Esophageal and Gastric Cancer Incidence and Mortality Trends in Norway, 1993–2022: A Registry-Based Study

Monireh Sadat Seyyedsalehi,1 Paolo Boffetta,1– 3 Cassia B Trewin-NybrÃ¥ten,4 Hilde Langseth,5,6,* Trude Eid Robsahm5,* 1Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; 2Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA; 3Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA; 4Departmentof Registration, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway; 5Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway; 6Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK*These authors contributed equally to this workCorrespondence: Trude Eid Robsahm, Cancer Registry of Norway, PB 5313, Majorstuen, Oslo, N-0304, Norway, Tel +47 2245 1300, +47 2292 8732, Email [email protected]: Esophageal and gastric cancers account for nearly 1.5 million new cases and 1.1 million deaths annually worldwide. In western countries, the incidence of esophageal cancer is rising while that of gastric cancer has decreased, although the pattern varies between the morphological types and subsites. We aim to describe the burden of esophageal and gastric cancers in Norway by providing national trends in incidence and mortality, separately for esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC), and for gastric ACs by gastric subsites.Methods: We extracted information about all esophageal (ICD10 C15) and gastric cancer (ICD10 C16) patients diagnosed 1993‒2022 from the Cancer Registry of Norway. Age-standardized (European standard population) rates and performed joinpoint regression analyses were calculated to examine trends in incidence and mortality over time, for esophageal cancer SCC and AC and by subsite for gastric AC (cardia: ICD10 C16.0 and non-cardia: ICD10 C16.1– 9). We used annual percent change (APC) and weighted average APC (AAPC), stratified by sex, age group, and stage at diagnosis.Results: During 1993– 2022, 6,433 esophageal cancers (2,616 SCC, 3,817 AC) and 14,453 gastric AC were diagnosed, and 4,683 esophageal and 10,421 gastric AC deaths occurred. The incidence and mortality of esophageal ACs increased whereas the rates for esophageal SCC declined in men and were stable in women. The highest AC incidence and mortality increases were seen in men (incidence AAPC = 2.8) and ages ≥ 70 years (incidence AAPC = 5.9). In contrast, the incidence and mortality of gastric cancer decreased over time, most pronounced for non-cardia gastric AC (incidence AAPC men =− 5.3, women =− 3.9).Conclusion: The incidence and mortality of esophageal AC has increased in Norway during the last decades, most pronounced in men, ages ≥ 70 years. The rates of SCCs decreased, although trends differed between sex and age groups. The incidence and mortality of gastric AC decreased in all age-groups for both sexes, especially for non-cardia gastric cancer.Plain Language Summary: Over recent decades, the incidence of esophageal adenocarcinoma has increased in North America and parts of Europe, while in other regions, including East Asia, the trend varies by subtype and country. In this study, we observed that the incidence and mortality rates of esophageal ACs have risen in Norway over the last two decades, particularly among elderly men, while for esophageal SCCs the incidence and mortality rates have decreased. Also the rates for gastric (AC) cancer have decreased across age-groups and sex, especially for non-cardia gastric cancer. Our trend analysis contributes as a valuable reference to guide clinical awareness, and surveillance strategies in similar high-risk populations.Keywords: esophageal, gastric, cancer incidence, cancer mortality, registry data, nationwide