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Ann Thorac Surg 2003;76:S1367-S1369
© 2003 The Society of Thoracic Surgeons

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Supplement: understanding disparities in cardiovascular and thoracic surgical outcomes in African-Americans

Geographical distribution and racial disparity in esophageal cancer

^a University of Michigan Medical Center, Ann Arbor, Michigan, USA

^* Address reprint requests to Dr Pickens, University of Michigan Medical Center, 362 Village Green Blvd, #202, Ann Arbor, MI 48105, USA
e-mail: allanp@med.umich.edu

Presented at the symposium on Understanding Disparities in Cardiovascular and Thoracic Surgical Outcomes in African Americans, San Diego, CA, Jan 30, 2003.

The first 300 words of the full text of this article appear below.

Esophageal cancer is a devastating disease that continues to have less than 10% 5-year survival despite advances in multimodality therapy. Esophageal cancer is the eighth most common cancer in the world, yet our understanding of this lethal disease is very limited [1].

The epidemiology of esophageal cancer is characterized by distinctly higher incidence in certain geographical locations and in specific races. These epidemiologic observations are important because of the potential contributions to the understanding of the etiology and pathogenesis of esophageal cancer. The etiology of esophageal cancer remains unknown.

An estimated 80% of primary esophageal neoplasms are malignant. Squamous cell carcinoma and adenocarcinoma are the most common histologic subtypes of esophageal cancer [2]. Both histologic subtypes have very different biological and epidemiologic profiles; consequently, esophageal squamous cell carcinoma and esophageal adenocarcinoma should be viewed as separate disease entities. Squamous cell carcinoma primarily occurs in the middle third of the esophagus, while adenocarcinoma predominately occurs in the lower third of the esophagus [3]. Squamous cell carcinoma remains the most common histologic subtype of esophageal cancer worldwide [1]. The incidence of squamous cell carcinoma has remained relatively stable. However, the incidence of adenocarcinoma has been rising over the past two decades. The incidence of primary esophageal adenocarcinoma has increased at a rate exceeding any other cancer [4]. The allocation of adenocarcinoma of the gastroesophageal junction to distal esophagus rather than gastric cardia may be influenced by increasing awareness of the epidemic of Barrett's esophagus [5].

Barrett's esophagus is metaplastic change of esophageal mucosa to "intestinelike" columnar epithelium. Patients with Barrett's esophagus have a 30- to 40-fold increased risk of developing adenocarcinoma, thus Barrett's mucosa should be considered a premalignant lesion. Nevertheless, most patients with esophageal adenocarcinoma do not have a previous diagnosis of Barrett's esophagus. The . . . [Full Text of this Article]

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