1. Johns Hopkins University and DC Cancer Registry
A Preliminary Investigation on Birthplace Distribution among Esophageal Cancer Cases from Nine SEER Registries,
Xuguang (Grant) Tao, MD , Ph.D., CTR
Genevieve M Matanoski, MD, Dr. PH, CTR
Arron Adade, Ph.D.
Linda Schwartz, CTR
Kathy Davis
Johns Hopkins University and DC Cancer Registry

2. Background
Incidence of esophageal cancer has been increasing slowly among white males while decreasing dramatically among black males in US for the past 20 years.
Incidence of esophageal cancer varies considerably according to geographic locations in the world. This cancer is much more common in areas such as northern Iran and southern republics of the former Soviet Union or so called “Esophageal Cancer Belt”.
It is not clear if the immigrants from areas with much higher incidences have had any impact on esophageal cancer patterns especially among white males in US since esophageal cancer once was a relatively rare cancer site in US among white males.

3. The origins from which white Americans may come

4. The Central Asian Esophageal Cancer Belt Extending from Iran to China
Kamangar F, et al. 2006

5. Objectives
To examine if the increasing trend of esophageal cancer incidence rate among white males in US correlates to the distribution trend of foreign born cases for the last 30 years.

6. Method
To compare the trend of age adjusted esophageal cancer incidence rates with the distribution trend of foreign born cases among all US esophageal cancer cases by gender, race, and histology over time ( ) .
To compare the histology distribution of US born esophageal cancer cases with foreign born cases.
SEER 9 Registry public-use database and SEER*stat software were used.

7. Esophageal Cancer Incidence Rate (1/100,000) by Gender and Race, SEER 9 Registries, 1973-2004

8. Esophageal Cancer Incidence Rate by Gender, Race, and Histology, SEER 9, 1973-2004

9. White Male Esophageal Cancer Incidence Rate by Histology, 1973-2004

10. Percentage of Selected Foreign Born Esophageal Cancer Cases, White Males, SEER 9, 1973-2002

11. Percentage of Adenocarcinoma of White Male Esophageal Cancer, SEER 9, 1973-2004
Differences are all statistically significant at P<0.05 compared to US born cases

12. Discussion
This analysis showed that the changing trend of percentages of foreign born esophageal cancer cases (such as born in Europe, south America, and Asia) did not match the increasing trend of esophageal cancer incidence rate observed among US white males.
The proportion of adenocarcinoma among foreign-born cases was significantly smaller than US born cases so that it could not explain the increase of adenocarcinoma among US white males.

13. Conclusion
The increasing trend of esophageal cancer among white males in US could not be explained by immigration activities based on this preliminary investigation