Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Clin Transl Gastroenterol. 2024 Aug 1;15(8):e00745. doi: 10.14309/ctg.0000000000000745.
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.
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.
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).
UGI cancers impose a significantly higher mortality burden on non-White population subgroups that are not currently targeted by any systematic screening approach.
目前，上消化道（UGI）癌症筛查策略主要针对癌症特异性风险，重点关注食管腺癌（EAC）。然而，所有 UGI 癌症都可以通过上内窥镜检查进行筛查和早期发现。本研究评估并探讨了累积 UGI 癌症的发病率相关死亡率（IBM），旨在确定基于种族或性别的差异。
我们使用监测、流行病学和最终结果研究数据，分析了 2000 年至 2019 年期间诊断为 EAC、食管鳞状细胞癌、贲门胃癌、非贲门胃癌或结直肠腺癌的患者。年龄调整后的 IBM 以每 10 万人的发病率计算，并按性别和种族/民族进行分层。我们还将 UGI 癌症 IBM 与结直肠癌进行了比较，结直肠癌有已建立的人群内镜筛查指南。
UGI 癌症的累积 IBM 为 8.40（95%置信区间[CI]8.34-8.46）。特异性 IBM 率最高的癌症是 EAC（2.26，95%CI2.23-2.29），其次是非贲门胃癌（2.07，95%CI2.04-2.10）、贲门胃癌（1.60，95%CI1.57-1.62）、食管鳞状细胞癌（1.21，95%CI1.19-1.23）和其他 UGI 癌症（1.27，95%CI1.13-1.40）。UGI 癌症 IBM 在黑人男性中最高（16.43，95%CI15.97-16.89）、美洲印第安人/阿拉斯加原住民男性（15.23，95%CI13.75-16.82）和西班牙裔男性（13.76，95%CI13.42-14.11）。这些比率明显高于白人男性（12.81，95%CI12.68-12.95）。
UGI 癌症对非白人亚组造成了更高的死亡率负担，而目前没有任何系统的筛查方法针对这些亚组。
