Cancer Research UK : UK Oesophageal Cancer incidence statistics

UK Oesophageal Cancer incidence statistics

This section contains oesophageal cancer incidence statistics by age and sex, deprivation, geographical distribution and trends over time. The ICD code for oesophageal cancer is ICD9 150, and ICD10 C15.

Oesophageal cancer incidence by age and sex

In the UK in 2005, 7,823 people were diagnosed with oesophageal cancer. The male/female ratio of Uk is 1.8:1 ( Table 1.1)1-4.

Table showing the number of new cases and rates of oesophagus cancer in the UK

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However, the male/female ratio reported for adenocarcinomas (ACs) is much higher, generally around 5 to10-fold, which makes it one of the highest sex differentials of any non-occupational cancer5. In 1998 the male/female ratio for adenocarcinomas in England and Wales was 4.8:16.

Oesophageal cancer is the ninth most common cancer in the UK. The risk of developing the disease increases with age with very few cases diagnosed in people aged under 40 years as Figure 1.1 shows1-4.

Figure showing the numbers of new cases and age-specific incidence rates cancer of the oesophagus, by sex, in the UK

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Oesophageal cancer incidence and deprivation

Overall there is a clear positive association with social deprivation. Data for England and Wales in 1992-93 reported rates 30% higher in the most deprived groups compared to the least deprived7. However, there is evidence that this gradient differs for the main histological groups, suggestive of different aetiological backgrounds. An analysis of Scottish data showed a clear association between deprivation and non-adenocarcinoma but no clear association with deprivation for adenocarcinoma8, 9.

Geographical distribution of oesophageal cancer incidence

Each year 462,000 people are diagnosed with oesophageal cancer worldwide and 386,000 people die from it. There is an eighteen fold variation in male incidence rates between the different regions of the world and an almost forty fold variation in female rates and variation in mortality rates are similar.10

The majority of cases (80-85%) are diagnosed in developing countries where it is the fourth most common cancer in men and most cases are squamous cell carcinoma (SCC)10 (Figure 1.2).

Figure 1.2: World age-standardised incidence rates for oesophageal cancer, 2002 estimates

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Wide variation in incidence10 has been reported both between countries and in different ethnic groups and populations within a country. For example, in the USA, the incidence of SCC is almost six times higher in black men than in white men, while the incidence of AC is almost four times higher in white men than in black men.11

The area with the highest reported incidence for oesophageal cancer is the so-called Asian ‘oesophageal cancer belt’, which stretches from eastern Turkey through north-eastern Iran, northern Afghanistan and southern Russia to northern China.12 In the high risk area of Gonbad in Iran, world age-standardised rates are more than 200 per 100,000 and the male/female ratio is reported as 0.8:1.0.13

In the Cixian province of China, world age-standardised rates per 100,000 are 184 for men and 123 for women compared with 8.4 for English men and 3.5 for English women.14 High rates have also been reported for south and south-east Africa, parts of south America and parts of Europe.15-20Incidence rates in the UK are significantly higher than the EU average; French men have the highest rates, followed by men from the UK and Hungary, while UK women have the highest reported incidence of female oesophageal cancer, almost fifteen times higher than the rates reported for Cypriot women (Figure 1.3)21.

Figure 1.3: Age-standardised (European) incidence rates, oesophageal cancer, EU countries, 2002 estimates

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Within the UK the highest rates are recorded in Scotland as shown in Table 1.1 above. A recent analysis of cancer incidence in the UK and Ireland, recorded a clear north/south divide across Great Britain with highest incidence for oesophageal cancer in Scotland, urban areas of North West England and north Wales22. Scotland currently has some of the highest rates in Europe8.

Trends in oesophageal cancer incidence

Over the last thirty years incidence rates for oesophageal cancer have increased in Britain, particularly for men (Figure 1.4)23.

Figure showing the age-standardised (European) incidence rates for oesophageal cancer, by sex, in the GB

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The male European age-standardised incidence rates in Britain rose from 8.8 per 100,000 population in 1975 to 14.2 in 2005 with the corresponding female rates rising from 4.8 to 5.7.

In Scotland, particularly, the male rates have show a substantial increase, with the male European age-standardised rates rising from 11.3 per 100,000 population in 1975 to 17.3 in 2004. For Scottish women, the European age-standardised rates increased from 6.6 in 1975 to 9.2 in 1993 but have since decreased to 7.2 in 2005.2

Figure 1.5 shows the oesophageal cancer incidence trend in the UK.

Figure showing the age-standardised (European) incidence rates for oesophageal cancer, by sex, in the UK

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Anatomy and Histology

The oesophagus (gullet) extends from the back of the mouth to the stomach and in adults is approximately 26 centimetres (cms) in length and 2cms wide. In the chest region it lies between the trachea and spinal cord that need to be protected during treatment. The oesophagus is traditionally divided into three sections as shown in Figure One.

There are two main histological types of oesophageal cancer: squamous cell carcinoma (SCC) and adenocarcinoma (AC). In the upper two-thirds the most common histology is SCC: in the lower third AC. Until the 1970s SCC accounted for the vast majority of oesophageal cancer diagnosed in the UK and they still do in developing countries.

