Epidemiologic Trends and Disparities in Esophageal Cancer in the U.S.: A SEER and CDC WONDER Analysis

Background and Objective: Esophageal cancer remains a highly fatal malignancy with notable disparities based on sex and race. This study aimed to assess recent trends in incidence, stage at diagnosis, survival outcomes, and mortality in the U.S., with a focus on demographic disparities. Methods: Data from the SEER Program (2017–2021) were used to assess incidence across sex, race/ethnicity, subtype, and stage. Five-year survival (2014–2020) was analyzed by demographic factors and stage. Mortality trends (1999–2020) were evaluated using CDC WONDER death certificate data, stratified by race and gender. Results: Esophageal cancer incidence was 4.2/100,000—higher in males (7.1) than females (1.7). American Indian/Alaska Natives had the highest rates (5.2) whereas Asian/Pacific Islanders the lowest (2.2). Adenocarcinoma was the predominant subtype (2.7), followed by squamous cell carcinoma (1.1). Most cases were diagnosed at regional (1.3) or distant stages (1.5). 5-year survival was higher in females (21.6%) and highest at localized stage (48.1%). Survival varied by race, lowest in American Indian (14.8%). Age-adjusted mortality (AAMR) declined from 4.36 in 1999 to 3.67 in 2020. Male AAMRs peaked in 2001 (7.83) and declined to 6.45 (2020); female AAMRs peaked the same year (1.78→1.36). Overall (1999–2020), rates were 7.31 (males) vs 1.56 (females), with 4.7× higher mortality in men. Mortality among Black/African Americans decreased significantly, narrowing racial gaps. Conclusion: Findings underscore the need for transdisciplinary efforts integrating epidemiology, surgical oncology, policy, and community outreach. Culturally tailored screening, equitable surgical access, and workforce diversity are key to strengthening surgical systems.