A Population-Based Analysis of Esophageal and Gastric Cardia Adenocarcinomas in Ontario, Canada: Incidence, Risk Factors, and Regional Variation
- First Online:
- 145 Downloads
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.
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.
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.
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.
KeywordsEsophagus Gastric cardia Adenocarcinoma Population-based study
- 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
- 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
- 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.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.
- 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.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.Anonymous. “The Johns Hopkins University ACG Case-Mix System.” Retrieved August 19, 2007, from http://www.acg.jhsph.edu/.
- 28.Canadian Cancer Society's Steering Committee: Canadian Cancer Statistics 2009. In: Society CC, ed: Government of Canada, 2009:127.Google Scholar