A Population-Based Analysis of Esophageal and Gastric Cardia Adenocarcinomas in Ontario, Canada: Incidence, Risk Factors, and Regional Variation

  • Jill Tinmouth
  • Josh Green
  • Yoo-Joung Ko
  • Ying Liu
  • Lawrence Paszat
  • Rinku Sutradhar
  • Linda Rabeneck
  • David Urbach
Original Article

Abstract

Introduction

In Western countries, the incidence of esophageal adenocarcinoma (EA) and gastric cardia adenocarcinoma (GCA) is increasing. This population-based study describes the incidence of, associated patient risk factors for, and regional variation in EA/GCA in Ontario, Canada.

Methods

All adults with a new diagnosis of EA or GCA between 1972 and 2005 in Ontario were identified. Adjusted annual incidence rates were calculated, and multivariate models were used to identify patient risk factors. Maps were created to explore regional variation.

Results

Over the study period, 8,245 persons were diagnosed with EA/CGA; incidence increased from 1.01 to 3.9 per 100,000. Age (>65 vs. <50 years; rate ratio (RR), 3.4; 95% confidence interval (CI), 2.8–4.1) and comorbidity (highest vs. lowest, RR, 3.5; 95% CI, 2.9–4.2) were most strongly associated with the development of EA/GCA. We found considerable regional variation in the rates of EA/GCA (North West vs. Central region, RR, 6.5; 95% CI, 4.4–9.6). Maps suggested ethnicity may explain some regional variation, and that the current allocation of designated surgical treatment centers for EA/CGA may be suboptimal.

Conclusions

The incidence of EA/GCA is rising dramatically in Ontario. Further investigation of observed regional variation is warranted, particularly for the allocation of cancer health resources.

