Descriptive epidemiology of esophageal carcinoma in the Ohio Cancer Registry

Background: Etiologic factors and demographics in esophageal cancer have not been fully characterized at a population-level. This study aimed to compare incidence rates of esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) by race. Other aims were to evaluate the impact of race, age, gender, and histology on presenting stage, and to describe tobacco use history in EAC as documented in a cancer registry. Methods: Invasive esophageal cancer cases reported to Ohio's Cancer Registry 1998-2002 were identified. Incident staged EAC and ESCC cases were analyzed for factors associated with metastatic disease. Results: 930 ESCC and 1801 EAC cases were identified. African-Americans had higher ESCC incidence than whites (5.0 versus 1.3 cases/100,000/year). However, whites had higher EAC incidence (3.3 versus 0.8 cases/100,000/year). 77% of EAC cases with available tobacco history were reported in tobacco users. In univariate analyses, race, age, gender, and histology differed significantly by stage. 31% of patients aged ≥65 presented with distant stage, versus 26% of those <65 (p < 0.001). 32% of African-Americans had distant stage, versus 34% of whites (p = 0.048). In logistic regression modeling, male gender [OR 1.76, CI (1.15, 2.67)] and age <75 [OR 1.95, CI (1.21, 3.15)], but not race, predicted distant stage ESCC. Distant stage EAC was associated with age <56 [OR 1.82, CI (1.39, 2.38)] but not significantly associated with African-American race (p = 0.062) for the sample size available. Conclusions: Whites had higher EAC rates, and African-Americans had higher ESCC rates. African-Americans were not more likely than whites to present with metastatic ESCC.