The influence of age, sex, and race on the incidence of esophageal cancer in the United States (1992–2006)

Helena Nordenstedt*ab & Hashem El-Seragaa Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine, Houston Center for Quality of Care and Utilization Studies, Houston, TX, USAb Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedenCorrespondence: Helena Nordenstedt,MD, PhD, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden. helena.nordenstedt@ki.se Abstract Background. There is a striking male predominance in esophageal cancer patients. Sex hormones have been suggested as a contributing factor and these are influenced by age and race. In this study, we examined the male-to-female incidence rate ratios of esophageal cancer in the United States. Methods. We used data from 13 registries in the Surveillance, Epidemiology, and End Results (SEER) database to calculate male-to-female incidence rate ratios of esophageal adenocarcinoma (EA) and esophageal squamous cell carcinoma (ESCC) diagnosed during 1992–2006 in different age and race groups. Results. For EA, all races had similar sex and age-specific incidence patterns showing a peak in the male-to-female incidence rate ratio in the age group 50–59, and an age-related decline thereafter. The highest male-to-female ratio was seen in Hispanics (20.5) and the lowest in Blacks (7.0) compared with 10.8 in Whites. By contrast, the male-to-female incidence rate ratios were low and fairly stable throughout the different age groups in ESCC. Conclusion. The male-to-female incidence rate ratios in esophageal cancer vary considerably according to histology, age, and race. The highest sex ratios were seen in EA in the age group 50–59, rendering plausibility to the hypothesis that female sex hormone exposure may play a protective role in the development of this cancer.