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Does the Incidence of Adenocarcinoma of the Esophagus and Gastric Cardia Continue to Rise in the Twenty-First Century?—a SEER Database Analysis

  • 2013 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The rising incidence and histological change to adenocarcinoma in esophageal cancer over the past four decades has been among the most dramatic changes ever observed in human cancer. Recent reports have suggested that its increasing incidence may have plateaued over the past decade. Our aim was to examine the latest overall and stage-specific trends in the incidence of esophageal adenocarcinoma.

Patients and Methods

We used the Surveillance Epidemiology and End Results (SEER) database of the National Cancer Institute to identify all patients with adenocarcinoma of the esophagus and gastric cardia between 1973 and 2009. Both overall and stage-specific trends in incidence were analyzed using joinpoint regression analysis.

Results

The overall incidence of adenocarcinoma of the esophagus and the gastric cardia increased from 13.4 per million in 1973 to 51.4 per million in 2009, a nearly 400 % increase. Jointpoint analysis demonstrated that the yearly increase in incidence has slowed somewhat from 1.27 per million before 1987 to 0.97 between 1987 and 1997 and 0.65 after 1997. Stage-specific analysis suggests that the incidence of noninvasive cancer has actually declined after 2003 with a yearly decrease of 0.22. The percentage of patients diagnosed with in situ cancer declined after 2000 and remained under 2.5 % through the study period.

Conclusions

The incidence of esophageal adenocarcinoma continues to rise in the USA. The percentage of patients diagnosed with in situ cancer has declined in the twenty-first century.

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Conflict of Interest

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Klinikum Nürnberg, Prof. Ernst-Nathan Str. 1, 90419, Nuremberg, Germany

    A. Dubecz, R. J. Stadlhuber, M. Schweigert & H. J. Stein

  2. Faculty of Veterinary Science, Szent István University, Budapest, Hungary

    N. Solymosi

  3. Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    J. H. Peters

Authors
  1. A. Dubecz
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  2. N. Solymosi
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  3. R. J. Stadlhuber
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  4. M. Schweigert
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  5. H. J. Stein
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  6. J. H. Peters
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Corresponding author

Correspondence to A. Dubecz.

Additional information

Discussant

Dr. Selwyn Vickers (Minneapolis, Minnesota): The study “Does the Incidence of Adenocarcinoma of the Esophagus and Gastric Cardia Continue to Rise in the 21st Century?” is a well-written paper by Dr. Dubecz and Dr. Peters of the University of Rochester. The study documents what appears to be a continued astronomic rise of the incidence of adenocarcinoma of the esophagus and gastric cardia. Using the SEER database from the National Cancer Institute, they outline the incidence of this disease from 1973 to 2009. This study demonstrated that there is nearly a 400 % increase in the incidence of these tumors. The questions that I believe are relevant as I reviewed this are the following:

1. Do the authors see any significant correlate of this rise in esophageal adenocarcinoma to the increased incidence of H2 blockers as well as proton pump inhibitors? That is, does the process of achlohydria create an increased level of carcinogenesis in the distal esophagus and the cardia of the stomach?

2. Is there potential risk of misdiagnosis of tumors of the esophagus and the gastric cardia in the SEER database which could accumulate to this large increase of incidence that we’re seeing?

3. Has there been a correlate increase in survival with this earlier detection and increased incidence in the last 20 years?

Thank you for the opportunity to review this paper and the outstanding work done by this group under the leadership of Dr. Jeff Peters.

Closing Discussant

Dr. Attila Dubecz: Dr Vickers, thank you for your kind comments and questions. To answer your first question, there is a good deal of experimental evidence supporting the cause-and-effect relationship between alkaline reflux and adenocarcinoma of the distal esophagus. Furthermore, acidic gastric juice seems to have a protective effect against esophageal carcinogenesis in a rat tumor model. On the other hand, according to the results of our study, the incidence of esophageal adenocarcinoma has been on the rise since the early 1970s, but the first H2 blockers were introduced on the US market in the late 1970s, and omeprazole was marketed only in 1989. Therefore, these drugs could not have played a deciding role in the initial rise in the incidence of adenocarcinoma of the esophagus and the gastric cardia.

Secondly, a possible misclassification of any patient information must always be considered when analyzing a population-based database. Studies evaluating the role of misclassification of the tumor site in incidence trends of esophageal and cardia cancer have shown that the incidence of subsite unspecified gastric cancer has fallen during the last 40 years which could eventually result in an artificially increased incidence of cardia cancer, yet this cannot fully explain the observed temporal trends in esophageal adenocarcinoma.

Lastly, this increase in incidence seems to be a true change since the percentage of patients diagnosed with in situ disease has actually been declining, and the incidence of all invasive stages has been increasing during the study period. Despite these facts, long-term survival of patients with carcinoma of the gastric cardia and the esophagus seems to be improving probably due to therapeutic advances in the treatment of this malignancy.

This paper was part of the DDW 2013 plenary presentation.

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Dubecz, A., Solymosi, N., Stadlhuber, R.J. et al. Does the Incidence of Adenocarcinoma of the Esophagus and Gastric Cardia Continue to Rise in the Twenty-First Century?—a SEER Database Analysis. J Gastrointest Surg 18, 124–129 (2014). https://doi.org/10.1007/s11605-013-2345-8

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  • DOI: https://doi.org/10.1007/s11605-013-2345-8

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