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NAACCR Annual Meeting Detroit, 2007

Incidence of Esophageal and Gastric Cancers Subsite and Histology Differences between Hispanics and Non-Hispanics Wu XC, Chen VW, Andrews PA, Ruiz B, Correa, PL Louisiana Tumor Registry. NAACCR Annual Meeting Detroit, 2007. Outline. Background information Objective Methods Results

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NAACCR Annual Meeting Detroit, 2007

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  1. Incidence of Esophageal and Gastric CancersSubsite and Histology Differences between Hispanics and Non-HispanicsWu XC, Chen VW, Andrews PA, Ruiz B, Correa, PLLouisiana Tumor Registry NAACCR Annual Meeting Detroit, 2007

  2. Outline • Background information • Objective • Methods • Results • Discussion

  3. Background information • Hispanics/Latinos constitute the largest and the fastest growing minority group in the United States. • From 1990 to 2000, the U.S. Hispanic population increased by 58%. According to the 2000 U.S. Census, Hispanics account for 13% of U.S. population.

  4. Background information • Gastric cancer is one of the few cancers for which Hispanic population has a higher incidence rate than non-Hispanics. • Esophageal cancer occurs less frequently among Hispanics than non-Hispanics even though it shares some risk factors as gastric cancer.

  5. Background information • Previous studies have suggested that the magnitude of risk for the same risk factors differs by histology and subsite for esophageal and gastric cancers (El-Serag H, 2002; Zhang Z, 1996). • The attributable risk of the same factors may vary from population to population (Brown L, 2000; Engel L, 2003).

  6. Background information • Information on subsite- and histology-specific incidence of these diseases is limited for Hispanics in the literature. • One recent study examined multi-ethnic variations of esophageal and gastric cancers using data from SEER Program. But non- cardia gastric adenocarcinoma was not included (Kubo A, 2004).

  7. Objective • Examine esophageal and gastric cancer incidence rates by subsite and histology among Hispanics and compare them with those of non-Hispanics.

  8. Methods – data source • We used 1998-2002 cancer incidence data from 37 population-based cancer registries, covering 68% of US population including 66% of Hispanic population. • Ethnicity was coded based on information from medical records and NAACCR’s Hispanic identification algorithm (NHIA).

  9. Methods – inclusion criteria • Invasive cancer • Topographic codes (ICD-O-3) - Esophageal cancer: C15.0-C15.9 - Gastric cancer: C16.0-C16.9 • No lymphoma • Microscopically confirmed only (6%)

  10. Methods – esophageal anatomic subsites • Proximal & middle segments: - cervical esophagus (C15.0) - upper third of esophagus (C15.3) - middle third of esophagus (C15.4) • Distant segment - abdominal esophagus (C15.2) - lower third of esophagus (C15.5) • Unspecified - thoracic esophagus (C15.1) - overlapping (C15.8) - esophagus, NOS (C15.9)

  11. Methods - gastric anatomic subsites • Cardia (C16.0) • Noncardia (C16.1-C16.6) - fundus and corpus (C16.1-C16.2) - antrum and pylorus (C16.3-C16.4) - curvatures (C16.5-C16.6) • Unspecified (C16.8-C16.9) - overlapping (C16.8) - stomach, NOS (C16.9)

  12. Methods - histology types • Squamous cell carcinoma (SCC) ICD-O-3 morphology codes: M8050-M8084 • Adenocarcinoma ICD-O-3 morphology codes: M8140-M8576 • Others

  13. Methods – statistical analysis • The following statistics were generated by subsite and histology for Hispanics and non-Hispanic whites (NHW). - relative frequencies - age-adjusted (2000 U.S) incidence rates - rate ratios and 95% CI

  14. Outline • Background information • Objective • Methods • Results • Discussion

  15. Histology Types of Esophageal Cancer by Race/Ethnicity1998-2002, Men

  16. Histology Types of Esophageal Cancer by Race/Ethnicity1998-2002, Women

  17. Rates* and Rate Ratios of Esophageal Cancer 1998-2002, Men * Age-adjusted (2000 U.S.) rate per 100,000

  18. Rates* and Rate Ratios of Esophageal Cancer 1998-2002, Women * Age-adjusted (2000 U.S.) rate per 100,000

  19. Rates of Esophageal Cancer by Histology and Anatomic Subsite, 1998-2002, Men • The rates of SCC were significantly higher in Hispanics than NHW for proximal & middle segments and unspecified subsite group. • The rates of adenocarcinoma were significantly lower in Hispanics than NHW for all anatomic subsites.

  20. Rates of Esophageal Cancer by Histology and Anatomic Subsite, 1998-2002, Women • For SCC, there were no significant differences between Hispanics and NHW for all anatomic subsites. • The rates of adenocarcinoma were significantly lower in Hispanics than NHW for proximal & middle segments and distal segment.

