Epidemiologic pattern of esophageal cancer at an inner-city university hospital

The incidence of esophageal adenocarcinoma has increased significantly during the past 25 years in the United States and Europe. This increase has occurred predominantly among white men. To determine the effect of ethnicity and selected clinical features on the type of esophageal cancer in an urban, minority population, we retrospectively reviewed esophageal cancer at our institution. All patients with esophageal cancer from 1980 to 1995 were identified using the tumor registry data base and patient medical records at UMDNJ-University Hospital. Inclusion criteria were self-reported ethnicity and a confirmed pathologic diagnosis of either esophageal adenocarcinoma (ADENO) or squamous cell carcinoma (SCCA). Data abstracted from the record included age and year of diagnosis, weeks of survival, and risk factors, such as Barrett's esophagus and tobacco and alcohol abuse. Of 150 cases of esophageal cancer, 139 (93%) were SCCA and 11 (7%) were ADENO; the male:female ratio was 11:4. African and Latino Americans comprised 87% and white Americans 13% of the group. The incidence of ADENO increased during the study period: 1980-1984, 1 case; 1985-1989, 3 cases; and 1990-1995, 7 cases (P = .022); whereas the incidence of SCCA remained constant during the same intervals: 51, 52, and 36 cases, respectively (P > .05). By ethnicity, ADENO occurred more frequently among whites (7/19, 37%) than among African and Latino Americans (4/131, 3%); SCCA was more common among African and Latino Americans (127/131, 97%) than among whites (12/19, 63%) (P < .001). Other risk factors did not influence the type of esophageal cancer. The study concluded that the incidence of ADENO increased, primarily among white men, from 1980 to 1995 at UMDNJ-University Hospital. In contrast, the incidence of SCCA remained constant and was the primary type of esophageal cancer in African and Latino Americans. This study supports previous reports that ethnicity influences the histology of esophageal cancer.