Adenocarcinoma of the Esophagus and Gastric Cardia
Studies in the 1980s of esophageal and gastric cancers used data from SEER registries to describe histologic and epidemiological characteristics. These studies described different patterns by age, sex, and race (black/white) and helped to define a set of squamous cell carcinomas and adenocarcinomas that were increasing in the population. Concomitant with similar observations in European countries, an analysis of 1973-1987 cancer incidence data from nine SEER registries showed steadily rising rates of adenocarcinomas of the esophagus and gastric cardia. The rate of increase surpassed that of any other cancer for the time period, including non-Hodgkin's lymphoma and lung cancer. To learn more about these cancers, a multicenter case-control study was conducted using cancer registry data on recently diagnosed cases in Connecticut, New Jersey, and western Washington state. This study revealed that smoking is a major risk factor for these adenocarcinomas, accounting for approximately 40 percent of cases. Later studies looked into the possible effects of medications on these cancers, using interviews with patients and controls from the same registry areas as the previous study. Following on the finding that regular users of nonsteroidal anti-inflammatory drugs (NSAIDS) are at reduced risk of colon cancer, investigators found that regular users of either aspirin or other NSAIDs are also at reduced risk of adenocarcinoma of the esophagus and gastric cardia. A second study examined a number of common medications that are known to promote gastroesophageal reflux by relaxing the lower esophageal sphincter (LES). The investigators found that people who took asthma drugs containing theophylline or beta-agonists were at higher risk for esophageal adenocarcinoma, and the risk increased with duration of use. However, the study also provided the reassuring finding that use of other LES-relaxing drugs, specifically calcium channel blockers, is not likely to be related to increased risk for these cancers. Worldwide, research continues to investigate this interesting group of cancers.
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