S962 Trends in Incidence of Esophageal Squamous Cell Carcinoma in the United States Between 2001-2021: A United States Cancer Statistics Database Study

Introduction: Although esophageal squamous cell carcinoma (ESCC) is the most common histological subtype of esophageal cancer worldwide, it is less common than esophageal adenocarcinoma (EAC) in the U.S. While there has been extensive research on the epidemiology of EAC in the U.S., ESCC remains understudied. This study aimed to examine trends in incidence of ESCC in the U.S. over the past 2 decades using the United States Cancer Statistics (USCS) database. Methods: ESCC incidence rates between 2001 and 2021 were age-adjusted to the standard 2000 U.S. population and calculated from the USCS database (covers ∼98% of the U.S. population). ESCC was identified using International Classification of Diseases-O Third Edition codes. Incidence rates were categorized by gender (men and women), age (young-onset aged <50 years and late-onset aged >50 years), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic American Indian/Alaskan Native, and non-Hispanic Asian/Pacific Islander), stage of diagnosis (early and late), and geographical region (Northeast, Midwest, West, and South). Annual percent change (APC) and average APC (AAPC) were calculated utilizing Joinpoint Regression and the weighted Bayesian Information Criteria method (P < 0.05). Results: There were 99,501 patients diagnosed with ESCC between 2001 and 2021. Most patients were men (65%), non-Hispanic White (63%), >50 years of age (95%), from the southern region of the U.S. (40%), and diagnosed at a late stage (66%). Overall, ESCC incidence decreased over the study period (AAPC -2.37; P < 0.001). The declining trend was seen in both men (AAPC -2.80; P < 0.001) and women (AAPC -1.67; P < 0.001), and in both young-onset (AAPC -3.17; P < 0.001) and late-onset ESCC (AAPC -2.30; P < 0.001). All racial/ethnic groups experienced a similar decrease except non-Hispanic American Indian/Alaskan Natives who had a stable trend (AAPC -0.74; P = 0.34). The decrease was noted in both early (AAPC -2.80; P < 0.001) and late-stage tumors (AAPC -1.28; P < 0.001), and in all geographical regions (P < 0.001 for all regions). Conclusion: This study provides the most comprehensive analysis of ESCC in the U.S. using the USCS database which is representative of 98% of the population. Over the past 2 decades, there was a decline in ESCC incidence overall and across various subgroups. These findings may be attributed to advancements in endoscopic identification and management of esophageal squamous dysplasia and possibly due to public health efforts targeting risk factors such as tobacco use.