Oesophageal cancer cases have tripled in under 50s over the past 30 years, a study presented at UEG Week Virtual 2021 has found.
The research, conducted in the Netherlands on almost 60,000 patients, found new cases of oesophageal adenocarcinoma had risen from 0.34 to 0.92 per 100,000 population between 1989 and 2018. There was an average increase of 1.5% in males and 3% in females. The dramatic increases were seen in patients under the age of 50 years old with oesophageal adenocarcinoma.
Experts believe that the rise in cases of oesophageal adenocarcinoma reflect changes in lifestyle-related risk factors for the disease, with increases in unhealthy habits including smoking, poor diet and reduced physical exercise.
Ali Al-Kaabi, from Radboud University Medical Centre in Nijmegen, Netherlands, and lead author of the study, explained, “The incidence of oesophageal adenocarcinoma is increasing in young adults. We know the disease is associated with Barrett’s oesophagus, which is a premalignant condition in the lower end of the oesophagus. Gastro-oesophageal reflux (acid reflux), obesity and smoking are also important risk factors for oesophageal adenocarcinoma. We also know that rates of these risk factors have all increased in young adults over the past 30 years.”
Oesophageal cancer is the seventh most common cancer worldwide and it is a highly fatal disease, accounting for 500,000 deaths each year. There are two main subtypes: oesophageal adenocarcinoma, which is linked to obesity and gastro-oesophageal reflux disease, and oesophageal squamous cell carcinoma, which is linked to alcohol and tobacco consumption.
Although patients under the age of 50 were more likely to be diagnosed at an incurable stage compared to those aged 50-74 and over 74 years (47%, 40% and 29% respectively), younger patients were more likely to undergo multimodality treatments and relative survival for the younger age group rose accordingly in comparison to older patients.
Over the study period, the highest survival rates were seen in under 50s with early-stage diseases, with their five-year survival increasing to 99% (+52%). Those who were classed as ‘potentially curable’ had a five-year survival rate of 46% (+22%), whilst incurable or palliative patients had an one-year survival rate of 32% (+11%).
“Relative survival has markedly improved in the younger age group, with a widening survival gap in comparison to older adults”, commented Ali Al-Kaabi. “These differences may reflect the fact that younger patients are more likely to be treated more aggressively with multiple treatments, including chemoradiotherapy followed by surgery, helping either to provide a cure or prolong patient life.
There are many symptoms for oesophageal cancer, but they can often be difficult to spot and confused with other gastrointestinal symptoms. These include having problems swallowing, feeling or being sick, heartburn and indigestion.
“Based on these study findings, it is important that adults under 50 are aware of these oesophageal cancer symptoms to enable earlier diagnosis and a higher chance of survival”, furthered Ali Al-Kaabi. “This is especially important in high-risk groups, including those that smoke, those with obesity, or those that have high levels of alcohol consumption.”
