A new study published by Codipilly et al in Cancer Epidemiology, Biomarkers & Prevention investigated the trends in incidence, stage at presentation, and survival outcomes of young-onset esophageal adenocarcinoma—defined as patients aged 50 and younger at diagnosis—over the past 4 decades. Researchers found that young-onset esophageal cancer is rapidly rising in incidence and that these younger adults are more likely to present with more advanced-stage disease and have poorer survival outcomes than their older counterparts.
Although it is unclear what biologic, genetic, or environmental factors may influence the rise in esophageal cancer in younger adults, current diagnostic and management strategies for the cancer in this age group may need to be reevaluated.
Although fewer than 15% of individuals diagnosed with esophageal cancer are younger than age 55, they present with advanced-stage cancer at higher rates than older patients, and they tend to have worse survival outcomes. This year, about 18,440 people (14,350 men and 4,090 women) in the United States will be diagnosed with esophageal cancer, and about 16,170 will die from the disease.
Photo credit: Getty
Study Methodology
The researchers used data from the Surveillance, Epidemiology, and End Results 9 database, which incorporates data from 18 geographic regions in the United States, to identify patients who were diagnosed with esophageal adenocarcinoma between 1975 and 2015. The patients were stratified into three age groups: younger than 50, 50–69, and 70 or older. Staging was stratified as localized, regional, and distant. Trends in incidence, disease stage, and survival were assessed in three time periods: 1975–1989, 1990–1999, and 2000–2015. Univariate and multivariate models were created to identify predictors of mortality.
Results
The researchers found that esophageal adenocarcinoma incidence has increased in patients younger than age 50, with an annual percentage change of 2.9% (95% confidence interval = 1.4%–4.4%) from 1975 to 2015. Patients with young-onset esophageal adenocarcinoma presented at more advanced stages (regional and distant) compared with older patients (84.9% vs 67.3%; P < .01), with an increasing proportion of advanced stages over the study period. These younger patients also experienced poorer 5-year esophageal adenocarcinoma–free survival compared with older patients (22.9% vs 29.6%; P < .01), although this finding was attenuated on stage-stratified analysis.
“Young-onset esophageal adenocarcinoma, while uncommon, is rising in incidence. Concerningly, the proportion of advanced disease continues to increase. Young-onset esophageal adenocarcinoma also presents at more advanced stages, resulting in poorer esophageal adenocarcinoma–free survival,” concluded the study authors.
Clinical Significance
Although esophageal adenocarcinoma remains a rare cancer, especially in individuals younger than age 50, clinicians and patients should be aware of the increasing incidence and the poor survival outcomes in younger patients, cautioned Don C. Codipilly, MD, a gastroenterology fellow at the Mayo Clinic in Rochester, Minnesota, and the lead author of this study.
“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,” said Dr. Codipilly in a statement. “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.”
Disclosure: Funding for this study was provided by the National Cancer Institute and the National Center for Advancing Translational Sciences. For full disclosures of the study authors, visit cebp.aacrjournals.org.
