Skip to main content

Racial Disparities in Esophageal Cancer Outcomes

Annals of Surgical Oncology volume 20, pages 1136–1141 (2013)Cite this article

Abstract

Background

Racial disparities in outcomes have been documented among patients with esophageal cancer. The purpose of this study is to identify mechanisms for ethnicity/race-related differences in the use of cancer-directed surgery and mortality.

Methods

Data from the Surveillance, Epidemiology and End Results (SEER) program were used to evaluate non-Hispanic black, non-Hispanic white and Hispanic patients diagnosed with non-metastatic esophageal cancer (squamous cell carcinoma or adenocarcinoma) from 2003–2008. Age, marital status, stage, histology and location were examined as predictors of receipt of surgery and mortality in multivariate analyses.

Results

A total of 6,737 patient files (84 % white, 10 % black, 6 % Hispanic) were analyzed. Black and Hispanic patients were more likely than whites to have squamous cell carcinoma (86 vs. 41 vs. 26 %, respectively; p < 0.001) and lesions in the midesophagus (58 vs. 38 vs. 26 %, respectively; p < 0.001). Blacks and Hispanics were less likely to undergo esophagectomy (adjusted odds ratio 0.48, 95 % confidence interval (CI) 0.39–0.60 and 0.71, 95 % CI 0.56–0.90]. We noted significant variations in esophagectomy rates among patients with midesophageal cancers; 15 % of blacks underwent esophagectomy compared to 22 % of Hispanics and 29 % of whites (p < 0.001). Black and Hispanic patients had a higher unadjusted risk of mortality (hazard ratio 1.38, 95 % CI 1.25–1.52 and 1.20, 95 % CI 1.05–1.37). However, differences in mortality were no longer significant after adjusting for receipt of surgery.

Conclusions

Disparities in esophageal cancer outcomes are associated with the lower use of cancer-directed surgery. To decrease disparities in mortality it will be necessary to understand and target underlying causes of lower surgery rates in nonwhite patients and develop interventions, especially for midesophageal cancers.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.

    PubMed  Article  Google Scholar 

  2. 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.

    PubMed  Google Scholar 

  3. Miller JA, Rege RV, Ko CY, Livingston EH. Health care access and poverty do not explain the higher esophageal cancer mortality in African Americans. Am J Surg. 2004;188:22–6.

    PubMed  Article  Google Scholar 

  4. Greenstein AJ, Litle VR, Swanson SJ, et al. Racial disparities in esophageal cancer treatment and outcomes. Ann Surg Oncol. 2008;15:881–8.

    PubMed  Article  Google Scholar 

  5. Steyerberg EW, Earle CC, Neville BA, Weeks JC. Racial differences in surgical evaluation, treatment, and outcome of locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol. 2005;23:510–7.

    PubMed  Article  Google Scholar 

  6. Surveillance, Epidemiology, and End Results (SEER) Program. Cancer of the esophagus: 5-year relative and period survival (percent) by race, sex, diagnosis year, stage and age. http://seer.cancer.gov/csr/1975_2008/results_single/sect_08_table.08.pdf. Accessed 11 Jan 2012.

  7. Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999;341:1198–205.

    PubMed  Article  CAS  Google Scholar 

  8. Morris AM, Rhoads KF, Stain SC, Birkmeyer JD. Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg. 2010;211:105–13.

    PubMed  Article  Google Scholar 

  9. Morris AM, Billingsley KG, Hayanga AJ, Matthews B, Baldwin LM, Birkmeyer JD. Residual treatment disparities after oncology referral for rectal cancer. J Natl Cancer Inst. 2008;100:738–44.

    PubMed  Article  Google Scholar 

  10. Paulson EC, Ra J, Armstrong K, Wirtalla C, Spitz F, Kelz RR. Underuse of esophagectomy as treatment for resectable esophageal cancer. Arch Surg. 2008;143:1198–203.

    PubMed  Article  Google Scholar 

  11. Mathur AK, Osborne NH, Lynch RJ, Ghaferi AA, Dimick JB, Sonnenday CJ. Racial/ethnic disparities in access to care and survival for patients with early-stage hepatocellular carcinoma. Arch Surg. 2010;145:1158–63.

    PubMed  Article  Google Scholar 

  12. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS. National failure to operate on early stage pancreatic cancer. Ann Surg. 2007;246:173–80.

    PubMed  Article  Google Scholar 

  13. Birkmeyer NJ, Gu N, Baser O, Morris AM, Birkmeyer JD. Socioeconomic status and surgical mortality in the elderly. Med Care. 2008;46:893–9.

    PubMed  Article  Google Scholar 

  14. Merkow RP, Bilimoria KY, McCarter MD, et al. Effect of histologic subtype on treatment and outcomes for esophageal cancer in the United States. Cancer. 2012;118:3268–76.

    PubMed  Article  Google Scholar 

  15. Ashktorab H, Nouri Z, Nouraie M, et al. Esophageal carcinoma in African Americans: a five-decade experience. Dig Dis Sci. 2011;56:3577–82.

    PubMed  Article  Google Scholar 

  16. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349:2241–52.

    PubMed  Article  CAS  Google Scholar 

  17. Brown LM, Hoover R, Silverman D, et al. Excess incidence of squamous cell esophageal cancer among US black men: role of social class and other risk factors. Am J Epidemiol. 2001;153:114–22.

    PubMed  Article  CAS  Google Scholar 

  18. Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246:363–72.

    PubMed  Article  Google Scholar 

  19. Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.

    PubMed  Article  CAS  Google Scholar 

  20. Breslin TM, Morris AM, Gu N, et al. Hospital factors and racial disparities in mortality after surgery for breast and colon cancer. J Clin Oncol. 2009;27:3945–50.

    PubMed  Article  Google Scholar 

  21. Manfredi C, Kaiser K, Matthews AK, Johnson TP. Are racial differences in patient–physician cancer communication and information explained by background, predisposing, and enabling factors? J Health Commun. 2010;15:272–92.

    PubMed  Article  Google Scholar 

Download references

Acknowledgment

This work is supported by funding from the University of Michigan Surgical Oncology Research Training Program (2T32 CA009672-21 National Institutes of Health/National Cancer Institute to SLR) and the Michigan Institute for Clinical and Health Research (UL1RR024986 National Institutes of Health/National Center for Research Resources to SLR and SLW).

Author information

Authors and Affiliations

  1. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Sha’Shonda L. Revels MD, MA, MS, Arden M. Morris MD, MPH, Rishindra M. Reddy MD, Clifford Akateh BS & Sandra L. Wong MD, MS

Authors
  1. Sha’Shonda L. Revels MD, MA, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arden M. Morris MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rishindra M. Reddy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Clifford Akateh BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandra L. Wong MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandra L. Wong MD, MS.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Revels, S.L., Morris, A.M., Reddy, R.M. et al. Racial Disparities in Esophageal Cancer Outcomes. Ann Surg Oncol 20, 1136–1141 (2013). https://doi.org/10.1245/s10434-012-2807-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2807-3

Keywords

  • Esophageal Cancer
  • Resection Rate
  • Black Patient
  • Hispanic Patient
  • Middle Esophagus