S1000 Racial and Gender Disparites in Esophageal Adenocarcinoma (EAC): A 20-Year-Trend Analysis From Surveillance, Epidemiology, and End Results (SEER) Database

Introduction: Esophageal adenocarcinoma (EAC) is the most common form of esophageal cancer in the Western world, with rising incidence over recent decades. EAC typically develops from Barrett’s esophagus, a condition resulting from chronic gastroesophageal reflux disease (GERD). In the U.S., EAC has surpassed squamous cell carcinoma as the predominant esophageal cancer type. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) 22 registry database to analyze EAC trends from 2001 to 2021, focusing on incidence and incidence-based mortality (IBM). Age-adjusted rates stratified by gender and race were obtained using SEER*Stat version 8.4.4. Trends were assessed using the Joinpoint Regression Program version 5.3.0.0 (November 2024 release) with linear regression modeling to estimate annual percent change (APC). Results: Among men, EAC incidence rose from 2001 to 2008 (APC: 2.29%; P < 0.05), declined from 2008 to 2011 (-3.15%; P < 0.05), and then rose modestly from 2011 to 2021 (0.48%; P < 0.05). In women, incidence increased steadily throughout the study period (APC: 0.7%; P < 0.05), though rates remained substantially lower than in men. Racial disparities were prominent. Whites had the highest incidence overall. Recently, EAC incidence rose in American Indian/Alaska Natives (APC: 1.6%; P < 0.05), Asian/Pacific Islanders (1.3%; P < 0.05), and Whites (1.0%; P < 0.05). IBM was consistently higher in men. From 2015 to 2021, male IBM increased at an APC of 2.0% (P < 0.05); female IBM rose at 1.3% annually (P < 0.05) over the full study period. Whites had the highest IBM across all races. Alarmingly, IBM in the Black population surged from 2018 to 2021 (APC: 10.4%; P < 0.05). IBM among American Indian/Alaska Natives also showed a steady rise from 2001 to 2021 (APC: 2.8%; P < 0.05). Conclusion: Significant disparities in EAC incidence and IBM exist across gender and racial groups. Men—particularly White men—exhibit the highest rates, though concerning upward trends are now evident in American Indian/Alaska Native and Black populations. These findings highlight the urgent need for targeted prevention, early detection, and intervention strategies among high-risk groups to address the rising burden of EAC.