Rise in Early Onset Esophageal Cancer

by Melissa Fray

Esophageal cancer is one of the deadliest forms of cancer. While it is still uncommon, the incidence of this disease has been on the rise in the previous 40 years, especially among people under the age of 50. In fact, while cases among young people still makes up less than 10 percent of all esophageal cancer cases, the incidence of this cancer rose more than 200 percent between 1975 and 2015, according to the results of a new study.

About Esophageal Cancer

Esophageal cancer starts in the inside lining of the esophagus. It then spreads outwards through the other layers of the esophagus as it progresses. Esophageal adenocarcinoma (EAC) and squamous cell carcinoma are the two most common types of esophageal cancer. EAC forms in the glandular cells in the lining. This is typically in the lower part of the esophagus near the stomach, and releasing fluids such as mucus.

Squamous cell carcinoma, also known as epidermoid carcinoma, starts in the thin, flat squamous cells lining the upper and middle part of the esophagus, although it may begin in the squamous cells anywhere along the esophagus.

EAC is relatively rare, affecting an estimate 18,440 people in the United States in 2020, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. EAC accounts for only about 1 percent of all cancer diagnoses in the nation. However, it is associated with poor outcomes and is lethal in most cases. The 5-year survival rate of EAC is only about 20 percent. The disease claimed an estimated 16,170 lives in 2020.

Risk Factors

Risk factors for esophageal cancer include older age, being male, and being African American. Smoking, heavy alcohol consumption, and Barrett’s esophagus can increase the risk for developing the condition. The American Cancer Society lists other factors that can affect the risk of esophageal cancer, including activity levels, consuming diets high in meat and low in fruits and vegetables, and drinking exceptionally hot liquids (exceeding 149° F or 65° C)

The uptick in cases may be the result of increasing obesity rates in younger people. This can cause the development of chronic gastroesophageal reflux disease (GERD) at an early age. GERD that begins in childhood is likely to continue as a chronic condition in adulthood. Both obesity and chronic GERD are established risk factors for Barrett’s esophagus and esophageal adenocarcinoma.

New Research Shows Cases of Early Onset EAC are Rising

Esophageal cancer typically develops in older adults. In fact, fewer than 15 percent of cases currently occur in people under the age of 55. The results of new research suggest the number of cases among younger patients is rising.

In a study published in January of 2021 in the medical journal, Cancer Epidemiology, Biomarkers & Prevention, researchers looked at the number of patients with esophageal adenocarcinoma between 1975 and 2015. They stratified patients into three age brackets: younger than 50, 50 to 69, and 70 years and older. Of the 34,443 cases of EAC that occurred during that time, 86.2 percent occurred in males in all three age groups; 95 percent occurred in white male and female patients.

The researchers classified the cancers as localized, regional, and distant. The scientific team assessed trends in incidence, disease stage, and survival in three periods: 1975 to 1989, 1990 to 1999, and 2000 to 2015. They created several models to identify predictors of mortality.

The team of researchers found that esophageal adenocarcinoma has increased in patients younger than 50, with an annual percentage change of 2.9 percent from 1975 to 2015. Nearly 85 percent of younger participants presented at the more advanced regional and distant stages. This was compared with 67.3 percent of older patients. The proportion of younger patients with advanced esophageal adenocarcinoma increased over the study period, and at a faster rate than in older groups: 81.8 percent in the 1975 – 1989 group, 75.5 percent in 1990 – 1999, and 84.9 percent in 2000 – 2015. Young-onset participants also experienced a poor 5-year cancer-free survival compared with their older counterparts.

April is Esophageal Cancer Awareness Month

Held every April, Esophageal Cancer Awareness Month is a great time to bring attention to this condition. It is also an ideal opportunity to urge individuals in the community to take preventative measures. This may include making lifestyle changes to reduce their risk of developing cancer of the esophagus.

The U.S. House of Representatives designated April as Esophageal Cancer Awareness Month in May of 2010. In the years since, medical professionals have supported the intent of the designation to recognize the importance of detecting esophageal cancer during its early stages and advancing medical research into the deadly form of cancer. In light of the rise of esophageal cancer in younger people, the event also highlights the importance of early onset EAC prevention.

Gastroenterologists and other healthcare professionals are participating in Esophageal Cancer Awareness Month this April by increasing awareness of the cancer and its risk factors. Many are also making patients more aware of the signs and symptoms of the condition. These include painful or difficulty swallowing, pain behind the breastbone, hoarseness and cough, weight loss, indigestion, and heartburn. Unfortunately, symptoms of esophageal cancer do not usually appear until the advanced stages of the disease.

Raising awareness during Esophageal Cancer Awareness Month can help patients recognize their risk factors for the disease. It also encourages GI doctors to consider esophageal cancer in younger patients presenting with risk factors, signs, and symptoms. You can leverage resources provided by the Esophageal Cancer Awareness Association and the Esophageal Cancer Action Network for ways to show your support virtually this April.