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Background: The rising incidence and histologic change to adenocarcinoma in esophageal cancer over the past four decades has been among the most dramatic changes ever observed in human cancer. Recent reports have suggested that its increasing incidence may have plateaued over the past decade. Our aim was to examine the latest trends in esophageal adenocarcinoma incidence and analyze its correlation with time and population density.
Patients and Methods: We used the Surveillance Epidemiology and End Results (SEER) database of the National Cancer Institute to identify all patients with adenocarcinoma of the esophagus and gastric cardia between 1973 and 2009. Both overall and stage specific trends in incidence were analyzed using joinpoint regression. The correlation of incidence with time and total population within the geographic areas covered by SEER was analyzed by linear regression.
Results: The overall incidence of adenocarcinoma of the esophagus and the gastric cardia increased from 13.4 per million in 1973 to 51.4 per million in 2009, a nearly 400% increase. Jointpoint analysis demonstrated that the yearly increase in incidence has slowed somewhat from 1.27 per million before 1987 to 0.97 between 1987-1997 and 0.65 after 1997. Stage-specific analyses suggests, that incidence of early stages has actually declined after 2001 with a yearly decrease of 0.22. The percentage of patients diagnosed with early cancer declined after 2000 and remained under 2.5% through the study period. Regression analysis showed a substantially higher correlation of incidence of adenocarcinoma of the esophagus and the gastric cardia with population (r2=0.95) than with time (r2=0.65).
Conclusion: The incidence of esophageal adenocarcinoma continues to rise in the 21st century in the United States. A significant linear correlation of incidence with total population was found.