The incidence of esophageal cancer is increasing among adults under the age of 50. These individuals also present with disease at a more advanced stage, according to results reported in Cancer Epidemiology, Biomarkers & Prevention.
“The magnitude of late-stage disease and poor cancer-related survival in this age group were surprising findings for us,” Prasad Iyer, MD, of the Mayo Clinic, Minnesota, said in a press release. “We are also concerned by the trend of increase over the past four decades.”
Making up only 1% of all cancer diagnoses in the United States, esophageal cancer is a rare but lethal cancer, with a five-year survival rate of about 20%. Esophageal adenocarcinoma is one of the most common forms of esophageal cancer. Although young-onset cases account for less than 10% of all esophageal adenocarcinoma diagnoses, its incidence rate has risen by more than 200% over the last few decades.
Thus far, limited data has been available for younger individuals with esophageal cancer. Iyer and colleagues studied time trends for incidence rates and outcomes of esophageal adenocarcinoma for individuals below the age of 50 years.
To do this, they used the Surveillance, Epidemiology, and End Results 9 database, which includes data from 18 geographic regions that represent 35% of the United States population, to identify 34,443 individuals with esophageal adenocarcinoma who were diagnosed between 1975 and 2015. They were split into three age groups: those younger than 50, those between the ages of 50 and 69 and those at least 70 years old. On the basis of their disease, they were classified into those with localized, regional and distant (metastatic) disease.
The team studied trends in incidence, disease stage and survival for three time periods: between 1975 and 1989, between 1990 and 1999, and between 2000 and 2015. They used models that considered single and multiple variables simultaneously to establish mortality predictors. The authors cautioned that their findings did not take into account comorbidities, as such data was unavailable in the database.
From 1975 to 2015, there was a yearly percentage increase of 2.9% in the incidence of esophageal adenocarcinoma among people younger than 50. Further, esophageal adenocarcinoma is more likely to be diagnosed at a later stage in younger people (84.9%) compared with individuals aged between 50 and 69 (77.6%) and those 70 years and older (67.8%).
Over the course of the study period, the proportion of younger individuals with advanced-stage disease has gone up at a higher rate than in older adults: 81.8% between 1975 and 1989, 75.5% between 1990 and 1999, and 84.9% between 2000 and 2015. Moreover, the five-year survival rate for younger individuals with esophageal cancer (22.9%) was worse than that of older individuals (29.6%), although this difference was diminished when the finding was adjusted for disease stages.
Hashem B. El-Serag, MD, MPH, of the Baylor College of Medicine, Texas, told MedPage Today that growing prevalence of obesity among younger people and the resultant chronic gastroesophageal reflux disease (GERD) could be contributing to the increase in esophageal adenocarcinoma among younger adults. "GERD that starts during childhood is also known to persist as a chronic condition in adulthood, and it’s possible that the reported increase in childhood GERD also underlies the observed trends in esophageal adenocarcinoma,” he said.
The researchers suggest that diagnostic and management practices for young-onset esophageal adenocarcinoma may need to be modified. “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,” Don Codipilly, MD, of the 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. While younger patients would typically not be at high risk for [esophageal adenocarcinoma], they may benefit from an upper endoscopy.”
Click here to read the study abstract in Cancer Epidemiology, Biomarkers & Prevention.