Media Contact: Lauren Love 734-764-2220

U of M Faculty Identifies Clustering of Esophageal Cancer Mortality in the Great Lakes States and New England

Joel Howard Rubenstein to Present Abstract at Digestive Diseases Week Meeting

Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Despite the rates of some cancers falling over the past 25 years, the frequency of some esophageal cancers is growing and physicians are unable to explain why.

“The incidence of esophageal adenocarcinoma have risen five-fold in the last three decades in the United States,” said Joel Howard Rubenstein, MD. “It’s becoming more common and we don’t know why.”

Rubenstein is an associate professor in the Division of Gastroenterology at the University of Michigan, and is a research scientist at the Veterans Affairs Center of Excellence for Clinical Management Research.

In a recent study, Rubenstein examined fatal cases of esophageal cancer in the United States, using data spanning from 1999 to 2014. He sought to determine if there was geographical clustering of esophageal cancer, and if so, was it explained by the known risk factors.  What he found sparked even more questions.

“We found clusters of high and low mortality rates with esophageal cancer among white non-Hispanic men in the U.S. that could not be explained by the known common risk factors: age, obesity, smoking and alcohol consumption,” he said.

To identify the clustering, Rubenstein looked at county death certificates in counties across the country. To get the most accurate representation, Rubenstein narrowed his scope to only include white, non-Hispanic men and limited his analysis to counties with at least 20 deaths associated with esophageal cancer over the 15-year period.

With data missing predominantly from the central U.S., Rubenstein’s cluster analysis showed an area of high mortality in New England and the Great Lakes States and an area of low mortality in the Southeast.  Those clusters remained significant even after adjusting for the prevalences of obesity, smoking, alcohol, and education in the individual counties.. Rubenstein had hypothesized that ultraviolet radiation exposure might protect against the cancer, but the clusters remained significant after adjusting for local ultraviolet radiation exposure.

“There might be additional unknown environmental factors that contribute to esophageal cancer mortality,” he said. “Figuring out what that factor or factors are could improve our ability to screen the right individuals for esophageal cancer.” 

Rubenstein’s study was presented at the national Digestive Disease Week annual conference, held in Chicago.

About Digestive Disease Week® (DDW)

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 16–19, 2015, at the Walter E. Washington Convention Center, Washington, DC. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at

 About Michigan Medicine: At Michigan Medicine, we create the future of healthcare through the discovery of new knowledge for the benefit of patients and society; educate the next generation of physicians, health professionals and scientists; and serve the health needs of our citizens. We pursue excellence every day in our three hospitals, 40 outpatient locations and home care operations that handle more than 2.1 million outpatient visits a year. The U-M Medical School is one of the nation's biomedical research powerhouses, with total research funding of more than $470 million. More information is available at

NOTICE: Except where otherwise noted, all articles are published under a Creative Commons Attribution 3.0 license. You are free to copy, distribute, adapt, transmit, or make commercial use of this work as long as you attribute Michigan Medicine as the original creator and include a link to this article.

Media Inquiries:  734-764-2220 8 a.m.-5 p.m. ET 

734-936-4000 after hours, weekends, and holidays (ask for the PR person on call) for embargoed news, videos & more