Young-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples

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dc.contributor.authorShepherdson, M.
dc.contributor.authorLeemaqz, S.
dc.contributor.authorSingh, G.
dc.contributor.authorRyder, C.
dc.contributor.authorUllah, S.
dc.contributor.authorCanuto, K.
dc.contributor.authorYoung, J.P.
dc.contributor.authorPrice, T.J.
dc.contributor.authorMcKinnon, R.A.
dc.contributor.authorPandol, S.J.
dc.contributor.authorRoberts, C.T.
dc.contributor.authorBarreto, S.G.
dc.date.issued2022
dc.description.abstractBackground and Aims: A concerning rise in incidence of young-onset cancers globally led to the examination of trends in incidence and survival of gastrointestinal (GI) adenocarcinomas in the Northern Territory (NT), Australia, over a 28-year period, with a special emphasis on Indigenous peoples. Methods: This cross-sectional analysis of a prospective longitudinal database, NT Cancer Registry (1990–2017), includes all reported cases of GI (oesophagus, gastric, small intestinal, pancreas, colon, and rectum) adenocarcinomas. Poisson regression was used to estimate incidence ratio ratios, and survival was modelled using Cox proportional hazard models separately for people aged 18–50 years and >50 years. Results: A total of 1608 cases of GI adenocarcinoma were recorded during the time of the study. While the overall incidence in people 18–50 years remained unchanged over this time (p = 0.51), the rate in individuals aged >50 years decreased (IRR = 0.65 (95% CI 0.56–0.75; p < 0.0001)). Incidence rates were significantly less in females >50 years (IRR = 0.67 95% CI 0.59–0.75; p < 0.0001), and their survival was significantly better (HR = 0.84 (95%CI 0.72–0.98; p < 0.03)) compared to males. Overall survival across all GI subsites improved in both age cohorts, especially between 2010 and 2017 (HR = 0.45 (95%CI 0.29–0.72; p < 0.0007) and HR = 0.64 (95%CI 0.52–0.78; p < 0.0001), respectively) compared to 1990–1999, driven by an improvement in survival in colonic adenocarcinoma alone, as the survival remained unchanged in other GI subsites. The incidence was significantly lower in Indigenous patients compared to non-Indigenous patients, in both age cohorts (18–50 years IRR = 0.68 95% CI 0.51–0.91; p < 0.009 and >50 years IRR = 0.48 95% CI 0.40–0.57; p < 0.0001). However, Indigenous patients had worse survival rates (18–50 years HR = 2.06 95% CI 1.36–3.11; p < 0.0007 and >50 years HR = 1.66 95% CI 1.32–2.08; p < 0.0001). Conclusions: There is a trend towards an increased incidence of young-onset GI adenocarcinomas in the NT. Young Indigenous patients have lower incidence but worse survival across all GI subsites, highlighting significant health inequities in life expectancy. Targeted, culturally safe Indigenous community-focussed programs are needed for early detection and patient-centred management of GI adenocarcinomas.
dc.description.statementofresponsibilityMia Shepherdson, Shalem Leemaqz, Gurmeet Singh, Courtney Ryder, Shahid Ullah, Karla Canuto, Joanne P. Young, Timothy J. Price, Ross A. McKinnon, Stephen J. Pandol, Claire T. Roberts, and Savio George Barreto
dc.identifier.citationCancers, 2022; 14(12)
dc.identifier.doi10.3390/cancers14122870
dc.identifier.issn2072-6694
dc.identifier.issn2072-6694
dc.identifier.orcidLeemaqz, S. [0000-0003-4616-8426]
dc.identifier.orcidUllah, S. [0000-0002-1825-7774] [0000-0003-0010-2640]
dc.identifier.orcidCanuto, K. [0000-0001-6184-8249]
dc.identifier.orcidYoung, J.P. [0000-0002-1514-1522]
dc.identifier.orcidPrice, T.J. [0000-0002-3922-2693]
dc.identifier.orcidRoberts, C.T. [0000-0002-9250-2192]
dc.identifier.urihttps://hdl.handle.net/2440/135695
dc.language.isoen
dc.publisherMDPI AG
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1174971
dc.rights© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).
dc.source.urihttps://doi.org/10.3390/cancers14122870
dc.subjectoutcomes; morbidity; mortality; stomach; pancreas; colon; Indigenous
dc.titleYoung-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples
dc.typeJournal article
pubs.publication-statusPublished

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