Cancer from the gastrointestinal tract and its associated excretory organs will occur in more than 300,000 Americans in 2017, with colorectal cancer responsible for >40% of that burden; there will be more than 150,000 deaths from this group of cancers in the same time period. Disparities among subgroups related to the incidence and mortality of these cancers exist. The epidemiology and risk factors associated with each cancer bear out differences for racial groups in the United States. Esophageal adenocarcinoma is more frequent in non-Hispanic whites, whereas esophageal squamous cell carcinoma with risk factors of tobacco and alcohol is more frequent among blacks. Liver cancer has been most frequent among Asian/Pacific Islanders, chiefly due to hepatitis B vertical transmission, but other racial groups show increasing rates due to hepatitis C and emergence of cirrhosis from non-alcoholic fatty liver disease. Gastric cancer incidence remains highest among Asian/Pacific Islanders likely due to gene−environment interaction. In addition to esophageal squamous cell carcinoma, cancers of the small bowel, pancreas, and colorectum show the highest rates among blacks, where the explanations for the disparity are not as obvious and are likely multifactorial, including socioeconomic and health care access, treatment, and prevention (vaccination and screening) differences, dietary and composition of the gut microbiome, as well as biologic and genetic influences. Cognizance of these disparities in gastrointestinal cancer risk, as well as approaches that apply precision medicine methods to populations with the increased risk, may reduce the observed disparities for digestive cancers.

2017 年，超过 300,000 名美国人将患上胃肠道及其相关排泄器官的癌症，其中结直肠癌占该负担的 >40%；同期将有超过 150,000 人死于此类癌症。与这些癌症的发病率和死亡率相关的亚组之间存在差异。与每种癌症相关的流行病学和危险因素证实了美国种族群体的差异。食管腺癌在非西班牙裔白人中更为常见，而具有烟草和酒精危险因素的食管鳞状细胞癌在黑人中更为常见。肝癌在亚洲/太平洋岛民中最为常见，主要是由于乙型肝炎垂直传播，但其他种族群体由于丙型肝炎和非酒精性脂肪肝引起的肝硬化，发病率也在增加。亚洲/太平洋岛民中胃癌发病率仍然最高，这可能是由于基因与环境的相互作用。除了食管鳞状细胞癌之外，小肠癌、胰腺癌和结直肠癌在黑人中的发病率最高，这种差异的解释并不那么明显，并且可能是多因素的，包括社会经济和医疗保健的获取、治疗和预防（疫苗接种和筛查）差异、饮食和肠道微生物组的组成，以及生物学和遗传影响。认识到胃肠道癌症风险的这些差异，以及对风险增加的人群应用精准医学方法，可能会减少观察到的消化道癌症的差异。