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. 2013 Apr;47(4):322-7.
doi: 10.1097/MCG.0b013e318260177a.

Diverging trends in the incidence of reflux-related and Helicobacter pylori-related gastric cardia cancer

Julian A Abrams  1 , Lou Gonsalves, Alfred I Neugut
Affiliations

Diverging trends in the incidence of reflux-related and Helicobacter pylori-related gastric cardia cancer

Julian A Abrams et al. J Clin Gastroenterol. 2013 Apr.

Abstract

Goals: To describe historical incidence trends of 2 subtypes of gastric cardia cancer.

Background: The incidence of gastric cardia cancer has increased in western countries. Prior studies have treated cardia cancer as a single entity, but recent data suggest that there are 2 distinct subtypes: reflux-related and Helicobacter pylori-related.

Study: We conducted a population-based study using Connecticut Tumor Registry data from 1955 to 2007. Age-adjusted incidence rates (per 100,000 person-years) were calculated for gastric cancer, as a whole and by anatomic subsite, and for esophageal adenocarcinoma. Cardia and noncardia cancer incidence rates were further adjusted to account for cases with unspecified subsite. Mathematical formulas were derived to calculate incidence rates for reflux-related and H. pylori-related cardia cancer.

Results: The adjusted incidence of cardia cancer was 4.0 per 100,000 in 1955 to 1959, decreased to 2.4 per 100,000 in 1965 to 1969 before increasing to 3.4 per 100,000 by 2003 to 2007. The incidence of H. pylori-related cardia cancer decreased from 3.7 to 1.0 per 100,000 over the study period, whereas reflux-related cardia cancer increased progressively from 0.3 to 2.4 per 100,000. The curves for reflux-related cardia cancer and esophageal adenocarcinoma closely mirrored each other, and their combined incidence increased from 0.5 per 100,000 in 1955 to 1959 to 5.6 per 100,000 in 2003 to 2007.

Conclusions: The incidence of reflux-related cardia cancer has steadily increased, whereas H. pylori-related cardia cancer has declined progressively since the mid-20th century. Trends in reflux-related cardia cancer and esophageal adenocarcinoma incidence are very similar, suggesting that these 2 cancers share a similar etiology and pathophysiological process.

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Figures

Figure 1
Figure 1
Age-adjusted incidence of cardia cancer, both without (“crude”) and with adjustment for gastric cancer cases with unspecified subsite, Connecticut, 1955–2007.
Figure 2
Figure 2
Incidence of H. pylori-related and reflux-related cardia cancer over time. Also shown as dotted lines are the incidence curves for each subtype, varying the baseline proportion of gastric cardia cancers that were H. pylori- or reflux-related.
Figure 3
Figure 3
The incidence of reflux-related cardia cancer, esophageal adenocarcinoma, and reflux-related upper gastrointestinal cancers, Connecticut, 1955–2007.
See this image and copyright information in PMC

References

    1. Abrams JA, Sharaiha RZ, Gonsalves L, Lightdale CJ, Neugut AI. Dating the rise of esophageal adenocarcinoma: analysis of Connecticut Tumor Registry data, 1940–2007. Cancer Epidemiol Biomarkers Prev. 2011;20:183–6. - PMC - PubMed
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    1. Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst. 2003;95:1404–13. - PubMed

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