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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

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.

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Acknowledgements

The authors wish to acknowledge the support of the Institutes for Clinical Evaluative Sciences, the Ontario Ministry of Health and Long-Term Care (MOHLTC), and Cancer Care Ontario (CCO). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, the Ontario MOHLTC, or CCO is intended or should be inferred.

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Authors and Affiliations

  1. Sunnybrook Health Sciences Centre, 2075 Bayview Ave Rm HG40, Toronto, ON, M4N 3M5, Canada

    Jill Tinmouth, Yoo-Joung Ko, Lawrence Paszat & Linda Rabeneck

  2. Institute for Clinical Evaluative Sciences, Toronto, Canada

    Jill Tinmouth, Ying Liu, Lawrence Paszat, Rinku Sutradhar, Linda Rabeneck & David Urbach

  3. University of Toronto, Toronto, Canada

    Jill Tinmouth, Yoo-Joung Ko, Lawrence Paszat, Rinku Sutradhar, Linda Rabeneck & David Urbach

  4. Dalla Lana School of Public Health, Toronto, Canada

    Lawrence Paszat & Rinku Sutradhar

  5. University Health Network, Toronto, Canada

    David Urbach

  6. Dalhousie University, Halifax, Canada

    Josh Green

  7. Cancer Care Ontario, Toronto, Canada

    Linda Rabeneck

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  1. Jill Tinmouth
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  2. Josh Green
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  3. Yoo-Joung Ko
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Corresponding author

Correspondence to Jill Tinmouth.

Additional information

Dr. Tinmouth was supported by an Industry-Partnered Canadian Institutes of Health Research New Investigator Award for this project. The industry partner was AstraZeneca Canada, Inc.

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Tinmouth, J., Green, J., Ko, YJ. et al. A Population-Based Analysis of Esophageal and Gastric Cardia Adenocarcinomas in Ontario, Canada: Incidence, Risk Factors, and Regional Variation. J Gastrointest Surg 15, 782–790 (2011). https://doi.org/10.1007/s11605-011-1450-9

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  • DOI: https://doi.org/10.1007/s11605-011-1450-9

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