Abstract
Background
Esophageal cancer accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in African Americans. Our aim was to describe the epidemiology of esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EA) among African Americans in the last five decades.
Methods
A total of 601 records of patients with documented esophageal cancer between 1959 and 2007 at Howard University Hospital were reviewed. Demographic characteristics, risk factors, clinical stage and histological findings were reviewed. The change in prevalence of the disease and the interaction between main risk factors with tumor stage of the patients were assessed over the years of this study.
Result
A total of 552 patients (91.8%) had ESCC while 49 patients (8.2%) had EA. The mean age at diagnosis was 60.1 and 60.6 years for ESCC and EA, respectively (P = 0.8). The peak incidence was in the 1980–1989 decade. Out of 136 ESCC patients with TNM staging information, 130 (95.6%) were diagnosed in stage 2 and above. The majority (73%) of the ESCC were in the mid- and upper third of the esophagus and associated with smoking and alcohol exposure. The majority (81%) of the EA were in the mid- and lower third. The most common presenting symptoms were dysphagia (77.7%), and weight loss (31.9%).
Conclusion
ESCC is the predominant esophageal cancer in African Americans and diagnosed in late stages, and its diagnosis in our institution has decreased since 1990. A combination of genetic factors, environmental influences (e.g., those related to diet), and the deleterious changes associated with smoking and alcohol consumption, and differences in tumor histology, are the obvious parameters that should be the focus of future studies, and early diagnosis at an earlier stage should be considered among blacks.
Similar content being viewed by others
Abbreviations
- AA:
-
African Americans
- EC:
-
Esophageal cancer
- ESCC:
-
Esophageal squamous cell carcinoma
- EA:
-
Esophageal adenocarcinoma
References
Jemal A, Center MM, Ward E. The convergence of lung cancer rates between blacks and whites under the age of 40, United States. Cancer Epidemiol Biomarkers Prev. 2009;18:3349–3352.
Kamangar F, Chow WH, Abnet CC, Dawsey SM. Environmental causes of esophageal cancer. Gastroenterol Clin North Am. 2009;38:27–57.
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–130.
SEER Cancer Statistics Review, 1975–2005. http://seer.cancer.gov/csr/1975_2005/.
Jemal A, Center MM, Ward E, Thun MJ. Cancer occurrence. Methods Mol Biol. 2009;471:3–29.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–249.
Jemal A, Ward E, Thun M. Declining death rates reflect progress against cancer. PLoS One. 2010;5:e9584.
Cummings LC, Cooper GS. Descriptive epidemiology of esophageal carcinoma in the Ohio Cancer Registry. Cancer Detect Prev. 2008;32:87–92.
Pottern LM, Morris LE, Blot WJ, Ziegler RG, Fraumeni JF Jr. Esophageal cancer among black men in Washington, DC. I. Alcohol, tobacco, and other risk factors. J Natl Cancer Inst. 1981;67:777–783.
Gammon MD, Schoenberg JB, Ahsan H, et al. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst. 1997;89:1277–1284.
Wu AH, Wan P, Bernstein L. A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinomas of the stomach and esophagus (United States). Cancer Causes Control. 2001;12:721–732.
Vioque J, Barber X, Bolumar F, et al. Esophageal cancer risk by type of alcohol drinking and smoking: a case–control study in Spain. BMC Cancer. 2008;8:221.
Brown LM, Devesa SS, Chow WH. Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst. 2008;100:1184–1187.
Blot WJ, McLaughlin JK. The changing epidemiology of esophageal cancer. Semin Oncol. 1999;26:2–8.
Younes M, Henson DE, Ertan A, Miller CC. Incidence and survival trends of esophageal carcinoma in the United States: racial and gender differences by histological type. Scand J Gastroenterol. 2002;37:1359–1365.
Mesihovic R, Vanis N, Gribajcevic M. Pretherapeutic staging of the esophageal cancer using endoscopic ultrasound. Med Arh. 2006;60:110–114.
Brown LM, Hoover R, Silverman D, et al. Excess incidence of squamous cell esophageal cancer among US Black men: role of social class and other risk factors. Am J Epidemiol. 2001;153:114–122.
Frederick L, Greene CMB, Haller DG, Morrow M. AJCC Cancer Staging Manual. 6th ed. 2002.
Balaji NS, DeMeester SR, Wickramasinghe KS, Hagen JA, Peters JH, DeMeester TR. Etiology of intestinal metaplasia at the gastroesophageal junction. Surg Endosc. 2003;17:43–48.
Derakhshan MH, Malekzadeh R, Watabe H, et al. Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gastric cardia cancer. Gut. 2008;57:298–305.
Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998;85:1457–1459.
Demeester SR. Epidemiology and biology of esophageal cancer. Gastrointest Cancer Res. 2009;3:S2–S5.
Kort EJ, Sevensma E, Fitzgerald TL. Trends in esophageal cancer and body mass index by race and gender in the state of Michigan. BMC Gastroenterol. 2009;9:47.
Brown LM, Devesa SS. Epidemiologic trends in esophageal and gastric cancer in the United States. Surg Oncol Clin N Am. 2002;11:235–256.
Ghafoor A, Jemal A, Cokkinides V, et al. Cancer statistics for African Americans. CA Cancer J Clin. 2002;52:326–341.
Chalasani N, Wo JM, Waring JP. Racial differences in the histology, location, and risk factors of esophageal cancer. J Clin Gastroenterol. 1998;26:11–13.
Fan YJ, Song X, Li JL, et al. Esophageal and gastric cardia cancers on 4238 Chinese patients residing in municipal and rural regions: a histopathological comparison during 24-year period. World J Surg. 2008;32:1980–1988.
Freedman J, Lagergren J, Bergstrom R, Naslund E, Nyren O. Cholecystectomy, peptic ulcer disease and the risk of adenocarcinoma of the oesophagus and gastric cardia. Br J Surg. 2000;87:1087–1093.
Brown LM, Hoover R, Gridley G, et al. Drinking practices and risk of squamous-cell esophageal cancer among Black and White men in the United States. Cancer Causes Control. 1997;8:605–609.
Dhillon PK, Farrow DC, Vaughan TL, et al. Family history of cancer and risk of esophageal and gastric cancers in the United States. Int J Cancer. 2001;93:148–152.
Acknowledgments
Grant support: CA102681, funded by the National Cancer Institute, NIH, and RCMI, Howard University.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ashktorab, H., Nouri, Z., Nouraie, M. et al. Esophageal Carcinoma in African Americans: A Five-Decade Experience. Dig Dis Sci 56, 3577–3582 (2011). https://doi.org/10.1007/s10620-011-1853-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-011-1853-1