Increased rates of esophageal cancer, BE in middle-aged adults prompt concern
“Esophageal cancer, unfortunately, is often a silent killer — there are minimal symptoms usually until somebody has advanced disease,” Bashar J. Qumseya, MD, MPH, FASGE, associate professor of medicine and chief of endoscopy at the University of Florida, Gainesville, said at a media briefing for Digestive Disease Week 2022. “While the prevalence of esophageal cancer and Barrett's esophagus is thought to have plateaued in recent years, our team wondered whether this apparent trend could be age-dependent.”
Seeking to assess the prevalence of BE and esophageal cancer by age group, Qumseya and colleagues conducted a cross-sectional analysis of electronic health records from the OneFlorida Clinical Data Research Network. The patient population varied by year (2012-2019) and ranged from 4,238,884 to 5,411,838 adults. In 2019, the gender distribution was 42.8% men and 57.1% women, and among all patients, 40% were white and 22.2% were Black.
Researchers stratified patients as young (18-44 years), middle-aged (45-64 years) and older (> 65 years) and assessed disease prevalence by age group per 100,000 patients. They used regression analysis to evaluate the association between the number of risk factors and BE diagnosis.
Compared with middle-aged patients, older patients had a higher prevalence of esophageal cancer in each year (P < .0001). However, while this prevalence was stable over time in older patients, it increased logarithmically from 49 per 100,000 patients to 94 per 100,000 patients in the middle-aged group.
Similarly, the prevalence of BE also increased logarithmically among the middle-aged population from 304 in 2012 to 466 in 2019, per 100,000 patients. The rate of increase in prevalence of BE was highest among patients aged 51 to 60 years, followed by patients 61 to 70 years, then 41 to 50 years, according to subgroup analysis.
In the same time period, researchers noted use of esophagogastroduodenoscopy remained stable.
“This strong growth in prevalence should be of concern to physicians, and we should consider screening more middle-aged patients for esophageal cancer if they are at higher risk,” Qumseya said in a related press release. “Whenever we see increasing prevalence of any type of cancer, we should ask whether this is merely due to better screening or it is a true increase in the disease prevalence. In our study, it was due to the latter.”
Qumseya noted further analysis aims to differentiate prevalence by esophageal adenocarcinoma and squamous cell carcinoma, and that results will be finalized in the next six months.