Young onset of esophageal cancer is rare but on the rise: Study says poor five-year survival rate likely among patients

You may not be as aware of the threat of esophageal cancer as you may be of breast, lung or even prostate cancer, but the prevalence of this cancer type is gradually increasing. According to the American Institute for Cancer Research, esophageal cancer is the seventh most commonly occurring cancer among men and the 13th among women worldwide.

The US National Cancer Institute says that esophageal cancer occurs when malignant cells and tumours form in the esophagus (the hollow tube that connects the mouth to the stomach). Smoking, heavy alcohol use and untreated gastroesophageal reflux disease can cause this type of cancer. The two most common forms of esophageal cancer are squamous cell carcinoma (usually found in the upper and middle part of the esophagus) and adenocarcinoma (usually located in the lower part of the esophagus, near the stomach).

Esophageal cancer in middle-aged adults?

Esophageal cancer incidence is also more associated with older age (above 50 years of age, commonly), which may be why many don’t realise that it can happen at a young age too. A study published in the Journal of Thoracic Disease in 2018 suggests that an increasing number of young patients are being diagnosed with esophageal cancer worldwide and the cases are more often of esophageal adenocarcinoma. This study also noted that while it’s likely that the clinical characteristics and outcomes of young-onset esophageal adenocarcinoma may be different from those in patients above 50 years of age, not much data or research is available on this subject.

A new study published in the journal Cancer Epidemiology, Biomarkers & Prevention throws much-needed light on this crucial subject. This study, conducted by gastroenterologists at the Mayo Clinic, Rochester, Minnesota, aimed to assess time-related trends in the incidence and outcomes of young-onset esophageal adenocarcinoma based on data collected from a population-based database called Surveillance, Epidemiology and End Results 9. The researchers identified 34,443 patients diagnosed with esophageal adenocarcinoma between 1975 and 2015 and stratified them into three age groups: below 50 years, between 50 and 69 years and 70 years or above.

Identifying the rise in young-onset esophageal cancer

The researchers then mapped trends in cancer incidence, disease stage and survival through three periods of 1975-1989, 1990-1999 and 2000-2015. They also tried to identify the predictors of cancer-related death. The scientists observed that esophageal adenocarcinoma incidence had steadily increased in patients below 50 years of age at an annual percentage of 2.9% over the 30-year period of study. While this steady increase is alarming enough, the researchers also found that the young-onset esophageal adenocarcinoma cases presented with more advanced stages of cancer compared to older patients who developed the disease in later stages of life.

What’s more, these young-onset patients had a comparatively poorer five-year survival rate. The five-year survival rate of younger patients was 22.9 percent, while the older patients had a rate of 29.6 percent. The researchers thus concluded that cases of young-onset esophageal adenocarcinoma, while rare, are gradually rising. Their findings support that since these patients have more severe cancer, the burden of advanced disease is also rising subsequently and leading to poorer cancer survival rates. Clearly, current diagnostic and management strategies for young-onset esophageal adenocarcinoma need to be reevaluated globally and tailored to suit the needs of these younger patients better.

For more information, read our article on Esophageal cancer.

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