PURPOSE: Squamous cell carcinoma and adenocarcinoma represent the major mucosal histopathologic subtypes of esophageal carcinoma. Their respective etiologies have been presumed to be related to smoking and alcohol consumption and to sequelae of reflux pathology. Our study seeks to identify and evaluate the relative changes in the incidence rates and trends of esophageal squamous cell and adenocarcinoma in Blacks and Whites during 31 years (1973–2004).
METHODS: Data were obtained from Registry 9 of NCI's SEER program, for the years 1973–2004. During this period, there were 16,090 cases of esophageal squamous cell carcinoma (SCC) reported, 10,590 in Whites and 4,293 in Blacks. Of 8,844 cases of esophageal adenocarcinoma (AC), 8,518 were reported in Whites and 154 cases in Blacks. Age, racial group, gender, and anatomical location in the esophagus were investigated. Incidence rates are expressed as number of cases per 100,000 persons. All results were statistically significant.
RESULTS: Black men and women had respectively higher rates (13.0, 3.8) of SCC compared to the respective rates in White men and women (2.7, 1.2). In contrast, White males had a higher rate (2.9) of AC than that of Black males (0.5). Middle esophagus predominated in SCC and decreased over recent years, whereas lower esophagus predominated in AC and markedly increased in recent years. The decreasing incidence rates of esophageal SCC have occurred among all age, racial, and gender groups. The increasing rate of AC was significantly higher in men relative to women, and Whites relative to Blacks. The rate of esophageal squamous cell carcinoma, but not adenocarcinoma, was linearly correlated with the respective histopathologic rate of lung cancer.
CONCLUSION: Esophageal SCC and AC incidence rates vary by age, period, gender, ethnicity and anatomic location. In the study period, SCC in the middle esophagus has decreased, whereas, AC in the distal esophagus has significantly increased.
CLINICAL IMPLICATIONS: Histopathologic subtypes (SCC and AC) of esophageal cancers have divergent epidemiologic parameters indicative of their disparate etiologies and prevention strategies.
DISCLOSURE: Arnold Schwartz, No Financial Disclosure Information; No Product/Research Disclosure Information