and US regional location/histology.ResultsThe overall incidence of esophageal cancer from 2001-2015 was 4.7 per 100,000 people per year. Overall incidence rates were greatest for each stratification in males, blacks, distant disease, adenocarcinoma, and those in the Midwest with adenocarcinoma. Blacks, compared to other races, had the greatest statistically significant decrease in incidence between 2001-2015 (annual percent change (APC) -4.55). The incidence rate is also increasing the most rapidly in those with adenocarcinoma in the Northeast from 2011 to 2015 (APC 2.16).ConclusionIn our study, we were able to determine the incidence of esophageal cancer using data from all 50 states in the US. Our findings of decreasing incidence in blacks and increasing incidence of adenocarcinoma in the Midwest and Northeast help elucidate the at-risk populations. Moreover, our findings help bring to light risk factors that may be contributing to the development of esophageal cancer and how diagnosis and surveillance can be improved based on these risk factors.

Introduction Gastrointestinal stromal tumor (GIST) was once a mislabeled cancer with inaccurate incidence data in the United States (US). Since the discovery of a gain of function mutation in kit, the proper identification of GIST has greatly improved. Given this inaccuracy in prior GIST incidence, our goal in this study was to evaluate the true incidence of GIST in at-risk populations in all 50 states. Methods The United States Cancer Statistics (USCS) was used to obtain data for GISTs from 2001 to 2015. Incidence analysis was done for sex, race, stage, primary location, and US regional location. Results The overall incidence of GISTs from 2001-2015 was 0.70 per 100,000 people per year. Overall incidence rates were greatest for each stratification of males, blacks, localized disease, primary location in the stomach, and the Northeast. The incidence in blacks increased with an annual percent change (APC) of 6.27 between 2001 and 2015. Between 2001 and 2015, the incidence of localized disease and GISTs with a primary location in the stomach increased with APCs of 8.90 and 6.25, respectively. In the Northeast, between 2001 and 2003, the incidence initially increased expeditiously (APC 13.35); however, after 2003, the incidence continued to rise but no longer at the same rapid rate (APC 3.05). Conclusion In our study, we investigated the incidence of GISTs using data from the USCS database for all 50 states in the US. We found an alarming rise in the incidence in blacks, localized disease, the stomach, and those in the Northeast. Ultimately, further studies are required to identify risk factors for the development of GISTs; however, our study will serve as a template to help guide those studies.

Introduction Neuroendocrine tumors (NETs), once considered a rare malignancy, has started to become a more common cancer within the United States (US). Given the limited data available on the incidence of NETs in the entire US population, our goal in this study was to investigate the incidence of NETs in at-risk populations in all 50 states. Methods The United States Cancer Statistics (USCS) was used to obtain data for NETs from 2001 to 2015. An incidence analysis was done for sex, race, stage, primary location within the gastrointestinal (GI) tract, and US regional location. Results The overall incidence of NETs from 2001 to 2015 was 2.89 per 100,000 people per year. The overall incidence rates were the greatest for each stratification of males, blacks, localized disease, primary location in the small intestine, and in the Northeast. The incidence in males between 2013 and 2015 increased with an annual percent change (APC) of 8.44. Between 2006 and 2015, the incidence in blacks increased with an APC of 1.89. Between 2013 and 2015, the incidence of localized disease and a primary location in the small intestine increased with an APC of 16.89 and 14.37, respectively. In the Northeast, between 2013 and 2015, the incidence increased with an APC of 11.09. Conclusion In this study, we investigated the incidence of NETs using data obtained from the USCS database, which covers all 50 states. We found that there is a rising incidence in most subpopulations possibly related to improved compliance with surveillance colonoscopies and improved endoscopic and radiographic techniques. Further studies are needed to ultimately determine the exact causes of our findings. However, our study will serve as an important first step to determine the exact etiology for the rising incidence of NETs in all 50 states.

Introduction Pancreatic cancer is one of the leading causes of death in both males and females in the United States. Nearly 85% of pancreatic cancer is adenocarcinoma. Given the silent disease progression of pancreatic cancer, identifying at-risk populations will help diagnose these fatal cancers as early as possible. Methods The United States Cancer Statistics (USCS) registry was used to obtain data for pancreatic adenocarcinoma from 2001 to 2015. The incidence analysis was stratified based on sex, race, stage, and US regional location. Results The overall incidence of pancreatic adenocarcinoma from 2001 to 2015 was 5.2 per 100,000 people per year. The overall incidence rates were the greatest for each stratification in males, blacks, distant disease, and in the Northeast. The incidence in blacks continued to rise with an annual percent change (APC) of 2.28 between 2001 and 2015. Between 2001 and 2006, the incidence of distant disease increased at a rapid rate (APC 5.34). However, after 2006, the incidence continued to increase but no longer at the previously rapid rate (APC 1.91). For incidence based on US regional location, the overall incidence was greatest in the Northeast and Midwest. The incidence in the South was increasing at an expeditious rate (APC 2.70). Conclusion In our study, we analyzed the incidence of pancreatic adenocarcinoma using data from all 50 states in the US. Our findings showed that there was a worsening incidence in blacks, those with a distant stage at diagnosis, and those in the North and Midwest. Ultimately our findings help identify at-risk populations and can contribute to improving surveillance of this deadly disease.