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Sunday Poster Session

Category: Practice Management

P1211 - Upper Gastrointestinal Cancer Incidence-Based Mortality Is Highest in Racial and Ethnic Minority Groups Not Prioritized by Current Screening Paradigms

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
Alyyah Malick, MD1, Jennifer Ferris, PhD2, Chin Hur, MD, MPH3, Julian Abrams, MD, MS2, Ali Soroush, MD, MS4
1New York Presbyterian Columbia University Irving Medical Center, New York, NY; 2New York Presbyterian, New York, NY; 3Columbia University Irving Medical Center, New York, NY; 4Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Current strategies for upper gastrointestinal (UGI) cancer screening focus on cancer-specific risk, and particularly on esophageal adenocarcinoma (EAC). A cumulative cancer approach is best tailored to a single upper endoscopic screening exam. This study aims to assess cumulative incidence-based mortality (IBM) of all UGI cancers to compare cumulative and cancer-specific racial/ethnic and sex disparities.

Methods: All analyses were performed using Surveillance, Epidemiology, and End Results Research data covering 17 cancer registries and approximately 26.5% of the United States population. Data for patients 20 years old or greater who were diagnosed with EAC, esophageal squamous cell carcinoma (ESCC), cardia gastric cancer (CGC), non-cardia gastric cancer (NCGC), or colorectal adenocarcinoma (CRC) from 2000 to 2019 were extracted. Colorectal cancer data is shown as a comparison since population-wide endoscopic screening is performed for this cancer. Age-adjusted incidence-based mortality (IBM) was calculated as a rate per 100,000 population and measures death among incident cases, providing more accuracy for deaths attributable to cancer compared to death certificate mortality. IBM was stratified by sex and race/ethnicity.

Results: Cumulative IBM from upper GI cancers is highest among Blacks (10.61) and higher among all minority groups (8.62-10.61) compared to non-Hispanic whites (7.80, p< 0.01, Figure panel A). For EAC and CGC, IBM is highest among non-Hispanic whites (2.90 and 1.83 respectively, Table). For ESCC, IBM is highest among Blacks (3.16, p < 0.01). For NCGC, IBM is highest among Asian/Pacific Islanders (4.02, p< 0.01). IBM from ESCC among Blacks as well as IBM from NCGC among all minority groups is higher than IBM from EAC among non-Hispanic whites (p < 0.02). IBM from UGI cancer in males (13.19) is not significantly different than IBM from CRC in females (13.28, p = 0.24, Figure panel B). IBM from UGI cancers among Black, Hispanic, and American Indian/Alaska Native males (16.43, 13.76, and 15.23 respectively) is greater than IBM from CRC among white females (13.26, p < 0.01).

Discussion: This study highlights the extent and patterns of disparities in UGI cancer mortality. These cancers have a significantly higher mortality burden for nonwhite populations that are currently not targeted by any systematic population-level screening approach. Current screening approaches must be reevaluated to reduce these health disparities.

Figure: Figure: Comparative Analysis of Cancer-Specific and Cumulative Upper Gastrointestinal Cancer Incidence-Based Mortality. (A) Stratified by race/ethnicity, (B) Stratified by sex (cumulative only).
Abbreviations: EAC = esophageal adenocarcinoma, ESCC = esophageal squamous cell carcinoma, CGC = cardia gastric cancer, NCGC = non-cardia gastric cancer, UGI = upper gastrointestinal tract cancer, CRC = colorectal adenocarcinoma. All rates per 100,000.
 Incidence-Based Mortality (Rates per 100,000, 95% CI)
 EACESCCCGCNCGCUGICRC
Overall2.26 (2.23-2.29)1.21 (1.18-1.23)1.60 (1.57-1.62)2.07 (2.04-2.10)8.40 (8.34-8.46)15.87 (15.79-15.96)
       
Sex      
Male4.35 (4.28-4.41)1.74 (1.70-1.78)2.81 (2.76-2.86)2.66 (2.61-2.71)13.19 (13.08-13.30)19.16 (19.02-19.29)
Female0.57 (0.55-0.59)0.77 (0.75-0.80)0.62 (0.59-0.64)1.63 (1.59-1.66)4.57 (4.51-4.63)13.28 (13.18-13.38)
       
Race/Ethnicity      
Non-Hispanic White2.90 (2.86-2.94)0.99 (0.97-1.02)1.83 (1.80-1.87)1.21 (1.18-1.24)7.80 (7.73-7.87)15.80 (15.70-15.90)
Black0.65 (0.60-0.71)3.16 (3.04-3.28)0.96 (0.89-1.03)3.82 (3.68-3.96)10.61 (10.38-10.84)22.81 (22.47-23.15)
American Indian/Alaska Native1.79 (1.48-2.15)1.44 (1.15-1.79)1.47 (1.17-1.81)3.37 (2.91-3.87)10.24 (9.44-11.09)17.97 (16.87-19.11)
Asian or Pacific Islander0.48 (0.43-0.53)1.27 (1.19-1.34)0.99 (0.93-1.06)4.02 (3.88-4.15)8.62 (8.43-8.82)12.38 (12.15-12.61)
Hispanic1.35 (1.28-1.42)0.90 (0.85-0.96)1.21 (1.15-1.28)3.84 (3.72-3.96)9.46 (9.28-9.64)13.75 (13.53-13.97)

Table: Incidence-Based Mortality Stratified by Sex and Race/Ethnicity.
Abbreviations: EAC = esophageal adenocarcinoma, ESCC = esophageal squamous cell carcinoma, CGC = cardia gastric cancer, NCGC = non-cardia gastric cancer, UGI = upper gastrointestinal tract cancer, CRC = colorectal adenocarcinoma.


Disclosures:
Alyyah Malick indicated no relevant financial relationships.
Jennifer Ferris indicated no relevant financial relationships.
Chin Hur: Exact Sciences – Consultant. Vivante – Stock Options.
Julian Abrams: Castle Biosciences – Consultant. Exact Sciences – Consultant. IsoThrive – Consultant. Pentax medical – research support.
Ali Soroush indicated no relevant financial relationships.


Alyyah Malick, MD1, Jennifer Ferris, PhD2, Chin Hur, MD, MPH3, Julian Abrams, MD, MS2, Ali Soroush, MD, MS4. P1211 - Upper Gastrointestinal Cancer Incidence-Based Mortality Is Highest in Racial and Ethnic Minority Groups Not Prioritized by Current Screening Paradigms, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.