title: Esophageal carcinoma in African Americans: a five-decade experience.
abstract: BACKGROUND
  Esophageal cancer accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in African Americans. Our aim was to describe the epidemiology of esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EA) among African Americans in the last five decades.
  
  
  METHODS
  A total of 601 records of patients with documented esophageal cancer between 1959 and 2007 at Howard University Hospital were reviewed. Demographic characteristics, risk factors, clinical stage and histological findings were reviewed. The change in prevalence of the disease and the interaction between main risk factors with tumor stage of the patients were assessed over the years of this study.
  
  
  RESULTS
  A total of 552 patients (91.8%) had ESCC while 49 patients (8.2%) had EA. The mean age at diagnosis was 60.1 and 60.6 years for ESCC and EA, respectively (P = 0.8). The peak incidence was in the 1980-1989 decade. Out of 136 ESCC patients with TNM staging information, 130 (95.6%) were diagnosed in stage 2 and above. The majority (73%) of the ESCC were in the mid- and upper third of the esophagus and associated with smoking and alcohol exposure. The majority (81%) of the EA were in the mid- and lower third. The most common presenting symptoms were dysphagia (77.7%), and weight loss (31.9%).
  
  
  CONCLUSIONS
  ESCC is the predominant esophageal cancer in African Americans and diagnosed in late stages, and its diagnosis in our institution has decreased since 1990. A combination of genetic factors, environmental influences (e.g., those related to diet), and the deleterious changes associated with smoking and alcohol consumption, and differences in tumor histology, are the obvious parameters that should be the focus of future studies, and early diagnosis at an earlier stage should be considered among blacks.
authors.affiliation: Department of Medicine, Cancer Center, Howard University Cancer Center, Howard University Hospital, Rm#320, 2041 Georgia Ave., Washington, DC 20059, USA. hashktorab@howard.edu
authors.forename: Hassan
authors.initials: H
authors.lastname: Ashktorab
authors.forename: Zahra
authors.initials: Z
authors.lastname: Nouri
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nouraie
authors.forename: Hadi
authors.initials: H
authors.lastname: Razjouyan
authors.forename: Edward E
authors.initials: EE
authors.lastname: Lee
authors.forename: Ehsan
authors.initials: E
authors.lastname: Dowlati
authors.forename: El-Waleed
authors.initials: el-W
authors.lastname: El-Seyed
authors.forename: Adeyinka
authors.initials: A
authors.lastname: Laiyemo
authors.forename: Hassan
authors.initials: H
authors.lastname: Brim
authors.forename: Duane T
authors.initials: DT
authors.lastname: Smoot
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000208:ethnology* / Q000473:pathology; D004219:District of Columbia / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000208:ethnology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors