Atlas of Cancer Mortality -

Atlas of Cancer Mortality

Results -- Geographic Patterns for Esophageal Cancer

Marked geographic variation among white males and females was seen in both periods, especially in recent years, with elevated rates primarily in the northeastern and mid-Atlantic states and in scattered midwestern areas. Low rates have persisted among white males in the southern and Rocky Mountain states and among white females in the central portions of the country. The geographic variation has been more pronounced among males than females and among whites than blacks. However, high rates among white females have emerged recently in certain areas along the Gulf coast and in the far western states. Tobacco smoking and alcohol drinking are the major risk factors for esophageal cancer,^22,23 as they are for oral cancer, and they contribute to the high rates in urban areas and to the striking black/white differentials in rates. ²⁴ In Washington, DC, and coastal areas of South Carolina, where the rates are especially high in blacks, case-control studies have revealed strong associations with alcohol consumption and tobacco use along with deficiencies of fruit and vegetable consumption. ^25-27 Heavy use of moonshine (home-brewed) whiskeys among blacks in the South Carolina low country appears partly responsible for the elevated rates in that area. ²⁷ Mortality rates for esophageal cancer almost doubled among blacks from the 1950s to their peak in the 1980s, accounting for increases in the black/white rate ratios over time. ^23,28

In recent decades, a remarkable shift has occurred in the histologic patterns of esophageal cancer among whites, as incidence rates for squamous cell cancer have decreased while rates for adenocarcinoma have increased dramatically to surpass the rates for squamous cancer of the esophagus among males. ^29,30 The reasons for the upward trend in esophageal adenocarcinoma are not entirely clear but may be related in part to smoking habits ³¹ and obesity, ³² which appear to promote the development of reflux esophagitis and its evolution to Barrett's esophagus, a precursor state for this cancer. ^33,34 Since histologic type is not routinely recorded on death certificates, the geographic differences in the two forms of esophageal cancer could not be evaluated. Incidence rates among white males in the Surveillance, Epidemiology, and End Results (SEER) program during 1973–95 were highest in Connecticut and Seattle for esophageal cancer overall and for esophageal adenocarcinoma, while the rates for squamous cell carcinoma were highest in Hawaii and Connecticut (unpublished SEER data). Rates for total esophageal cancer and both histologic types were lowest in New Mexico and Utah.

References

22. Fraumeni JF Jr, Blot WJ. Geographic patterns of esophageal cancer mortality in the United States. J Chronic Dis 1977;30:759-67.

23. Blot WJ. Esophageal cancer trends and risk factors. Semin Oncol 1994;21:403-10.

24. Brown LM, Hoover RN, Greenberg RS, Schoenberg JB, Schwartz AG, Swanson GM, Liff JM, Silverman DT, Hayes RB, Pottern LM. Are racial differences in squamous cell esophageal cancer explained by alcohol and tobacco use? J Natl Cancer Inst 1994;86:1340-5.

25. Pottern LM, Morris LE, Blot WJ, Ziegler RG, Fraumeni JF Jr. Esophageal cancer among black men in Washington, DC. I. Alcohol, tobacco, and other risk factors. J Natl Cancer Inst 1981;67:777-83.

26. Ziegler RG, Morris LE, Blot WJ, Pottern LM, Hoover R, Fraumeni JF Jr. Esophageal cancer among black men in Washington, DC. II. Role of nutrition. J Natl Cancer Inst 1981;67:1199-206.

27. Brown LM, Blot WJ, Schuman SH, Smith, VM, Ershow AG, Marks RD, Fraumeni JF Jr. Environmental factors and high risk of esophageal cancer among men in coastal South Carolina. J Natl Cancer Inst 1988;80:1620-5.

28. Blot WJ, Fraumeni JF Jr. Trends in esophageal cancer mortality among US blacks and whites. Am J Public Health 1987;77:296-8.

29. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991;265:1287-9.

30. Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998;83:2049-53.

31. Gammon MD, Schoenberg JB, Ahsan H, Risch HA, Vaughan TL, Chow WH, Rotterdam H, West AB, Dubrow R, Stanford JL, Mayne ST, Farrow DC, Niwa S, Blot WJ, Fraumeni JF Jr. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia (see comments). J Natl Cancer Inst 1997;89(17):1277-84.

32. Chow WH, Blot WJ, Vaughan TL, Risch HA, Gammon MD, Stanford JL, Dubrow R, Schoenberg JB, Mayne ST, Farrow DC, Ahsan H, West AB, Rotterdam H, Niwa S, Fraumeni JF Jr. Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 1998;90(2):150-5.

33. Chow WH, Finkle WD, McLaughlin JK, Frankl H, Ziel HK, Fraumeni JF Jr. The relation of gastroesophageal reflux disease and its treatment to adenocarcinomas of the esophagus and gastric cardia. JAMA 1995;274:474-7.

34. Reid BJ, Barrett MT, Galipeau PC, Sanchez CA, Neshat K, Cowan DS, Levine DS. Barrett's esophagus: ordering the events that lead to cancer. Eur J Cancer Prev 1996;5 Suppl 2:57-65.

Suggested Citation

Devesa SS, Grauman DG, Blot WJ, Pennello G, Hoover RN, Fraumeni JF Jr. Atlas of cancer mortality in the United States, 1950-94. Washington, DC: US Govt Print Off; 1999 [NIH Publ No. (NIH) 99-4564].