Esophageal Cancer Rates Have Declined Since 2004

An analysis of the incidence of esophageal cancer in the United States between 1975 and 2018 found that rates increased from 1975 before decreasing overall since 2004. This study was published in JAMA Network Open.

The study utilized data from the Surveillance, Epidemiology, and End Results (SEER) registries from January 1975 through December 2019 for patients with a diagnosis of esophageal cancer, including its 2 primary histologic subtypes: squamous cell carcinoma of the esophagus (SCE) and adenocarcinoma of the esophagus (ACE). Age-adjusted incidence rates (AAIRs) were calculated for esophageal cancer overall and for SCE and ACE, as well as annual percentages changes (APC).

Esophageal Cancer Incidence Over Time

In total, 47,648 patients with esophageal cancer were included in the analysis—47.1% had a diagnosis of SCE, 46.6% had ACE, and 6.3% had another subtype. Over the analysis period, the AAIR of esophageal cancer changed from 4.14 cases per 100,000 individuals in 1975 to 4.18 per 100,000 in 2018. For SCE, AAIRs decreased from 3.06 to 1.15 cases per 100,000 individuals from 1975 to 2018; for ACE, AAIRs increased over the study period from 0.42 to 2.78 cases per 100,000. The most common subtype changed over time, from SCE, which accounted for 73.91% of esophageal cancer incidence in 1975, to ACE, which accounted for 66.51% of cases in 2018.

Between 1975 and 2004, the incidence of esophageal cancer overall increased significantly, with an APC of 0.53 (95% CI, 0.4-0.7). After 2004, incidence declined significantly, by 1.0% each year through 2018 (95% CI, −1.3 to −0.7). Between 2000 and 2018, incidence of SCE significantly decreased, with an APC of –2.8 (95% CI, −3.0 to −2.6). Incidence of ACE sharply increased from 2000 to 2006 (APC, 2.51; 95% CI, 1.0-4.0) before plateauing.

A subgroup analysis that looked at changes according to race, age, and sex found that non-Hispanic White males exhibited the fastest increase in esophageal cancer overall and ACE specifically at any point. “Studies to understand the reason for the higher incidence in this group are needed, although the higher incidence of [gastroesophageal reflux disease] and Barrett esophagus, which predisposes to ACE, in this population likely plays a role,” the authors wrote.

Understanding Changes in Esophageal Rates

The authors listed several factors that may be associated with the changes in esophageal cancer incidence over time, as well as points that are less well defined. For example, as obesity and metabolic syndrome are more commonly associated with ACE compared with SCE, the rising rates of ACE over time may be in part due to rising obesity rates in the United States. However, “while obesity rates in the [United States] continue to increase, ACE incidence has plateaued during the last decade,” they wrote. Declining smoking rates may also impact rates of esophageal cancer and may counteract associations of the increasing obesity rates.

The utilization of upper endoscopies has increased in the United States over time, which the authors hypothesized could be associated with greater identification of premalignant lesions. However, they did not observe a greater incidence of localized disease, “which would be expected if more premalignant lesions were identified through upper endoscopies.”

In conclusion, the authors wrote, “We hope these findings will motivate public health interventions to reduce exposure to modifiable risk factors for esophageal cancer. Interventions targeting obesity, metabolic syndrome, and smoking may decrease the incidence of esophageal cancer.”