A Marked Rise in Esophageal Cancer Prevalence in Middle Age

According to a study conducted in Florida, where more than 5 million people live, from 2012 to 2019 esophageal cancer nearly doubled in prevalence among middle-aged people.

Because there was no increase in esophagogastroduodenoscopy during the study period, the researchers concluded that these data reflected a real rise in esophageal cancer prevalence.

NOTE: Prevalence is a measure of how often a disease occurs in a population within a given period, such as 1 year. In cancer, prevalence refers, for example, to the number of people with that diagnosis per 100 thousand.

In a news release, Bashar J. Qumseya of the University of Florida in Gainesville said: "Whenever we see an increase in the prevalence of any cancer, we should ask whether it is solely due to better cancer screening or represents a real increase in the disease's prevalence."

Dr. Qumseya presented these study results in a news release before the 2022 Digestive Disease Week meeting.

Dr. Qumseya and colleagues evaluated the prevalence of esophageal cancer and Barrett's esophagus (or Barrett syndrome) using electronic health data from the OneFlorida Clinical Data Research Network.

NOTE: If gastric acid reflux reaches the lower esophagus for a long time, it can damage the inner surface. This causes an area normally lined with squamous cells to be replaced by glandular cells (an abnormal metaplastic change). These glandular cells resemble stomach and intestinal cells and are more resistant to stomach acid. This condition is called Barrett's esophagus. The longer reflux continues, the more likely Barrett's esophagus is to develop.

The number of patients in the database varied from year to year, ranging from 4.2 to 5.4 million. Patients were categorized into 3 age groups: younger patients (18 – 44 years), middle-aged patients (45 – 64 years) and older patients (≥ 65 years).

Esophageal cancer prevalence was significantly higher in the older group than in the middle-aged group. However, prevalence remained stable over time in the older group while increasing in the middle-aged group.

Among middle-aged patients, esophageal cancer prevalence increased from 49 per 100 thousand in 2012 to 94 per 100 thousand in 2019. Barrett's esophagus prevalence in this group also increased, from 304 per 100 thousand in 2012 to 466 per 100 thousand in 2019.

Dr. Qumseya said of these increases: “This large increase in prevalence should concern us as physicians, and we should request more esophageal cancer screening for middle-aged patients if they are at risk. Other analyses we have conducted with these data show that patients do not undergo endoscopy even when they have 4 or more risk factors for esophageal cancer. We can therefore do better from both the patient and healthcare provider perspectives. Most people in the US now begin colonoscopy at age 45. Performing endoscopy at the same time in people with multiple risk factors may help identify more patients with Barrett's esophagus and esophageal cancer.”

Esophageal cancer risk factors include:

• Older age and female sex
• Smoking and alcohol
• Barrett's esophagus
• Gastroesophageal reflux disease
• Obesity
• Diet (hot foods and a low-fiber diet)
• Achalasia
• Tylosis
• Plummer-Vinson syndrome
• HPV infection