Hafiz Muhammad Sharjeel Arshad, MD1, Ayesha Arshad, MBBS2, Ayesha Cheema, MBBS3, Pearl Princess Uy, MD1, Umer Farooq, MD4, Kenneth J. Vega, MD5; 1Medical College of Georgia, Augusta, GA; 2Fatima Memorial Hospital, Lahore, Punjab, Pakistan; 3Sargodha Medical College, North Augusta, SC; 4Loyola Medicine/MacNeal Hospital, Berwyn, IL; 5Augusta University Medical College of Georgia, Augusta, GA
Introduction: It is well recognized that esophageal adenocarcinoma (EAC) is the predominant esophageal cancer seen in the United States and primarily affects non-Hispanic white (nHW) males. However, in non-Hispanic Blacks (nHB) esophageal squamous cell carcinoma (ESCC) remains predominant. Limited data exists evaluating esophageal cancer in Hispanic American (Hisp), despite its status as the largest minority group nationally per the US Census Bureau. The aim of our study was to investigate incidence rate trends of esophageal carcinoma (both EAC & ESCC) among the 3 main US racial groups, with a focus on Hisp, using 25 years of data. Methods: Using data from the Surveillance, Epidemiology, and End Results 13 (SEER) program of cancer registries, we collected 25 years (1992-2016) data on EAC and ESCC in the US. After adjusting for age to the US 2000 standard population using SEERStat®, this data was plotted to visually compare trends in EAC and ESCC over 25 years in nHw, nHB and Hisp. Annual percent change (APC) was calculated using weighted least squares method and p values were calculated using SEERStat®. Results: For the 3 ethnic groups, age adjusted incidence of EAC is on the rise while that of ESCC is declining. In Hisp, EAC incidence rate increased from 0.8 to 1.5/100,000 (APC=1.5, p< 0. 001) while ESCC decreased from 2.2 to 0.8/100,000 (APC=-3.1, p< 0.001) (Fig 1, Table1). This has resulted in EAC as the predominant esophageal cancer since 2011 in this group. Among nHW, the incidence rate for EAC has increased from 1.7 to 3/100,000 (APC =2.2, p< 0. 001) while incidence of ESCC decreased from 1.8 to 0.9/100,000 (APC=-2.5, p< 0. 001) (Fig 1, Table 1). This has resulted in EAC as the predominant esophageal cancer since 1993 within this group. For non-Hispanic Blacks (NHB), EAC increased from 0.4 to 0.8/100,000 (APC=2.6, p< 0. 001) while ESCC has dramatically decreased from 8.8 to 2.7/100,000 (APC=-5.2, p< 0. 001) (Fig.2, Table 1). However, ESCC remains the predominant esophageal cancer in this group in spite of these changes. Discussion: Hisp have now joined nHW as US ethnic groups more likely to have EAC than ESCC based on SEER data from 1992-2016. Also, the wide disparity in esophageal cancer previously observed in nHB has narrowed dramatically. Studies are needed to investigate combinations of genetic and environmental factors leading to the variations currently observed in esophageal cancer nationally.
Fig 1. Age adjusted incidence rates (1992-2016) of esophageal adenocarcinoma and squamous cell carcinoma in non-Hispanic Whites (Left) and Hispanics (Right)
Fig 2. Age adjusted incidence rates (1992-2016) of esophageal adenocarcinoma and squamous cell carcinoma in non-Hispanic Blacks.
Table 1. Age adjusted incidence rates (1992-2016) and annual percent changes for esophageal squamous cell and adenocarcinomas for different racial groups in the US
Disclosures: Hafiz Muhammad Sharjeel Arshad indicated no relevant financial relationships. Ayesha Arshad indicated no relevant financial relationships. Ayesha Cheema indicated no relevant financial relationships. Pearl Princess Uy indicated no relevant financial relationships. Umer Farooq indicated no relevant financial relationships. Kenneth Vega indicated no relevant financial relationships.