Racial, Ethnic, and Sex Differences in Incidence-Based Mortality of Aggregate Upper Gastrointestinal Cancers

Abstract

INTRODUCTION: Current strategies for upper gastrointestinal (UGI) cancer screening primarily target cancer-specific risk, with the strongest focus on esophageal adenocarcinoma (EAC). However, all UGI cancers are amendable to screening and early detection with an upper endoscopic examination. This study assesses and explores incidence-based mortality (IBM) for cumulative UGI cancers, aiming to identify race-based or sex-based disparities. METHODS: We used Surveillance, Epidemiology, and End Results Research data to analyze patients diagnosed with EAC, esophageal squamous cell carcinoma, cardia gastric cancer, noncardia gastric cancer, or colorectal adenocarcinoma from 2000 to 2019. Age-adjusted IBM was calculated as a rate per 100,000 population and stratified by sex and race/ethnicity. We also compared UGI cancer IBM with that of colorectal cancer, a cancer with established population-wide endoscopic screening guidelines. RESULTS: Cumulative IBM for UGI cancers was 8.40 (95% confidence interval [CI] 8.34–8.46). The highest cancer-specific IBM rates were for EAC (2.26, 95% CI 2.23–2.29), followed by noncardia gastric cancer (2.07, 95% CI 2.04–2.10), cardia gastric cancer (1.60, 95% CI 1.57–1.62), esophageal squamous cell carcinoma (1.21, 95% CI 1.19–1.23), and miscellaneous UGI cancer (1.27, 95% CI 1.13–1.40). UGI cancer IBM was highest among Black men (16.43, 95% CI 15.97–16.89), American Indian/Alaska Native men (15.23, 95% CI 13.75–16.82), and Hispanic men (13.76, 95% CI 13.42–14.11). These rates are significantly greater than among White men (12.81, 95% CI 12.68–12.95). DISCUSSION: UGI cancers impose a significantly higher mortality burden on non-White population subgroups that are not currently targeted by any systematic screening approach.