Dating the rise of esophageal adenocarcinoma: analysis of Connecticut Tumor Registry data, 1940-2007

Abstract

Background: The timing of onset of the rise in incidence of esophageal adenocarcinoma (EAC) has not been clearly defined, and doing so may provide clues with regard to exposures associated with the changed epidemiology of this malignancy. We therefore aimed to investigate historical trends in the incidence of EAC and other upper gastrointestinal malignancies.

Methods: We did a population-based study using Connecticut Tumor Registry (1940-2007) and Surveillance, Epidemiology, and End Results (SEER; 1973-2007) data. Age-adjusted incidence rates (per 100,000 person-years) were calculated for EAC and other upper gastrointestinal malignancies.

Results: The incidence of EAC remained relatively constant until 1965-69, and then rose from 0.41 (95%CI, 0.26-0.56) to 1.31 (95%CI 1.07-1.54) in 1978-82 and 5.31 (95%CI 4.89-5.73) in 2003-07. The incidence of gastric cardia cancer began to rise in the 1950s and plateaued in the 1990s. The incidence of esophageal squamous cell carcinoma began to decrease around 1980. The trends from Connecticut Tumor Registry data closely mirrored those from SEER data.

Conclusions: The incidence of EAC began to rise in the late 1960s, predating the rise in obesity by a decade. Reduced infection rates of Helicobacter pylori, changes in microbiome, or other exposures may have contributed to the changed epidemiology of this malignancy.

Impact: Analysis of historical data of trends in EAC incidence implicate a change in environmental factors from the mid-20th century as primarily responsible for the initial rise in EAC incidence, predating the rise in obesity prevalence in the United States by over a decade.

Figure 1

Age-adjusted incidence of esophageal adenocarcinoma (EAC), esophageal squamous cell cancer (ESCC), gastric cardia cancer (Cardia GC), and gastric non-cardia cancer (Non-Cardia GC), Connecticut 1940–2007. Age-adjusted incidence of EAC from SEER data also shown (EAC (SEER)). (note: y-axis scale is logarithmic)

Figure 2

Schematic of potential historical factors responsible for the observed rise in incidence of esophageal adenocarcinoma. (BE, Barrett’s esophagus; GERD, gastro-esophageal reflux disease)