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. 2024 Aug 1;15(8):e00745.
doi: 10.14309/ctg.0000000000000745.

Racial, Ethnic, and Sex Differences in Incidence-Based Mortality of Aggregate Upper Gastrointestinal Cancers

Alyyah Malick  1 , Jennifer S Ferris  2 , Chin Hur  3 , Julian A Abrams  1   2 , Ali Soroush  4   5
Affiliations

Racial, Ethnic, and Sex Differences in Incidence-Based Mortality of Aggregate Upper Gastrointestinal Cancers

Alyyah Malick et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Current strategies for upper gastrointestinal (UGI) cancer screening primarily target cancer-specific risk, with the strongest focus on esophageal adenocarcinoma (EAC). However, all UGI cancers are amendable to screening and early detection with an upper endoscopic examination. This study assesses and explores incidence-based mortality (IBM) for cumulative UGI cancers, aiming to identify race-based or sex-based disparities.

Methods: We used Surveillance, Epidemiology, and End Results Research data to analyze patients diagnosed with EAC, esophageal squamous cell carcinoma, cardia gastric cancer, noncardia gastric cancer, or colorectal adenocarcinoma from 2000 to 2019. Age-adjusted IBM was calculated as a rate per 100,000 population and stratified by sex and race/ethnicity. We also compared UGI cancer IBM with that of colorectal cancer, a cancer with established population-wide endoscopic screening guidelines.

Results: Cumulative IBM for UGI cancers was 8.40 (95% confidence interval [CI] 8.34-8.46). The highest cancer-specific IBM rates were for EAC (2.26, 95% CI 2.23-2.29), followed by noncardia gastric cancer (2.07, 95% CI 2.04-2.10), cardia gastric cancer (1.60, 95% CI 1.57-1.62), esophageal squamous cell carcinoma (1.21, 95% CI 1.19-1.23), and miscellaneous UGI cancer (1.27, 95% CI 1.13-1.40). UGI cancer IBM was highest among Black men (16.43, 95% CI 15.97-16.89), American Indian/Alaska Native men (15.23, 95% CI 13.75-16.82), and Hispanic men (13.76, 95% CI 13.42-14.11). These rates are significantly greater than among White men (12.81, 95% CI 12.68-12.95).

Discussion: UGI cancers impose a significantly higher mortality burden on non-White population subgroups that are not currently targeted by any systematic screening approach.

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Conflict of interest statement

Guarantor of the article: Ali Soroush, MD, MS.

Specific author contributions: A.M.: collecting and interpreting data, visualization of data, drafting and editing manuscript. J.S.F.: interpreting data, visualization of data, editing manuscript. C.H.: planning study, interpreting data. J.A.A.: planning study, editing manuscript. A.S.: planning study, interpreting data, editing manuscript.

Financial support: This publication was supported by the NIH/NCI Cancer Center Support Grant P30CA013696 and the AGA Research Foundation's 2023 AGA-Amgen Fellowship-to-Faculty Transition Award AGA2023-32-06.

Potential competing interests: A.M., J.S.F., C.H., and A.S.: no conflict to disclose. J.A.A.: consulting for Exact Sciences and Castle Biosciences, research support from Pentax Medical.

Data transparency/IRB statement: All data included in this study are publicly available through the Surveillance, Epidemiology, and End Results (SEER) Program. No IRB approval was required.

Figures

Figure 1.
Figure 1.
IBM for cumulative upper gastrointestinal cancer and subtypes stratified by race/ethnicity and sex. Race/ethnicity-stratified IBM (rates per 100,000) of UGI cancers compared with histologic subtypes: EAC, ESCC, CGC, and NCGC. All minority groups have significantly different IBM compared with non-Hispanic Whites (P < 0.05) within each histologic subtype and overall. CGC, cardia gastric cancer; EAC, esophageal adenocarcinoma; ESCC, esophageal squamous cell carcinoma; IBM, incidence-based mortality; NCGC, noncardia gastric cancer; UGI, upper gastrointestinal.
Figure 2.
Figure 2.
Comparison of cumulative upper gastrointestinal cancer IBM rates for population subgroups. For each histologic subtype of upper gastrointestinal cancers, IBM rates are presented as ratios compared with IBM of White men. Error bars represent 95% confidence intervals. AI/AN, American Indian/Alaska Native; API, Asian/Pacific Islander; IBM, incidence-based mortality; UGI, upper gastrointestinal.
Figure 3.
Figure 3.
IBM for cumulative upper gastrointestinal cancer and colorectal cancer stratified by race and ethnicity and sex. Race/ethnicity-stratified IBM (rates per 100,000) of UGI cancers and CRC. Error bars represent 95% confidence intervals. CRC, colorectal adenocarcinomas; IBM, incidence-based mortality; UGI, upper gastrointestinal.
Figure 4.
Figure 4.
Incidence and survival of UGI cancers by race-ethnicity. (a) Incidence (rates per 100,000) of cumulative UGI cancers stratified by race/ethnicity. Error bars represent 95% confidence intervals. *Indicates significant difference compared with non-Hispanic Whites (P < 10−4). (b) 5-Year relative survival (%) of cumulative UGI cancers stratified by race/ethnicity. Error bars represent 95% confidence intervals. *indicates significant difference compared with non-Hispanic Whites (P < 0.001). UGI, upper gastrointestinal.
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References

    1. Surveillance Research Program—National Cancer Institute. SEER*Explorer: An interactive website for SEER cancer statistics (https://seer.cancer.gov/statistics-network/explorer/) (2023) Accessed Jun 16, 2023.
    1. Ngamruengphong S, Wolfsen HC, Wallace MB. Survival of patients with superficial esophageal adenocarcinoma after endoscopic treatment vs surgery. Clin Gastroenterol Hepatol 2013;11(11):1424–9.e2; quiz e81. - PMC - PubMed
    1. Pourmousavi MK, Wang R, Kerdsirichairat T, et al. Comparable cancer-specific mortality of patients with early gastric cancer treated with endoscopic therapy vs surgical resection. Clin Gastroenterol Hepatol 2020;18(12):2824–32.e1. - PubMed
    1. Corona E, Yang L, Esrailian E, et al. Trends in esophageal cancer mortality and stage at diagnosis by race and ethnicity in the United States. Cancer Causes Control 2021;32(8):883–94. - PMC - PubMed
    1. Hur C, Miller M, Kong CY, et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer 2013;119(6):1149–58. - PMC - PubMed

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