Source/Disclosures
Disclosures: Iyer reports grants from Exact Sciences outside the submitted work. Another study author reports a data and safety monitoring board role with Erbe outside the submitted work. The other authors report no relevant financial disclosures.
December 16, 2020
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Esophageal adenocarcinoma rates increase steadily among younger adults

Source/Disclosures
Disclosures: Iyer reports grants from Exact Sciences outside the submitted work. Another study author reports a data and safety monitoring board role with Erbe outside the submitted work. The other authors report no relevant financial disclosures.
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The rate of early-onset esophageal adenocarcinoma increased an average of 2.9% per year between 1975 and 2015, according to results of a study published in Cancer Epidemiology, Biomarkers & Prevention.

Moreover, these younger patients were more frequently diagnosed at advanced stages and had higher rates of disease-specific mortality, the researchers found.

Younger patients demonstrated lower rates of 5-year esophageal adenocarcinoma-free survival than patients in the older age groups.

“The magnitude of late-stage disease and poor cancer-related survival in this age group were surprising findings for us,” Prasad G. Iyer, MD, MSc, professor of medicine in the Barrett’s esophagus unit of the division of gastroenterology and hepatology at Mayo Clinic in Rochester, Minnesota, said in a press release. “We are also concerned by the trend of increase over the past 4 decades.”

Prasad Iyer, MD
Prasad G. Iyer

Iyer and colleagues reviewed the SEER database to gather data on 34,443 patients diagnosed with esophageal adenocarcinoma between 1975 and 2015. They divided patients into three age categories: younger than 50 years (n = 2,765; 88.3% male, 93.2% white); 50 to 69 years (n = 17,650; 89.2% men, 94.6% white), and 70 years and older (n = 14,028; 82% men, 96% white).

The researchers stratified staging as localized, regional or distant and evaluated trends in incidence, disease stage and survival during three time periods: 1975 to 1989, 1990 to 1999 and 2000 to 2015. They used univariate and multivariate models to determine predictors of mortality.

Results showed that among patients aged younger than 50 years, the rate of esophageal adenocarcinoma increased yearly by 2.9% (95% CI, 1.4-4.4) between 1975 and 2015. These younger patients were diagnosed at more advanced stages, including regional and distant, than older patients (84.9% vs. 67.3%; P < .01).

The proportion of advanced-stage cancers among patients aged younger than 50 years increased steadily over the study period, accounting for the majority of the overall increase in esophageal carcinoma among that group (annual percent change = 3.6; 95% CI, 2-5.2).

The younger patients also demonstrated lower rates of 5-year esophageal adenocarcinoma-free survival than patients in the older age groups (22.9% vs. 29.6% for both aged 50-69 years and 70 years; P < .01). However, an analysis stratified by disease stage showed this finding appeared to reflect the advanced stage at presentation.

“Patients who present with late-stage esophageal cancer typically have poorer outcomes than those with early-stage disease,” Iyer said. “As such, it is important to understand the epidemiology of esophageal cancer to target our screening strategies.”

The authors cited parallels between the rising incidence of early-onset esophageal adenocarcinoma and a similar trend in colon cancer. Symptoms of both diseases may be erroneously attributed to other causes, delaying diagnosis. Esophageal adenocarcinoma is characterized by difficulty swallowing, chest discomfort or unintended weight loss. Individuals with long-term reflux and those with a family history of esophageal cancer should consider screening, according to the authors.

“Physicians must keep in mind that esophageal adenocarcinoma is not a disease of the elderly, and that outcomes for young people with [esophageal adenocarcinoma] are dismal,” study co-author Don C. Codipilly, MD, gastroenterology fellow at Mayo Clinic, said in the press release. “Our findings suggest that physicians should have a low threshold of suspicion for patients who present with dysphagia (difficulty swallowing). [Although] younger patients would typically not be at high risk for [esophageal adenocarcinoma], they may benefit from an upper endoscopy.”