Objective: To investigate trends in the incidence of adenocarcinoma (AC) of the oesophagus in New South Wales, factors associated with a diagnosis of AC, and factors associated with survival of patients with AC.
Design and setting: We examined all cases of invasive oesophageal cancer recorded in the NSW Central Cancer Registry from 1972 to 2005. The Accessibility/Remoteness Index of Australia was used to assess geographical remoteness and the Index of Relative Socio-Economic Disadvantage to assess socioeconomic status.
Results: The overall incidence of oesophageal AC in NSW increased in both males and females (annual percentage change, 4.2% [95% CL, 2.7%, 5.8%] in males [1988–2005] and 4.3% [95% CL, 1.8%, 7.0%] in females [1983–2005]). A diagnosis of AC was significantly associated with being male (adjusted odds ratio [AOR], 4.37 [95% CL, 3.84, 4.98]; P < 0.001); a younger age at diagnosis (P trend < 0.001); having distant rather than localised disease spread (AOR, 2.12 [95% CL, 1.82, 2.48]; P < 0.001); higher socioeconomic status (P trend < 0.001); and living in an inner regional area (AOR, 1.26 [95% CL, 1.11, 1.43]; P < 0.001) or outer regional area (AOR, 1.19 [95% CL, 1.00, 1.41]; P = 0.05) compared with a major city. Early diagnosis of AC was associated with substantial improvement in survival outcomes: patients with metastatic disease at diagnosis had a three times greater risk of dying than those with localised AC at diagnosis.
Conclusion: The incidence of AC is increasing in NSW. Possible contributing factors include increasing obesity, which is associated with increased incidence of gastro-oesophageal reflux disease. Survival may be improved by diagnosis at an earlier stage and changes in modifiable risk factors (eg, smoking, diet, exercise).
- 1. Ginsberg GG, Fleisher DE. Tumors of the esophagus. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology, diagnosis, management. 8th ed. Philadelphia: Saunders Elsevier, 2006.
- 2. Tracey EA, Baker D, Chen W, et al. Cancer in New South Wales: incidence, mortality and prevalence report 2005. Sydney: Cancer Institute NSW, 2007.
- 3. Chou JC, Gress FG. Esophageal tumors. In: Friedman SL, McQuaid K, Grendell JH, editors. Current diagnosis and treatment in gastroenterology. 2nd ed. New York: McGraw-Hill, 2003.
- 4. Pera M, Cameron AJ, Trastek VF, et al. Increasing incidence of adenocarcinoma of the esophagus and esophago-gastric junction. Gastroenterology 1993; 104: 510-517.
- 5. El-Serag HB, Sonnenberg A. Opposing time trends of peptic ulcer disease and reflux disease. Gut 1998; 43: 327-331.
- 6. Crane SJ, Locke GR 3rd, Harmsen WS, et al. The changing incidence of oesophageal and gastric adenocarcinoma by anatomic sub-site. Aliment Pharmacol Ther 2007; 25: 447-453.
- 7. Lord RV, Law MG, Ward RL, et al. Rising incidence of oesophageal adenocarcinoma in men in Australia. J Gastroenterol Hepatol 1998; 13: 356-362.
- 8. Whiteman DC, Sadeghi S, Pandeya N, et al. Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus. Gut 2008; 57: 173-180.
- 9. De Jonge PJ, Wolters LM, Steyerberg EW, et al. Environmental risk factors in the development of adenocarcinoma of the oesophagus or gastric cardia: a cross-sectional study in a Dutch cohort. Aliment Pharmacol Ther 2007; 26: 31-39.
- 10. Spechler SJ. Esophageal diseases. In: Friedman SL, McQuaid K, Grendell JH, editors. Current diagnosis and treatment in gastroenterology. 2nd ed. New York: McGraw-Hill, 2003.
- 11. Posner MC, Forastiere AA, Minsky BD. Cancers of the gastrointestinal tract. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 7th ed. Philadelphia: Lippincott, Williams and Wilkins, 2005.
- 12. Crane SJ, Locke GR 3rd, Harmsen WS, et al. Subsite-specific risk factors for esophageal and gastric adenocarcinoma. Am J Gastroenterol 2007; 102: 1596-1602.
- 13. Esteban D, Whelan S, Laudico A, Parkin D, editors. Manual for cancer registry personnel. Lyon: International Agency for Research on Cancer, 1995. (IARC Technical Report No 10.)
- 14. Barraclough H, Morrell S, Arcorace M, et al. Degree-of-spread artefact in the New South Wales Central Cancer Registry. Aust N Z J Public Health 2008; 32: 414-416.
- 15. GISCA. About ARIA+ (Accessibility/Remoteness Index of Australia). http://www.gisca.adelaide.edu.au/products_services/ariav2_about.html (accessed Jun 2009).
- 16. Pink B. An Introduction to Socio-Economic Indexes for Areas (SEIFA). Information paper. Canberra: Australian Bureau of Statistics, 2006. (ABS Cat. No. 2039.0.)
- 17. Reeves GK, Pirie K, Beral V, et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007; 335: 1134-1144.
- 18. Population Health Division. The health of the people of New South Wales. Report of the Chief Health Officer, 2006. Sydney: NSW Department of Health, 2006.
- 19. Janus ED, Laatikainen T, Dunbar JA, et al. Overweight, obesity and metabolic syndrome in rural southeastern Australia. Med J Aust 2007; 187: 147-152. <MJA full text>
- 20. Di Sipio T, Rogers C, Newman B, et al. The Queensland Cancer Risk Study: behavioural risk factor results. Aust N Z J Public Health 2006; 30: 375-382.
- 21. Hughes-Anderson W, Rankin SL, House J, et al. Open access endoscopy in rural and remote Western Australia: does it work? ANZ J Surg 2002; 72: 699-703.
- 22. Harris MF, McKenzie S. Men’s health: what’s a GP to do? Med J Aust 2006; 185: 440-444. <MJA full text>
- 23. Aldulaimi DM, Cox M, Nwokolo CU, et al. Barrett’s surveillance is worthwhile and detects curable cancers. A prospective cohort study addressing cancer incidence, treatment outcome and survival. Eur J Gastroenterol Hepatol 2005; 17: 943-950.
- 24. Inadomi JM, Sampliner R, Lagergren J, et al. Screening and surveillance for Barrett esophagus in high-risk groups: a cost–utility analysis. Ann Intern Med 2003; 138: 176-186.
- 25. Mashimo H, Wagh MS, Goyal RK. Surveillance and screening for Barrett oesophagus and adenocarcinoma. J Clin Gastroenterol 2005; 39 (4 Suppl 2): S33-S41.
- 26. Macdonald CE, Wicks AC, Playford RJ. Final results from 10 year cohort of patients undergoing surveillance for Barrett’s oesophagus: observational study. BMJ 2000; 321: 1252-1255.
- 27. Ajani J, Bekaii-Saab T, D’Amico TA, et al. NCCN clinical practice guidelines in oncology. Esophageal cancer. Fort Washington, Pa: National Comprehensive Cancer Network, 2008. http://www.nccn.org/professionals/physician_gls/PDF/esophageal.pdf (accessed Jul 2009).
- 28. Population Health Division. The health of the people of New South Wales. Report of the Chief Health Officer, 2008: summary report. Sydney: NSW Department of Health, 2008.
- 29. Australian Bureau of Statistics. ASGC remoteness classification: purpose and use. Canberra: ABS, 2003. (Census Paper No. 03/01.)
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