Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease

Abstract

Gastroesophageal (GE) junction carcinoma is a rare but often lethal condition with increasing importance as a public health problem in recent decades. Whereas diagnosis of this disease has been complicated historically by the lack of uniform classification standards, available data from the Surveillance, Epidemiology, and End Results cancer registry program in the United States show an approximate 2.5-fold increase in the incidence of GE junction adenocarcinoma from 1973 to 1992, with rates stabilizing in the past 2 decades. Similar proportional trends are observed among subgroups defined by race and gender, but rates are significantly higher in males relative to females, and in white males relative to black males. Smoking, obesity, and GE reflux disease are significant risk factors for GE junction adenocarcinoma, and may account for a substantial fraction of total disease burden. Infection with Helicobacter pylori has been associated with reduced incidence, and high dietary fiber intake has also been linked to lower disease risk. Ongoing studies continue to explore a potential role for nonsteroidal anti-inflammatory drugs in chemoprevention.

Figure 1

Trends in incidence of adenocarcinoma of the esophagus, gastroesophageal junction (GEJ), and non-cardia stomach in the United States, 1973 to 2008 (per 100,000, adjusted for age, race, and sex to the 2000 US standard population, with lowess smoothing). Data from the National Cancer Institute’s SEER Program (SEER*Stat Database: Incidence: SEER 9 Regs Public Use, November 2010 submission).

Figure 2

Trends in incidence of adenocarcinoma of the gastroesophageal junction (GEJ) in the United States by race and gender, 1973 to 2008 (per 100,000, age-adjusted to the 2000 US standard population, with lowess smoothing). Data from the National Cancer Institute’s SEER Program (SEER*Stat Database: Incidence: SEER 9 Regs Public Use, November 2010 submission).

Figure 3

Age-specific incidence of adenocarcinoma of the gastroesophageal junction (GEJ) in the United States by race and gender, 1973 to 2008 (per 100,000, with lowess smoothing). Data from the National Cancer Institute’s SEER Program (SEER*Stat Database: Incidence: SEER 9 Regs Public Use, November 2010 submission).

Figure 4

Kaplan-Meier curves comparing percent survival for 5 years among cases of gastroesophageal junction adenocarcinoma by (A) stage, and (B) year of diagnosis (1973–1984, 1985–1996, 1997–2008). Unstaged cases were excluded from analysis. Data from the National Cancer Institute’s SEER Program (SEER*Stat Database: Incidence: SEER 9 Regs Public Use, November 2010 submission).

Figure 4

Kaplan-Meier curves comparing percent survival for 5 years among cases of gastroesophageal junction adenocarcinoma by (A) stage, and (B) year of diagnosis (1973–1984, 1985–1996, 1997–2008). Unstaged cases were excluded from analysis. Data from the National Cancer Institute’s SEER Program (SEER*Stat Database: Incidence: SEER 9 Regs Public Use, November 2010 submission).