The epidemic of esophageal adenocarcinoma☆
Section snippets
Incidence of EAC in the United States
The Surveillance, Epidemiology, and End Results (SEER) [7] is an ongoing program of the National Cancer Institute to collect population-based cancer incidence and survival data in a uniform registry that account for approximately 10% of the United States population. ICDO [2] is employed to encode for malignancies in the SEER registry. According to data obtained from SEER, the overall age-adjusted incidence rate for EAC has progressively increased since the early 1970s, reaching 1.8 per 100,000
Is there a true increase in EAC?
Changes in tumor classification could explain, in part, the observed secular trends of EAC [5], [6], [9]. The incidence and mortality rates for adenocarcinoma of the distal stomach in the United States and the developed countries of Europe have decreased steadily for many years [13]. Meanwhile, the gastric cancer site–unspecified decreased disproportionately to the rest of specific-site gastric cancer. Nonspecific gastric cancer in white men constituted 38% of all gastric cancer in the 1970s
EAC and adenocarcinoma of the cardia: are these the same or two different cancers?
Given the difficulties in diagnosis, classification, and coding, is it even important to distinguish between these two malignancies? If, indeed, these are two different malignancies, then this could lead to different specific prevention strategies, treatment, and survival. Recent studies have indicated that risk factors for BE, the precursor lesion of esophageal adenocarcinoma, are different from those for intestinal metaplasia (IM) of the gastric cardia [14], [15], [16]. Although GERD is a
Global incidence of EAC
Worldwide, there are significant geographic variations in the reported incidence rates of EAC. The incidence rates for several countries are shown in Fig. 6 for men and Fig. 7 for women. In general, the incidence rates of EAC are greater in men than women, irrespective of geography. Developed countries in Europe and North America have higher incidence rates than countries in Africa and Asia. Interestingly, areas with high or rising incidence of EAC have low or declining adenocarcinoma of the
Survival
Despite the wider use of diagnostic procedures, the frequency of EAC detected at an early stage remains very small. In the United States, the proportion of patients with carcinoma in situ increased from 0.32% of all EAC diagnosed during 1973 to 1977 to a mere 2.3% in 1993 to 1997; there were no significant changes in the proportion of localized, regional, and distant tumors [28] (Fig. 8). At the time of diagnosis, the majority of patients with EAC are already symptomatic with locally advanced
EAC and BE
The presence of intestinal metaplasia at the lower end of the tubular esophagus (BE) is the only known precursor lesion for EAC [29]. The closest to a true population estimate for prevalence of BE among Caucasians (376 per 100,000) comes from a 0.4% autopsy study in Olmsted County, Minnesota [30]. No study has examined a randomly selected sample of the general population for the presence of BE. Therefore, the prevalence and incidence of BE in the general population are unknown. The frequency of
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Reprinted with permission from Gastroenterology Clinics of North America 2002;31(2):421–440.