Review article
The epidemic of esophageal adenocarcinoma

https://doi.org/10.1016/S0889-8553(02)00016-XGet rights and content

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 US 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 [95%

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 proportion of gastric cancer site–unspecified decreased disproportionately to the rest of site-specific gastric cancer. Nonspecific gastric cancer in white men constituted 38% of all gastric cancer

EAC and adenocarcinoma of the cardia: are these the same or two different cancers?

Given the difficulties in diagnosis, classification, and coding, is it 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 the precursor lesion of esophageal adenocarcinoma, BE, are different from those for intestinal metaplasia (IM) of the gastric cardia [14], [15], [16]. Although GERD is a strong

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 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. Areas with high or rising incidence of EAC have low or declining adenocarcinoma of the distal stomach. 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

First page preview

First page preview
Click to open first page preview

References (82)

  • M.G. Sarr et al.

    Barrett's esophagus: its prevalence and association with adenocarcinoma in patients with gastroesophageal reflux

    Am J Surg

    (1985)
  • E. Krug et al.

    Gastroesophageal reflux and Barrett's esophagus in adults born with esophageal atresia

    Am J Gastroenterol

    (1999)
  • Y. Romero et al.

    Familial aggregation of gastroesophageal reflux in patients with Barrett's esophagus and esophageal adenocarcinoma

    Gastroenterology

    (1997)
  • C.E. Ruhl et al.

    Overweight, but not dietary fat intake, increases the risk of gastroesophageal disease hospitalization: The NHANES I epidemiologic follow-up study

    Ann Epidemiol

    (1999)
  • G.R. Locke et al.

    Risk factors associated with symptoms of gastroesophageal reflux

    Am J Med

    (1999)
  • D.Y. Graham

    Helicobacter pylori in the pathogenesis of duodenal ulcer and gastric cancer: a model

    Gastroenterology

    (1997)
  • E.M. El-Omar et al.

    Helicobacter pylori infection in patients with duodenal ulcer disease

    Gastroenterology

    (1995)
  • D.R. Cave et al.

    Effect of a Campylobacter pylori protein on acid secretion by the parietal cells

    Lancet

    (1989)
  • C.C. McGowan et al.

    Helicobacter pylori and gastric acid: biological and therapeutic implications

    Gastroenterology

    (1996)
  • L.E. Hansson et al.

    Prevalence of Helicobacter pylori in subtypes of gastric cancer

    Gastroenterology

    (1995)
  • J.J. Vicari et al.

    The seroprevalence of cagA-positive Helicobacter pylori strains in the spectrum of gastroesophageal reflux disease

    Gastroenterology

    (1998)
  • E. El-Omar et al.

    Helicobacter pylori infection and chronic gastric hyposecretion

    Gastroenterology

    (1997)
  • J. Labenz et al.

    Curing Helicobacter pylori infection in duodenal ulcer patients may provoke reflux esophagitis

    Gastroenterology

    (1997)
  • A.P. Weston et al.

    Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett's esophagus, Barrett's dysplasia, and Barrett's adenocarcinoma

    Am J Gastroenterol

    (2000)
  • World Health Organization

    The international classification of diseases

    Clinical modification

    (1980)
  • World Health Organization

    International classification of diseases for oncology

    (1976)
  • W.J. Blot et al.

    Rising incidence of adenocarcinoma of the esophagus and gastric cardia

    JAMA

    (1991)
  • S.S. Devesa et al.

    The rising incidence of gastric cardia cancer

    J Natl Cancer Inst

    (1999)
  • A.M. Eksröm et al.

    Evaluating gastric cancer misclassification: a potential explanation for the rise in cardia cancer incidence

    J Natl Cancer Inst

    (1999)
  • Surveillance, Epidemiology, and End Results Program Public-Use CD-ROM (1973–1996), National Cancer Institute, DCPC,...
  • S.S. Devesa et al.

    Changing patterns in the incidence of esophageal and gastric carcinoma in the United States

    Cancer

    (1998)
  • H.B. El-Serag et al.

    Epidemiological difference between adenocarcinoma of the esophagus and adenocarcinoma of the gastric cardia

    Gut

    (2002)
  • H.B. El-Serag et al.

    Opposing time trends between esophagitis and peptic ulcer disease

    Gut

    (1998)
  • C.S. Fuchs et al.

    Gastric carcinoma

    N Engl J Med

    (1995)
  • T.G. Morales et al.

    Is Barrett's esophagus associated with intestinal metaplasia of the gastric cardia?

    Am J Gastroenterol

    (1997)
  • T.G. Morales et al.

    Intestinal metaplasia of the gastric cardia

    Am J Gastroenterol

    (1997)
  • J. Lagergren et al.

    Symptomatic gastroesophageal reflux disease as a risk factor for esophageal adenocarcinoma

    N Engl J Med

    (1999)
  • J. Lagergren et al.

    Association between body mass and adenocarcinoma of the esophagus and gastric cardia

    Ann Intern Med

    (1999)
  • R.W. Armstrong et al.

    Trends in incidence rates of adenocarcinoma of the esophagus and gastric cardia in New Zealand, 1978–1992

    Int J Epidemiol

    (1996)
  • A.A.M. Botterweck et al.

    Trends in incidence of adenocarcinoma of the esophagus and gastric cardia in ten European countries

    Int J Epidemiol

    (2000)
  • S. Hansen et al.

    Esophageal and gastric carcinoma in Norway 1958–1992: incidence time trend variability according to morphological subtypes and organ subsites

    Int J Cancer

    (1997)
  • Cited by (110)

    View all citing articles on Scopus
    View full text