December 21, 2020
The incidence of esophageal adenocarcinoma (EAC) is increasing in adults younger than 50 years and is more often diagnosed at advanced stages in this age group in comparison with cases diagnosed in older adults, according to Surveillance, Epidemiology, and End Results Program (SEERS) data.
Between 1975 and 2015, the age-standardized EAC incidence rate increased in three age groups: those younger than 50 years, those aged 50-69, and those aged 70 years and older.
The increase was greatest in those younger than 50, at 2.9% per year, Don Codipilly, MD, a gastroenterology fellow at the Mayo Clinic, Rochester, Minnesota, and colleagues report.
The findings were published December 11 in Cancer Epidemiology, Biomarkers and Prevention.
The investigators analyzed 34,443 cases of EAC diagnosed during the study period. In addition to the increasing incidence rates, they found that between 2000 and 2015, 84.9% of cases diagnosed in younger adults were of regional or distant disease, compared with 77.6% and 67.8% of cases in those aged 50–69 and 70 and older, respectively.
As a result, the younger adults had poorer survival outcomes: The 5-year EAC-free survival rates during the most recent period (2000–2011) were 22.9% among those younger than 50, compared with 29.6% in both the 50–69 and the 70 and older age groups, they note.
"The magnitude of late-stage disease and poor cancer-related survival in this age group were surprising findings for us," lead author Prasad G. Iyer, MD, professor of medicine, Mayo Clinic, Rochester, Minnesota, stated in a press release. "We are also concerned by the trend of increase over the past four decades."
Similar trends have been seen with colon cancer in young adults. In those cases, as with esophageal cancer in younger patients, symptoms are often attributed first to other causes, which contributes to delays in diagnosis and poorer outcomes.
As reported recently by Medscape Medical News, cancer rates in adolescents and young adults increased by 30% between 1973 and 2015, driven in part by an increase in colorectal cancer cases. A 2019 report also showed an increase in the incidence of colorectal cancer among younger adults, whereas rates in older adults either stabilized or decreased in several places, including the United States and the United Kingdom.
These increases and the increase in EAC rates in younger adults seen in the current analysis may be explained by several factors, Iyer told Medscape Medical News.
What's Going On?
In an email to Medscape Medical News, Iyers described likely contributors to these gastrointestinal tract cancers. "Certainly, combinations of increased rates of obesity, increased rates of reflux, and changes in diet or the microbiome may be playing a part," he stated. "Some of these will overlap with early-onset [colorectal cancer] as well."
Esophageal cancer remains rare -- the 18,440 cases of EAC expected to be diagnosed in the United States this year account for only about 1% of US cancer diagnoses; however, the rate of 5-year survival is only 19.9%. The current findings thus underscore the need for younger patients to be aware of risk factors and symptoms, such as difficulty swallowing, chest discomfort, and unintended weight loss, the investigators note.
Those with certain high-risk features, such as long-term reflux and a family history of esophageal cancer, should discuss screening with their healthcare providers, they add.
Further, physicians should set a low threshold for suspicion of EAC in younger patients who present with dysphagia, Codipilly noted. "EAC is not a disease of the elderly, and outcomes for young people with EAC are dismal," he said.
Those with dysphagia may benefit from an upper endoscopy, inasmuch as the procedure could rule out EAC or allow for earlier diagnosis at a more treatable stage, Codipilly noted.
The study was funded by the National Cancer Institute and the National Center for Advancing Translational Sciences. The authors have disclosed no relevant financial relationships.