Shifting Patterns in Racial and Ethnic Disparities in Esophageal Cancer: A Population-Based Analysis of 60,000...

Racial and ethnic disparities in esophageal cancer are well documented, particularly between White and Black patients, but less is known about disparities among other groups or how disparities have evolved. We aimed to characterize longitudinal trends in tumor characteristics, treatment, and survival across racial and ethnic groups.

Using the Surveillance, Epidemiology, and End Results database, we identified 59,573 patients diagnosed with esophageal cancer between 2004 and 2020. Patients were categorized as White, Black, Hispanic, Asian, or Native American. Trends in histology, tumor site, tumor (T) stage, and surgical utilization were analyzed. Multivariable Cox and logistic regression models assessed survival and factors associated with stage at diagnosis.

Histologic disparities narrowed, with significant declines in the esophageal squamous cell carcinoma (ESCC):esophageal adenocarcinoma (EAC) ratio among White, Black, and Hispanic patients. ESCC remained predominant among Black and Asian patients. Across most groups, T1 diagnoses decreased whereas T3 increased, making T3 the most common stage by 2020. Surgical utilization declined among White patients and remained lower among Black patients. In adjusted analyses, Black race was associated with worse survival, whereas Asian race was associated with improved survival.

Although histologic disparities are narrowing, concerning shifts across groups toward later T-stage diagnosis and declining surgical utilization highlight emerging challenges in early detection and treatment.

These findings update prior characterizations of disparities in esophageal cancer and identify emerging shifts in histology, stage at diagnosis, and treatment utilization, underscoring the need for targeted early detection strategies and structural interventions to reduce inequities in outcomes.