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Development of rare esophageal cancer in African-Americans may differ from whites

April 30, 2004

The development of an aggressive but rare type of esophageal cancer in African-Americans may follow a different path than the same disease in whites, and is more likely to be fatal, according to results of a study by researchers at Johns Hopkins.

Whites who develop the cancer, called esophageal adenocarcinoma, usually develop an abnormal lining of their throat condition called Barrett's metaplasia, the researchers say. This is followed by a precancerous condition called dysplasia, and finally, cancer. However, African-Americans who develop esophageal adenocarcinoma were observed not to develop Barrett's metaplasia as frequently.

"Our finding is significant because it suggests that physicians should be alert to the fact that esophageal adenocarcinoma doesn't necessarily present identically in African Americans and whites," says Pierre R. Theodore, M.D., a fellow and resident in Hopkins' Department of Surgery. "And though this cancer is rare in African-Americans, they have a worse rate of survival than do whites."

Theodore presented the results of this study this week at the 84th annual meeting of the American Association of Thoracic Surgeons in Toronto.

The Hopkins researchers made their findings during a study of 574 patients with esophageal adenocarcinoma, of whom 3.5 percent (20/574) were African-American.

Compared to whites, African-Americans were significantly less likely to have Barrett's metaplasia - the early form of esophageal adenocarcinoma. Specifically, 20 percent (4/20) of African-Americans had Barrett's metaplasia versus 57 percent of whites (317/554). Moreover, only 35 percent (7/20) of African Americans had a history of gastrointestinal reflux disease (GERD) versus 54 percent (301/554) of whites. GERD is a disorder in which stomach acid backs up into the esophagus, causing the symptom of heartburn. Continued GERD can destroy the layer of tissue lining of the esophagus, which, in some cases, is replaced by cancerous tissue.

Although a relatively small percentage of African-Americans compared to whites had the early signs of esophageal cancer - GERD and Barrett's metaplasia - 45 percent (9/20) of them had advanced stage disease compared with 22.2 percent (123/554) of whites, according to the Hopkins team.

In addition, the overall survival rates in African-Americans were significantly worse than whites, with no African-Americans surviving more than three years.

The other authors of this report include Craig Hooker, Eric Syphard, Leonard Sowah, Arlene Forastiere, Elizabeth Montgomery, David Mason, , James Herman, Stephen Yang and Malcolm V. Brock.
Johns Hopkins' Thoracic Oncology Program

American Association of Thoracic Surgeons

Johns Hopkins Medicine

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