Abstract
Esophageal adenocarcinoma (EAC) has increased substantially to become the most common type of esophageal cancer in the United States, surpassing esophageal squamous cell carcinoma (ESCC). Whether the increasing incidence of EAC is linked to trends in esophageal cancer mortality is unclear. We analyzed esophageal cancer data from the Surveillance, Epidemiology, and End Results-12 cancer registry program, using Joinpoint regression for trend analysis and a decomposition method to attribute changes to population growth, population aging, and epidemiological changes. Age-period-cohort models were employed to estimate incidence and mortality through 2044. Between 1992 and 2019, 39,700 individuals were diagnosed with esophageal cancer, and 35,259 deaths were recorded from 1993 to 2019. The overall incidence of esophageal cancer declined [average annual percent change (AAPC), - 0.7%], but the incidence of EAC increased by an AAPC of 1.6% per year (P < 0.001) from 1992 to 2019. The overall mortality rates decreased by an annual percentage change of 1.0% [95% confidence intervals - 1.2% to - 0.7%] from 1998 to 2019, primarily related to decline in ESCC in 1996-2019. The mortality of EAC increased by an AAPC of 2.2% per year (P < 0.001) over the study period and increased for all demographic characteristic groups. Population aging and growth largely explain the increase in esophageal cancer over the last 3 decades. Future projections (2019-2044) suggest a 31% increase in incidence and deaths, with EAC rates continuing to rise (AAPC, 0.25; 95% CI 0.23-0.28). The number of esophageal cancer cases and deaths have significantly increased and projections indicate that this trend will continue. Effective measures must be taken to address the burden of esophageal cancer.