Trends in Epidemiology of Esophageal Cancer in the US, 1975-2018

Abstract

ImportanceEsophageal cancer (EC) is the 7th most common cancer worldwide and 14th in the US. More data are needed to study the changing incidence patterns of its 2 primary histologic subtypes, squamous cell carcinoma of the esophagus (SCE) and adenocarcinoma of the esophagus (ACE).ObjectiveTo examine temporal trends in incidence rates of EC, ACE, and SCE from 1975 through 2018.Design, Setting, and ParticipantsIn this population-based cross-sectional study, data were derived from 9 Surveillance, Epidemiology, and End Results (SEER) registries from January 1975 through December 2018 and from all 21 registries for January 2000 through December 2018 for patients with a diagnosis of EC from 1975 through 2018 (International Classification of Disease—Oncology, Third Edition codes). Age-adjusted incidence rates (AAIRs) of EC, ACE, and SCE were calculated. The timing and magnitude of the annual percentage change (APC) in incidence were examined using Joinpoint regression analyses. Data analysis was started in 2021 and updated and completed in 2023.Main Outcome and MeasuresThe APC for age-adjusted EC incidence rates as stratified by histology, anatomical location, stage, sex, age, race and ethnicity, and geographic region.ResultsA total of 47 648 patients with a diagnosis of EC were retained for analysis. These included 22 419 (47.1%) with a diagnosis of SCE, 22 217 (46.6%) with ACE, and 3012 (6.3%) with other subtypes. The AAIR for EC changed from 4.14 per 100 000 population in 1975 to 4.18 in 2018, AAIRs of SCE declined from 3.06 in 1975 to 1.15 in 2018 as well as for ACE, and AAIRs increased from 0.42 in 1975 to 2.78 in 2018. From 1975 through 2004, EC incidence significantly increased (APC, 0.53; 95% CI, 0.4 to 0.7) but significantly decreased (APC, −1.03; 95% CI, −1.3 to −0.7) from then until 2018. The APC of SCE significantly continued to decline (−2.80, 95% CI, −3.0 to −2.6), and ACE increased from 2000 to 2006 (APC, 2.51; 95% CI, 1.0 to 4.0) but has since stabilized from 2006 to 2018.Conclusions and RelevanceThe results of this cross-sectional study suggest that the incidence of EC modestly declined since 2004 and that the incidence of SCE continued to decline while the incidence rate of ACE plateaued for more than a decade. Understanding factors associated with plateaued rates of ACE may help inform public health interventions.

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“…1 Within the United States (US), the incidence of EAC increased dramatically from 1975 to 2006 and has subsequently plateaued. 2 Barrett’s esophagus (BE) is the only known precursor lesion for EAC and is believed to progress to EAC in a step-wise manner from non-dysplastic BE (NDBE), to BE with low-grade dysplasia (BE-LGD), BE with high-grade dysplasia (BE-HGD), and finally EAC. 3 Current guidelines recommend surveillance for NDBE given low risk of progression to EAC and endoscopic eradication therapy (EET) for BE-HGD and intramucosal adenocarcinoma (IMC).…”

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“…The two most common histologic subtypes, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC), vary substantially in terms of aetiopathogenesis, genetic susceptibility, clinical features, and prognosis, as well as gender and geographic distribution. Approximately half of EC cases are EAC in Europe, Oceania, and some Western countries, including the United States [7], whereas ESCC remains the dominant type in other areas of the world, particularly in Asia and Africa. A male predominance is observed worldwide in EC and Gastric Cancer (GC), with male-to-female ratios of 6.7:1 for EAC, 3.3:1 for ESCC, and 4:1 for GC [8].…”

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“…Malignant esophageal cancer is one of the most common tumors, with a large number of new cases reported annually worldwide. This ranks as the sixth most common cause of cancer-related death ( 1 ). In Asia, the incidence of esophageal squamous cell carcinoma (ESCC) remains high, with over 90% of patients being pathologically classified as having this type of carcinoma ( 2 , 3 ).…”