Keywords

Esophagus Gastric cardia Adenocarcinoma Population-based study 

References

  1. 1.
    Chandrasoma P, Wickramasinghe K, Ma Y, DeMeester T. Adenocarcinomas of the distal esophagus and “gastric cardia” are predominantly esophageal carcinomas. Am J Surg Pathol 2007;31:569-75.PubMedCrossRefGoogle Scholar
  2. 2.
    Parfitt JR, Miladinovic Z, Driman DK. Increasing incidence of adenocarcinoma of the gastroesophageal junction and distal stomach in Canada -- an epidemiological study from 1964-2002. Can J Gastroenterol 2006;20:271-6.PubMedGoogle Scholar
  3. 3.
    Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825-31.PubMedCrossRefGoogle Scholar
  4. 4.
    Steffen A, Schulze MB, Pischon T, Dietrich T, Molina E, Chirlaque MD, Barricarte A, Amiano P, Quiros JR, Tumino R, Mattiello A, Palli D, Vineis P, Agnoli C, Misirli G, Boffetta P, Kaaks R, Rohrmann S, Bueno-de-Mesquita HB, Peeters PH, May AM, Spencer EA, Allen NE, Bingham S, Tjonneland A, Halkjaer J, Overvad K, Stegger J, Manjer J, Lindkvist B, Hallmanns G, Stenling R, Lund E, Riboli E, Gonzalez CA, Boeing H. Anthropometry and esophageal cancer risk in the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 2009;18:2079-89.CrossRefGoogle Scholar
  5. 5.
    Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265:2.CrossRefGoogle Scholar
  6. 6.
    Hansen S, Wiig JN, Giercksky KE, Tretli S. Esophageal and gastric carcinoma in Norway 1958–1992 Incidence time trend variability according to morphological subtypes and organ subsites. International Journal of Cancer 1997; 71:4.CrossRefGoogle Scholar
  7. 7.
    Sihvo EI, Salmien JT, Ramo OJ, Salo JA. The epidemiology of oesophageal adenocarcinoma: has the cancer of gastric cardia an influence on the rising incidence of oesophageal adenocarcinoma? Scand J Gastroenterol. 2000;35:4.Google Scholar
  8. 8.
    Powell J, McConkey C. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer 1990;62:3.CrossRefGoogle Scholar
  9. 9.
    Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005;97:142-6.PubMedCrossRefGoogle Scholar
  10. 10.
    Botterweck AA, Schouten LJ, Volovics A, Dorant E, van Den Brandt PA. Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries. Int J Epidemiol. 2000;29:9.CrossRefGoogle Scholar
  11. 11.
    Bollschweiler E, Wolfgarten E, Gutschow C, Holscher AH. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 2001;92:6.CrossRefGoogle Scholar
  12. 12.
    Lambert R, Hainaut P. The multidisciplinary management of gastrointestinal cancer. Epidemiology of oesophagogastric cancer. Best Pract Res Clin Gastroenterol 2007;21:24.CrossRefGoogle Scholar
  13. 13.
    Sundaresan S, Langer B, Oliver T, Schwartz F, Brouwers M, Stern H. Standards for thoracic surgical oncology in a single-payer healthcare system. Ann Thorac Surg 2007;84:693-701.PubMedCrossRefGoogle Scholar
  14. 14.
    Anonymous. (2009). “Thoracic Cancer Surgery Standards.” Retrieved January 6, 2010 from http://csqi.cancercare.on.ca/cms/One.aspx?portalId=40955&pageId=41173.
  15. 15.
    Anonymous. (June 16, 2009). “Local health integration networks: Building a true system.” Retrieved June 24, 2010, from http://www.health.gov.on.ca/transformation/lhin/lhin_mn.html.
  16. 16.
    Bashash M, Shah A, Hislop G, Brooks-Wilson A, Le N, Bajdik C. Incidence and survival for gastric and esophageal cancer diagnosed in British Columbia, 1990 to 1999. Can J Gastroenterol 2008;22:143-8.PubMedGoogle Scholar
  17. 17.
    Singh SM, Paszat LF, Li C, He J, Vinden C, Rabeneck L. Association of socioeconomic status and receipt of colorectal cancer investigations: a population-based retrospective cohort study. Can Med Ass J 2004;171:461-5.CrossRefGoogle Scholar
  18. 18.
    Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. NEJM 1999;341:1359-67.PubMedCrossRefGoogle Scholar
  19. 19.
    Wilkins R. Neighbourhood income quintiles derived from Canadian postal codes are apt to be misclassified in rural but not urban areas. In: Health Analysis and Measurement Group and Department of Epidemiology and Community Medicine UoO, ed: Statistics Canada, 2004:31.Google Scholar
  20. 20.
    Anonymous. “Local Health Integration Networks: Building a True System.” 2007, from http://www.health.gov.on.ca/transformation/lhin/100604/lhin_bul_1_100604.html.
  21. 21.
    Anonymous. “The Johns Hopkins University ACG Case-Mix System.” Retrieved August 19, 2007, from http://www.acg.jhsph.edu/.
  22. 22.
    Weiner JP, Starfield BH, Steinwachs DM, Mumford LM. Development and application of a population-based oriented measure of ambulatory care case-mix. Medical Care 1991;29:452-472.PubMedCrossRefGoogle Scholar
  23. 23.
    Starfield BH, Weiner JP, Mumford LM, Steinwachs DM. Ambulatory care groups: a categorization of diagnoses for research and development. Health Serv Res 1991;26:53-74.PubMedGoogle Scholar
  24. 24.
    Reid RJ, Roos NP, MacWilliam L, Frohlich N, Black C. Assessing population health care need using a claims-based ACG morbidity measure: a validation analysis in the Province of Manitoba. Health Serv Res 2002;37:1345-64.PubMedCrossRefGoogle Scholar
  25. 25.
    Reid RJ, MacWilliam L, Verhulst L, Roos N, Atkinson M, Reid RJ, MacWilliam L, Verhulst L, Roos N, Atkinson M. Performance of the ACG case-mix system in two Canadian provinces. Medical Care 2001;39:86-99.PubMedCrossRefGoogle Scholar
  26. 26.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology 1992;45:613-9.PubMedCrossRefGoogle Scholar
  27. 27.
    Lord RV, Law MG, Ward RL, Giles GG, Thomas RJ, Thursfield V. Rising incidence of oesophageal adenocarcinoma in men in Australia. J Gastroenterol Hepatol 1998;13:356-62.PubMedCrossRefGoogle Scholar
  28. 28.
    Canadian Cancer Society's Steering Committee: Canadian Cancer Statistics 2009. In: Society CC, ed: Government of Canada, 2009:127.Google Scholar
  29. 29.
    Prasad GA, Bansal A, Sharma P, Wang KK. Predictors of Progression in Barrett's Esophagus: Current Knowledge and Future Directions. Am J Gastroenterol 2010; 105:1490–1502.PubMedCrossRefGoogle Scholar
  30. 30.
    Hongo M, Nagasaki Y, Shoji T. Epidemiology of esophageal cancer: Orient to Occident. Effects of chronology, geography and ethnicity. J Gastroenterol Hepatol 2009;24:729-35.PubMedCrossRefGoogle Scholar
  31. 31.
    Kort EJ, Sevensma E, Fitzgerald TL. Trends in esophageal cancer and body mass index by race and gender in the state of Michigan. BMC Gastroenterol 2009;9:47.PubMedCrossRefGoogle Scholar
  32. 32.
    Baquet CR, Commiskey P, Mack K, Meltzer S, Mishra SI. Esophageal cancer epidemiology in blacks and whites: racial and gender disparities in incidence, mortality, survival rates and histology. J Natl Med Assoc 2005;97:1471-8.PubMedGoogle Scholar
  33. 33.
    Henteleff HJ, Darling G. Canadian Association of General Surgeons Evidence Based Reviews in Surgery. 6. "GERD" as a risk factor for esophageal cancer. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. Can J Surg 2003;46:208-10.PubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Jill Tinmouth
    • 1
    • 2
    • 3
  • Josh Green
    • 6
  • Yoo-Joung Ko
    • 1
    • 3
  • Ying Liu
    • 2
  • Lawrence Paszat
    • 1
    • 2
    • 3
    • 4
  • Rinku Sutradhar
    • 2
    • 3
    • 4
  • Linda Rabeneck
    • 1
    • 2
    • 3
    • 7
  • David Urbach
    • 2
    • 3
    • 5
  1. 1.Sunnybrook Health Sciences CentreTorontoCanada
  2. 2.Institute for Clinical Evaluative SciencesTorontoCanada
  3. 3.University of TorontoTorontoCanada
  4. 4.Dalla Lana School of Public HealthTorontoCanada
  5. 5.University Health NetworkTorontoCanada
  6. 6.Dalhousie UniversityHalifaxCanada
  7. 7.Cancer Care OntarioTorontoCanada

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