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, 9 (1), 401-417

Epidemiologic Trends and Geographic Distribution of Esophageal Cancer in Canada: A National Population-Based Study

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Epidemiologic Trends and Geographic Distribution of Esophageal Cancer in Canada: A National Population-Based Study

Leila Cattelan et al. Cancer Med.

Abstract

Background: Esophageal cancer can be subdivided into two main histological subtypes with significant variability in their etiology and epidemiology. The incidence of esophageal adenocarcinoma (AC) is increasing across the developed countries, whereas the incidence of esophageal squamous cell carcinoma (SCC) is declining. Several risk factors have been identified in the pathogenesis of each subtype, however, their epidemiologic characteristics and distribution throughout Canada remain poorly understood.

Methods: We performed a retrospective analysis of demographic data across Canada from 1992 to 2010 using two independent population-based cancer registries. The incidence of esophageal cancer, for each subtype, was examined at the levels of provinces/territories, cities, and postal codes.

Results: A total of 19 790 patients were diagnosed with esophageal cancer in Canada between 1992 and 2010; 74% were males. The average national incidence rate was 33.5 cases per million individuals per year. Incidence of esophageal AC increased over time, with notable high-incidence rates on the Vancouver Island, the coasts of the Great Lakes, and the coasts of the Northumberland Strait in the Maritimes. The overall incidence of esophageal SCC has decreased. However, high incidence of esophageal SCC was detected in the Vancouver city, rural eastern Québec, and in the Maritimes. We also report clustering for each subtype using postal codes, which sheds light onto new avenues of research for potential environmental etiologies.

Conclusions: This study, for the first time, provides a detailed analysis on the burden of esophageal cancer in Canada, revealing important geographic clustering trends.

Keywords: Barrett's esophagus; Canada; epidemiology; esophageal adenocarcinoma; esophageal cancer; esophageal squamous cell carcinoma; gastroesophageal reflux disease (GERD); geographic clustering; great lakes; incidence; obesity; pollution; risk factors; smoking.

Conflict of interest statement

Authors declare they have no conflict of interest regarding the content of this article.

Figures

Figure 1
Figure 1
Incidence of esophageal cancer throughout Canada between 1992 and 2010 over time and by province (in cases per million individuals per year). A. Changing incidence rates for esophageal cancer between 1992 and 2010. Linear regression analysis of incidence rates over time [R2] = 0.86; P = .002. The slope of the line was 0.69 cases per million individuals per year. Dotted lines indicate 95% confidence interval. B. Age‐standardized incidence rates of esophageal cancer across Canadian provinces between 1992 and 2010. *Statistically significant lower incidence rates (P < .05) compared to the Canadian average. **Statistically significant higher incidence rates (P < .05) compared to the Canadian average. C. Esophageal cancer incidence trends by province in Canada. Geographic maps illustrate age‐standardized incidence rates of esophageal cancer relative to the national average based on the Canadian Cancer Registry/ Le Registre Québecois du Cancer databases
Figure 2
Figure 2
Incidence of esophageal cancer subtypes throughout Canada between 1992 and 2010 over time and by province (in cases per million individuals per year). A. Changing incidence rates for esophageal adenocarcinoma between 1992 and 2010. Linear regression analysis of incidence rates over time [R2] = 0.95; P = .002. The slope of the line was 0.87 cases per million individuals per year. Dotted lines indicate 95% confidence interval. B. Age‐standardized incidence rates of esophageal adenocarcinoma across Canadian provinces between 1992 and 2010. *Statistically significant lower incidence rate (P < .05) compared to Canadian average. **Statistically significant higher incidence rates (P < .05) compared to Canadian average. C. Changing incidence rates for esophageal squamous cell carcinoma between 1992 and 2010. Linear regression analysis incidence rate over time [R2] = 0.74; P = .002. The slope of the line was −0.19 cases per million individuals per year. Dotted lines indicate 95% confidence interval. D. Age‐standardized incidence rates of esophageal squamous cell carcinoma (per 1 million individuals per year) in the Canadian provinces between 1992 and 2010. *Statistically significant lower incidence rate (P < .05) compared to Canadian average. **Statistically significant higher incidence rates (P < .05) compared to Canadian average
Figure 3
Figure 3
Esophageal adenocarcinoma incidence trends by FSA in Canada. Geographic maps illustrating incidence rates of esophageal adenocarcinoma (cases per million individuals per year) relative to the national average based on the Canadian Cancer Registry/ Le Registre Québécois du Cancer databases. A: Esophageal adenocarcinoma incidence trends by FSA in British Columbia (BC). This figure includes the highest incidence FSA, V8L in Sidney, North Saanich, BC. B: Esophageal adenocarcinoma incidence trends by FSA in Ontario. This figure shows high incidence esophageal adenocarcinoma FSAs in Eastern Ontario surrounding Lake Ontario. C: Esophageal adenocarcinoma incidence trends by FSA in the Maritimes. This figure shows high incidence esophageal adenocarcinoma FSAs in Nova Scotia and PEI
Figure 4
Figure 4
Esophageal squamous cell carcinoma incidence trends by FSA in Canada. Geographic maps illustrating incidence rates of esophageal squamous cell carcinoma (cases per million individuals per year) relative to the national average based on the Canadian Cancer Registry/Le Registre Québecois du Cancer databases. A, High incidence esophageal squamous cell carcinoma FSAs in British Columbia. This figure includes the highest incidence FSA, V6A in Vancouver, BC. B, High incidence esophageal squamous cell carcinoma FSAs in Quebec and New Brunswick. C, High incidence esophageal squamous cell carcinoma FSAs in Nova Scotia and PEI. D, High incidence esophageal squamous cell carcinoma FSAs in Newfoundland and Labrador province

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