Trends in esophageal adenocarcinoma incidence and mortality

Abstract

Background: Over the past several decades, the incidence of esophageal adenocarcinoma (EAC) has rapidly increased. The purpose of this analysis was to examine temporal trends in EAC incidence and mortality within the US population and, in addition, to explore these trends within subgroups of the population.

Methods: The National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER 9) data were used to examine incidence and incidence-based (IB) mortality in EAC from 1975 to 2009. Secular trends in incidence and IB mortality by cancer stage, sex, and race were further characterized using the NCI's Joinpoint Regression program.

Results: Based on SEER 9 data, EAC incidence and IB mortality continues to increase in the United States. However, since the mid-1990s, the overall rate of increase in both EAC incidence and IB mortality appears to be slowing. In addition, in early-stage cancers, there is a noticeable leveling off of IB mortality rates and divergence from incidence starting in the late 1990s. Over the study period, the average annual percentage increase in incidence was 6.1% in men and 5.9% in women.

Conclusions: EAC incidence and IB mortality rates continue to rise in the United States, although at a slower rate in more recent years. In early-stage cancers, IB mortality and incidence rates have diverged primarily because IB mortality rates have plateaued beginning in the late 1990s. Although EAC continues to be less common in women, the rate of increase in EAC incidence is similar in both sexes.

Figure 1

Graph depicts stage distribution of incident cases of esophageal adenocarcinoma showing unstaged cases, 1975 to 2009.

Figure 2

Graph shows SEER 9 esophageal adenocarcinoma incidence and incidence-based mortality, 1975 to 2009. From 1975 to 1997, EAC incidence increased at an annual percentage change (APC) of 8.4 (95% confidence interval [CI] = 7.7-9.1), whereas the APC was 1.6 (95% CI = 0.0-3.3) from 1997 to 2009. For incidence-based mortality, the APC was 8.0 from 1978 to 1998 (95% CI = 7.2-8.8) and 1.1 from 1998 to 2009 (95% CI = −0.7 to 2.9). All rates were age-adjusted to the 2000 Standard population using 19 age groups.

Figure 3

SEER 9 esophageal adenocarcinoma incidence and incidence-based mortality is shown in men and women, 1975 to 2009. (A) SEER 9 esophageal adenocarcinoma incidence and incidence-based mortality is shown in men, 1975 to 2009. From 1975 to 1996, the APC in EAC incidence in men was 9.0 (95% CI = 8.1-9.8) whereas from 1996 to 2009, the change was 1.7% per year (95% CI = 0.1-3.3). The APC in incidence-based EAC mortality was 8.1 (95% CI = 7.3-8.9) from 1978 to 1998, whereas after 1998, the rate of increase in mortality slowed to an APC of 0.8 (95% CI = −1.0 to 2.6) from 1998 to 2009. (B) SEER 9 esophageal adenocarcinoma incidence and incidence-based mortality in women, 1975 to 2009. The APC in EAC incidence in women was 5.9% (95% CI = 5.1-6.7) from 1975 to 2009. From 1978 to 1997, EAC incidence-based mortality in women increased at an APC of 7.8 (95% CI = 5.8-9.8) and slowed to an APC of 2.1 (95% CI = −1.5 to 6.0). All rates were age-adjusted to the 2000 Standard population using 19 age groups.

Figure 4

SEER 9 esophageal adenocarcinoma incidence and incidence-based mortality is shown by stage, 1975 to 2009. (A) Local esophageal adenocarcinoma incidence and incidence-based mortality. Incidence of localized EAC increased at an annual percentage change (APC) of 9.8 (95% confidence interval [CI] = 8.5-11.2) from 1975 to 1999. From 1999 to 2009, there was a slowing of the increased incidence to 0.1% per year (95% CI = −4.5 to 4.8). A similar pattern is also evident in localized EAC incidence-based mortality; from 1978 to 2000, the APC was 9.3 (95% CI = 78-10.8), whereas from 2000 to 2009 the incidence-based mortality trend decreased with an APC of —1.0 (95% CI = −6.1 to 4.5). (B) Regional esophageal adenocarcinoma incidence and incidence-based mortality. Incidence of regional EAC decreased at an APC of −2.4 from 1975 to 1981 (95% CI = −8.3 to 3.8), rose to an APC of 28.2 (95% CI = −11.3 to 85.3) from 1981 to 1984, but slowed to an APC of 7.7 (95% CI = 6.2-9.2) from 1984 to 2001 then decreased at an APC of −0.6 (95% CI = −4.5 to 3.5) from 2001 to 2009. Incidence-based mortality in this group increased at an APC of 9.2 (95% CI = 75-10.9) from 1978 to 1999, and slowed to an APC of 0.7 (95% CI = −3.9 to 5.6), from 1999 to 2009. (C) Distant esophageal adenocarcinoma incidence and incidence-based mortality. From 1975 to 1987, the incidence of distant EAC increased at an APC of 9.5 (95% CI = 74-11.7) but then slowed to an APC of 5.4 (95% CI = 4.6-6.3) from 1987 to 2009. In terms of incidence-based mortality, there was a sharp increase from 1978 to 1980 at an APC of 48.5 (95% CI = 3.9-112.3) whereas from 1980 to 2009 the APC was 5.8 (95% CI = 5.2-6.3). All rates were age-adjusted to the 2000 Standard population using 19 age groups.

Figure 5

Five-year relative age-adjusted survival is shown for esophageal adenocarcinoma, 1975 to 2004. Dashed lines indicate imputed data points for those years for which values were not available.