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Journal ArticleDOI

A global assessment of the oesophageal adenocarcinoma epidemic

01 Oct 2013-Gut (BMJ Publishing Group)-Vol. 62, Iss: 10, pp 1406-1414
TL;DR: The epidemic appears to be caused by some exposure that was first introduced around 1950, and at least 30 years' variation in estimated time of onset opens prospects for hypothesis-generating ecological analyses.
Abstract: Objective About 20 years ago, the scientific community was first alerted to an enigmatic increase of oesophageal adenocarcinomas in the UK and USA. Subsequently, a virtual epidemic—still unexplained—was confirmed in several western countries. Detailed descriptive data might provide clues to its causes. Design We collected data on incident cases of oesophageal adenocarcinoma from population-based cancer registries in Australia, Europe, North America and Asia. We calculated age-standardised incidence rates and fitted log-linear Poisson models to assess annual rate of increase and to disentangle age-period-cohort effects, linear spine models to estimate rate of increase since 1985, and Joinpoint models to identify possible inflection points. Results With considerable between-registry variation in magnitude and timing, we found a consistent dramatic increase in incidence with an observed or estimated start between 1960 and 1990. The average annual increase ranged from 3.5% in Scotland to 8.1% in Hawaii with similar proportional increase among men and women in most registries and a maintained three to sixfold higher incidence among men. Generally, calendar period was a more important determinant of incidence trends than birth cohort. Where possible to conduct, Joinpoint analyses indicated that the onset of the epidemic varied considerably even between neighbouring countries. Conclusions Given the preponderant period effect and the abrupt onset observed or inferred in most populations, the epidemic appears to be caused by some exposure that was first introduced around 1950. At least 30 years9 variation in estimated time of onset opens prospects for hypothesis-generating ecological analyses.
Citations
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Journal ArticleDOI
01 Mar 2015-Gut
TL;DR: These first global estimates of oesophageal cancer incidence by histology suggested a high concentration of AC in high-income countries with men being at much greater risk.
Abstract: Objective The two major histological types of oesophageal cancer—adenocarcinoma (AC) and squamous cell carcinoma (SCC)—are known to differ greatly in terms of risk factors and epidemiology. To date, global incidence estimates for individual subtypes are still lacking. This study for the first time quantified the global burden of oesophageal cancer by histological subtype. Design Where available, data from Cancer Incidence in Five Continents Vol. X (CI5X) were used to compute, age-specific, sex-specific and country-specific proportions of AC and SCC. Nine regional averages were computed for countries without CI5X data. The proportions were then applied to all oesophageal cancer cases from GLOBOCAN 2012 and age-standardised incidence rates calculated for both histological types. Results Worldwide, an estimated 398 000 SCCs and 52 000 ACs of the oesophagus occurred in 2012, translating to incidence rates of 5.2 and 0.7 per 100 000, respectively. Although SCCs were most common in South-Eastern and Central Asia (79% of the total global SCC cases), the highest burden of AC was found in Northern and Western Europe, Northern America and Oceania (46% of the total global AC cases). Men had substantially higher incidence than women, especially in the case of AC (male to female ratio AC: 4.4; SCC: 2.7). Conclusions These first global estimates of oesophageal cancer incidence by histology suggested a high concentration of AC in high-income countries with men being at much greater risk. This quantification of incidence will aid health policy makers to plan appropriate cancer control measures in the future.

1,046 citations

Journal ArticleDOI
24 Mar 2017-Science
TL;DR: In this article, the authors studied the relationship between the number of normal stem cell divisions and the risk of 17 cancer types in 69 countries throughout the world and revealed a strong correlation (median = 0.80) between cancer incidence and normal stem cells divisions in all countries, regardless of their environment.
Abstract: Cancers are caused by mutations that may be inherited, induced by environmental factors, or result from DNA replication errors (R). We studied the relationship between the number of normal stem cell divisions and the risk of 17 cancer types in 69 countries throughout the world. The data revealed a strong correlation (median = 0.80) between cancer incidence and normal stem cell divisions in all countries, regardless of their environment. The major role of R mutations in cancer etiology was supported by an independent approach, based solely on cancer genome sequencing and epidemiological data, which suggested that R mutations are responsible for two-thirds of the mutations in human cancers. All of these results are consistent with epidemiological estimates of the fraction of cancers that can be prevented by changes in the environment. Moreover, they accentuate the importance of early detection and intervention to reduce deaths from the many cancers arising from unavoidable R mutations.

