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Incidence, survival of gastroesophageal cancer similar regardless of locale
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Residents of rural areas were not significantly more likely to develop or die from gastroesophageal cancer than those living in metropolitan areas in a recent study.
Researchers evaluated data from 29,527 patients with esophageal adenocarcinoma (AE; n=12,814), gastric cardia adenocarcinoma (AGC; n=9,257) or squamous cell esophageal carcinoma (SCCE; n=7,456) collected from the SEER program between 2004 and 2009. Most cases (86.8%) occurred in metropolitan areas, while 9.2% were from urban and 4% from rural areas.
AE occurred more frequently in rural (RR=1.15; 95% CI, 1.06-1.25) and urban areas (RR=1.13; 95% CI, 1.06-1.2) than metropolitan areas. SCCE was less common in a rural setting (OR=0.8; 95%CI, 0.7-0.91), but more prevalent in urban areas (RR=1.12; 95% CI, 1.03-1.21) than in the metropolitan setting.
Among African-Americans, SCCE incidence was higher in urban (RR=1.49; 95% CI, 1.29-1.72) and rural areas (RR=1.6; 95% CI, 1.24-2.04), while SCCE was significantly less frequent among whites in rural areas (RR=0.76; 95% CI, 0.64-0.88 vs. metropolitan areas). Males had greater incidence of AE in rural (RR=1.12; 95% CI, 1.05-1.19) and urban settings (RR=1.20; 95% CI, 1.1-1.31), and SCCE was more frequent in urban areas (RR=1.17; 95% CI, 1.06-1.29).
Stage IV AE was seen less in rural areas (adjusted OR=0.79; 95% CI, 0.65-0.97 vs. metropolitan areas).
Multivariate analysis revealed no significant difference in mortality risk between metropolitan and rural areas for any of the evaluated cancers. Risk for death among AGC patients in urban areas was significantly greater (HR=1.32; 95% CI, 1.16-1.53 vs. metropolitan areas) and the difference was more pronounced for patients with stage IV disease.
“Our hypothesis was that incidence and outcomes of SCCE, AE and AGC vary across populations in metropolitan, urban and rural areas of the United States,” the researchers wrote. “In contrast … the incidence was similar in all three groups of patients.
“These findings add to the growing evidence that certain preconceptions about urban/rural disparities in the United States may be either unwarranted or out of date.”
Disclosure: Researcher Michael Goodman, MD, MPH, has served as a compensated consultant for Roche-Genentech.
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