Young-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples

Abstract

Background and Aims: A concerning rise in incidence of young-onset cancers globally led to the examination of trends in incidence and survival of gastrointestinal (GI) adenocarcinomas in the Northern Territory (NT), Australia, over a 28-year period, with a special emphasis on Indigenous peoples. Methods: This cross-sectional analysis of a prospective longitudinal database, NT Cancer Registry (1990–2017), includes all reported cases of GI (oesophagus, gastric, small intestinal, pancreas, colon, and rectum) adenocarcinomas. Poisson regression was used to estimate incidence ratio ratios, and survival was modelled using Cox proportional hazard models separately for people aged 18–50 years and >50 years. Results: A total of 1608 cases of GI adenocarcinoma were recorded during the time of the study. While the overall incidence in people 18–50 years remained unchanged over this time (p = 0.51), the rate in individuals aged >50 years decreased (IRR = 0.65 (95% CI 0.56–0.75; p < 0.0001)). Incidence rates were significantly less in females >50 years (IRR = 0.67 95% CI 0.59–0.75; p < 0.0001), and their survival was significantly better (HR = 0.84 (95%CI 0.72–0.98; p < 0.03)) compared to males. Overall survival across all GI subsites improved in both age cohorts, especially between 2010 and 2017 (HR = 0.45 (95%CI 0.29–0.72; p < 0.0007) and HR = 0.64 (95%CI 0.52–0.78; p < 0.0001), respectively) compared to 1990–1999, driven by an improvement in survival in colonic adenocarcinoma alone, as the survival remained unchanged in other GI subsites. The incidence was significantly lower in Indigenous patients compared to non-Indigenous patients, in both age cohorts (18–50 years IRR = 0.68 95% CI 0.51–0.91; p < 0.009 and >50 years IRR = 0.48 95% CI 0.40–0.57; p < 0.0001). However, Indigenous patients had worse survival rates (18–50 years HR = 2.06 95% CI 1.36–3.11; p < 0.0007 and >50 years HR = 1.66 95% CI 1.32–2.08; p < 0.0001). Conclusions: There is a trend towards an increased incidence of young-onset GI adenocarcinomas in the NT. Young Indigenous patients have lower incidence but worse survival across all GI subsites, highlighting significant health inequities in life expectancy. Targeted, culturally safe Indigenous community-focussed programs are needed for early detection and patient-centred management of GI adenocarcinomas.

Childhood Cancer Incidence and Survival in South Australia and the Northern Territory, 1990-2017, with Emphasis on Indigenous Peoples

“…A total of 895 patients across SA (N=753) and NT (N=142) were diagnosed with lymphocytic leukemia, nephroblastoma, neuroblastoma, Ewing sarcoma, osteosarcoma, retinoblastoma, hepatoblastoma, rhabdomyosarcoma or medulloblastoma between 1990 and 2017 (Table 1). The median ages for the combined SA and NT cohort, SA only and NT only cohorts were five (IQR 2-13), four (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and seven years (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), respectively. The overall IR was 193.04 (95%CI 180.60-206.12) per 100,000 residents across the combined cohort (SA and NT), 189.37 (176.09-203.39) in SA alone and the highest in the NT at 215.16 (181.23-253.60; Table 2), with no significant change over the three time periods.…”

“…In recent decades, there has been a concerning increase in global reports of cancers affecting children and young adults [1][2][3]. Recent interrogation of Australian data, derived from the South Australian (SA) and Northern Territory (NT) Cancer Registries (SACR and NTCR), revealed an increase in young-onset gastrointestinal adenocarcinomas in SA [4] and a higher-than-average incidence rate in the NT since 1990 [5]. Moreover, the overall incidence rate of childhood cancer in Australia increased by 34% between 1983 and 2015, rising by 1.2% yearly between 2005 and 2015, with an expected 7% rise by 2035 [6].…”

Childhood Cancer Incidence and Survival in South Australia and the Northern Territory, 1990–2017, with Emphasis on Indigenous Peoples

“…A total of 895 patients across SA (N = 753) and NT (N = 142) were diagnosed with lymphocytic leukemia, nephroblastoma, neuroblastoma, Ewing sarcoma, osteosarcoma, retinoblastoma, hepatoblastoma, rhabdomyosarcoma or medulloblastoma between 1990 and 2017 (Table 1). The median ages for the combined SA and NT cohort, SA only and NT only cohorts were five (IQR 2-13), four (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and seven years (2-16), respectively. The overall IR was 193.04 (95%CI 180.60-206.12) per 100,000 residents across the combined cohort (SA and NT), 189.37 (176.09-203.39) in SA alone and the highest in the NT at 215.…”

Young-Onset Cancers—Early Steps in the Right Direction

“…The incidence rates noted for pancreatic cancer mirror the values seen in younger Black and Hispanic women in the United States [6]. Shepherdson et al also addressed the incidence and survival rates amongst the Indigenous peoples (Aboriginal and Torres Strait Islander peoples) of Australia living in the Northern Territory [5]. The significantly lower survival compared with non-Indigenous peoples highlights an important area for health advocacy and the need for culturally safe Indigenous community-focused programs aimed at early detection and patient-centered management of GI adenocarcinomas.…”

“…The variability in cancer care (surgery and chemotherapy) delivery presents opportunities for intervention if we wish to improve survival within this subset of patients. Schell and Shepherdson and their colleagues from Australia provided compelling data (over two manuscripts) on the trends in YO GI (oesophagus, stomach, pancreas, colon, and rectum) adenocarcinomas from South Australia and the Northern Territory (of Australia) over the last 28 years [4,5]. Although the rising trends in YO GI adenocarcinomas in South Australia, especially amongst males, appear to attract one's attention, the existing high incidence for all YO GI adenocarcinomas in the Northern Territory, despite being unchanged over the study period, signals a worrying statistic that certainly warrants further investigation.…”