  21. Histology Types of Gastric Cancer by Race/Ethnicity 998-2002

  22. Anatomic Subsites of Gastric Adenocarcinoma by Race/Ethnicity, 1998-2002, Men

  23. Anatomic Subsites of Gastric Adenocarcinoma by Race/Ethnicity, 1998-2002. Women

  24. Rates* and Rate Ratios of Gastric Adenocarcinoma 1998-2002, Men * Age-adjusted (2000 U.S.) rate per 100,000

  25. Rates* and Rate Ratios of Gastric Adenocarcinoma 1998-2002, Women * Age-adjusted (2000 U.S.) rate per 100,000

  26. Rates of Noncardia Gastric Adenocarcinoma by Anatomic Subsite Group, 1998-2002 • The rates were significantly higher in Hispanics than NHW for all individual subsite groups of noncardia gastric adenocarcinoma for both men and women. - fundus and corpus (C16.1-C16.2) - antrum and pylorus (C16.3-C16.4) - curvatures (C16.5-C16.6)

  27. Discussion • Although overall rates of esophageal cancer are lower in Hispanics than NHW, the rates of esophageal SCC are statistically significantly higher in Hispanics than NHW for men. • The rates of esophageal adenocarcinoma are significantly lower in Hispanics than NHW, for both men and women.

  28. Discussion • Overall rates of gastric cancer are singificantly higher in Hispanics than NHW, for both men and women. • The rates of gastric cardia adenocarcinoma vary by sex: lower in Hispanics than NHW for men but higher in Hispanics for women. • The rates of noncardia gastric adenocarcinoma are significantly higher in Hispanics than NHW for both men and women.

  29. Discussion • The higher rate of esophageal SCC in Hispanics than NHW for men cannot be explained by prevalence of the known risk factors such as tobacco smoking, alcohol consumption, and diet. • The longitudinal data from NHIS indicate that Hispanics have the lowest prevalence of current smoking of all racial/ethnic groups over time and the percentages of persons with > 5 drinks in one day at least once in the past year are also significantly lower among Hispanics (Thompson F, 2005).

  30. Discussion • The data from the same survey also indicate that Hispanics have higher intakes of fruits and vegetables and fiber than do NHW (Thompson F, 2005). • Kaiser Permanent Medical Care Program (KPMCP) study found that Hispanics were less likely than NHW to eat vegetables and fruits (Otero-Sabogal R, 1995).

  31. Discussion • Chronic gastroesophageal reflux disease (GERD) and obesity have been found to have strong associations with occurrence of esophageal and gastric cardia adenocarcinoma (Lagergren J, 1999; Brown L, 1995). • One study found that prevalence of Barrett’s esophagus was similar in Hispanics and whites (Bersentes K, 1998).

  32. Discussion • The prevalence of obesity is about the same in Hispanics and whites for men but higher in Hispanics than whites for women (Denney J, 2004). • Smoking is a major risk factor for esophageal and gastric cardia adenocarcinoma, accounting for approximately 40% of cases (Gammon MD, 1997).

  33. Discussion • It is not clear the role of dietary factors plays in the substantially higher rates of noncardia gastric cancer in Hispanics than NHW. • Many traditional dietary commodities have not appropriately evaluated. It is not clear if they contain some high levels of nitrate, which is a risk factor for gastric cancer.

  34. Discussion • Helicobacter pyloriinfection has emerged as an important risk factor for gastric cancer (Correa P, 1991; Hansson L, 1993). • It appears that Helicobacter pylori infection is most likely to contribute to the high incidence rates of noncardia gastric adenocarcinoma in Hispanics than NHW.

  35. Discussion • Prevalence of H pylori infection is higher in developing countries than developed countries (EUROGAST study group, 1993). • Poor hygiene and crowded living condition facilitate the transmission of the infection among family members (Brown L, 2000). • The infection is predominantly acquired in childhood and tends to stay active unless it is treated with antibiotics (Banatvala N, 1993; Correa P, 2003). • In the U.S. 40% of Hispanics are foreign born and a high percentage of them lives in poverty.

  36. Discussion • The data from the National Health and Nutrition Examination Survey (NHANES) III indicate the sero-prevalence of H pylori is significantly higher in Mexican Americans than NHW (63% vs. 24%) (McQuillan G, 2005).

  37. Concluding remarks • Observed cancer incidence patterns cannot be explained clearly by what we know about prevalence of a few known risk factors. • Information on prevalence of risk factors is needed, especially for Hispanic population. • Research on effect of traditional diet, genetic polymorphism, and other risk factors is warranted.

  38. ACKNOWLEDGEMENTS This study was supported by NAACCR, in cooperation with Louisiana Tumor Registry/School of Public Health, LSUHSC with funds from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under Contract No. HSN261200444001C and ADB No. N02-PC 4401.

  39. Publication The manuscript from this study has been published in Cancer Causes and Control, April 4, 2007. For a copy of this manuscript, please email me at xwu@lsuhsc.edu

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