789 citations

Journal ArticleDOI
TL;DR: Medline and PubMed databases were searched on epidemiology of Helicobacter pylori for the period of April 2013–March 2014, confirming low socioeconomic conditions in childhood are confirmed to be the most important risk factors for H.pylori infection.
Abstract: Medline and PubMed databases were searched on epidemiology of Helicobacter pylori for the period of April 2013–March 2014. Several studies have shown that the prevalence of H. pylori is still high in most countries. In north European and North American populations, about one‐third of adults are still infected, whereas in south and east Europe, South America, and Asia, the prevalence of H. pylori is often higher than 50%. H. pylori remains highly prevalent in immigrants coming from countries with high prevalence of H. pylori. However, the lower prevalence of infection in the younger generations suggests a further decline of H. pylori prevalence in the coming decades. Low socioeconomic conditions in childhood are confirmed to be the most important risk factors for H. pylori infection. Although the way the infection is transmitted is still unclear, interpersonal transmission appears to be the main route. Finally, H. pylori recurrence after successful eradication can still occur, but seems to be an infrequent event.

341 citations

Journal ArticleDOI
TL;DR: The prognosis for patients with EAC has slightly improved, but remains poor, and studies are needed to investigate associations between risk factors and the molecular subtypes of EAC.

340 citations

Journal ArticleDOI
01 Apr 2011-BMJ

338 citations

References
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Book
31 Dec 1997
TL;DR: The aim of this study was to establish a database of histological groups and to provide a level of consistency and quality of data that could be applied in the design of future registries.
Abstract: 1. Techniques of registration 2. Classification and coding 3. Histological groups 4. Comparability and quality of data 5. Data processing 6. Age-standardization 7. Incidence data by site and sex for each registry 8. Summary tables presenting age-standardized rates 9. Data on histological type for selected sites

10,160 citations

Journal ArticleDOI
TL;DR: A joinpoint regression model is applied to describe continuous changes in the recent trend and the grid-search method is used to fit the regression function with unknown joinpoints assuming constant variance and uncorrelated errors.
Abstract: The identification of changes in the recent trend is an important issue in the analysis of cancer mortality and incidence data. We apply a joinpoint regression model to describe such continuous changes and use the grid-search method to fit the regression function with unknown joinpoints assuming constant variance and uncorrelated errors. We find the number of significant joinpoints by performing several permutation tests, each of which has a correct significance level asymptotically. Each p-value is found using Monte Carlo methods, and the overall asymptotic significance level is maintained through a Bonferroni correction. These tests are extended to the situation with non-constant variance to handle rates with Poisson variation and possibly autocorrelated errors. The performance of these tests are studied via simulations and the tests are applied to U.S. prostate cancer incidence and mortality rates.

3,950 citations

Journal ArticleDOI
TL;DR: There is a strong and probably causal relation between gastroesophageal reflux and esophageaal adenocarcinoma, and the relation between reflux And gastric cardia is relatively weak.
Abstract: Background The causes of adenocarcinomas of the esophagus and gastric cardia are poorly understood. We conducted an epidemiologic investigation of the possible association between gastroesophageal reflux and these tumors. Methods We performed a nationwide, population-based, case–control study in Sweden. Case ascertainment was rapid, and all cases were classified uniformly. Information on the subjects' history of gastroesophageal reflux was collected in personal interviews. The odds ratios were calculated by logistic regression, with multivariate adjustment for potentially confounding variables. Results Of the patients interviewed, the 189 with esophageal adenocarcinoma and the 262 with adenocarcinoma of the cardia constituted 85 percent of the 529 patients in Sweden who were eligible for the study during the period from 1995 through 1997. For comparison, we interviewed 820 control subjects from the general population and 167 patients with esophageal squamous-cell carcinoma. Among persons with recurrent sy...

2,949 citations

Journal ArticleDOI
13 Mar 1991-JAMA
TL;DR: Cancer incidence data from nine areas of the United States revealed steadily rising rates from 1976 to 1987 of adenocarcinomas of the esophagus and gastric cardia, which disproportionately affected white men and rarely occurred among women.
Abstract: Analyses of cancer incidence data from nine areas of the United States revealed steadily rising rates from 1976 to 1987 of adenocarcinomas of the esophagus and gastric cardia. The increases among men in this period ranged from 4% to 10% per year, and thus exceeded those of any other type of cancer. In contrast, there were relatively stable trends for squamous cell carcinoma of the esophagus and slight declines for adenocarcinoma of more distal portions of the stomach. Adenocarcinomas of the esophagus and gastric cardia disproportionately affected white men and rarely occurred among women. By the mid-1980s. among white men, adenocarcinomas accounted for about one third of all esophageal cancers, while cardia cancers accounted for about one half of all stomach cancers with specified subsites. The rising incidence rates and similar demographic patterns point to the need for investigation into the causes of these poorly understood cancers. (JAMA. 1991;265:1287-1289)

2,285 citations

Journal ArticleDOI
TL;DR: In this article, the authors describe the use of cubic splines in regression models to represent the relationship between the response variable and a vector of covariates, which can help prevent the problems that result from inappropriate linearity assumptions.
Abstract: We describe the use of cubic splines in regression models to represent the relationship between the response variable and a vector of covariates. This simple method can help prevent the problems that result from inappropriate linearity assumptions. We compare restricted cubic spline regression to non-parametric procedures for characterizing the relationship between age and survival in the Stanford Heart Transplant data. We also provide an illustrative example in cancer therapeutics.

2,186 citations