However, since the 1970s the incidence of SCC has remained stable or decreased in most western countries while that of AC has increased, particularly in men.24 If these trends continue, AC will become the dominant histology - this has happened for white men in the USA and UK. Indeed the reported rates of adenocarcinoma for white men in the UK are the highest in the world.25 26 27

The nearest (proximal) part of the stomach adjacent to the oesophagus is the cardia with the cardiac sphincter operating to prevent the regurgitation of acidic gastric contents into the oesophagus. The area around the lower oesophagus and the gastric-cardia is known as the gastro-oesophageal junction (GOJ).

The GOJ is associated with a medical condition called Barrett’s oesophagus, first described by Barrett in 1950.28 It has been suggested that ACs of the GOJ and gastric cardia, which share aetiological and clinico-pathological features, should be classified as a distinct subsite from the proximal parts of the oesophagus and distal stomach.29, 30

References for oesophageal cancer incidence

Office for National Statistics. Cancer Statistics registrations: Registrations of cancer diagnosed in 2005, England. Series MB1 no.36. 2008
ISD Online. Cancer Incidence, Mortality and Survival data. 2008
Northern Ireland Cancer Registry. Cancer Registrations in Northern Ireland, 2005. 2008
Welsh Cancer Intelligence and Surveillance Unit.Cancer Incidence in Wales. 2008
Wild, C.P. and L.J. Hardie, Reflux, Barrett's oesophagus and adenocarcinoma: burning questions. Nat Rev Cancer, 2003. 3(9): p. 676-84.
Newnham, A., et al., Trends in the subsite and morphology of oesophageal and gastric cancer in England and Wales 1971-1998. Aliment Pharmacol Ther, 2003. 17(5): p. 665-76.
Quinn, M., et al., Cancer Trends in England & Wales 1950-1999. Vol. SMPS No. 66. 2001: TSO.
Gilbert FJ, P.K., Thompson AM (eds), Scottish Audit of Gastric and Oesophageal Cancer. Report 1997-2000. A prospective audit. 2002, Scottish Audit of Gastric and Oesophageal Cancer Steering Group: Edinburgh.
Brewster, D., L. Fraser, and P. McKinney, Socioeconomic status and risk of adenocarcinoma of the oesophagus and cancer of the gastic cardia in Scotland. British Journal of Cancer, 2000. 83(3): p. 387-390.
Parkin, D.M., et al., Global cancer statistics, 2002. CA Cancer J Clin, 2005. 55(2): p. 74-108.
Vizcaino, A.P., et al., Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973-1995. Int J Cancer, 2002. 99(6): p. 860-8.
Parkin, D.M., International variation. Oncogene, 2004. 23(38): p. 6329-40.
Hormozdiari, H., et al., Dietary factors and esophageal cancer in the Caspian Littoral of Iran. Cancer Res, 1975. 35(11 Pt. 2): p. 3493-8.
Parkin, D.M., et al., eds. Cancer Incidence in Five Continents Volume VIII. IARC Scientific Publications. Vol. 155. 2002, International Agency for Research on Cancer: Lyon, France.
Parkin DM, F.J., Hamdi-Cherif M et al, Cancer in Africa: Epidemiology and Prevention, IARC Scientific Publications No 153. 2003, IARC: Lyon.
van Rensburg, S.J., Epidemiologic and dietary evidence for a specific nutritional predisposition to esophageal cancer. J Natl Cancer Inst, 1981. 67(2): p. 243-51.
Larsson, L.G., A. Sandstrom, and P. Westling, Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden. Cancer Res, 1975. 35(11 Pt. 2): p. 3308-16.
De Stefani, E., et al., Food groups and risk of squamous cell carcinoma of the oesophagus: a case-control study in Uruguay. Br J Cancer, 2003. 89(7): p. 1209-14.
Castellsague, X., et al., Influence of mate drinking, hot beverages and diet on esophageal cancer risk in South America. Int J Cancer, 2000. 88(4): p. 658-64.
Sewram, V., et al.,Mate consumption and the risk of squamous cell esophageal cancer in uruguay. Cancer Epidemiol Biomarkers Prev, 2003. 12(6): p. 508-13.
IARC. GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide (2002 estimates). 2006
Quinn M, W.H., Cooper N, Rowan S (eds), Cancer Atlas of the United Kingdom and Ireland 1991-2000. Studies on Medical and Population Subjects No. 68. 2005: Palgrave Macmillan.
Cancer Research UK Statistical Information Team. 2007.
Vizcaino, A.P., et al., Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973-1995. Int J Cancer, 2002. 99(6): p. 860-8.
Gilbert FJ, P.K., Thompson AM (eds), Scottish Audit of Gastric and Oesophageal Cancer. Report 1997-2000. A prospective audit. 2002, Scottish Audit of Gastric and Oesophageal Cancer Steering Group: Edinburgh.
Wild, C.P. and L.J. Hardie, Reflux, Barrett's oesophagus and adenocarcinoma: burning questions. Nat Rev Cancer, 2003. 3(9): p. 676-84.
Bollschweiler, E., et al., Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer, 2001. 92(3): p. 549-55.
Barrett, N.R., Chronic peptic ulcer of the oesophagus and 'oesophagitis'. Br J Surg, 1950. 38(150): p. 175-82.
Dolan, K., et al., New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology. Br J Cancer, 1999. 80(5-6): p. 834-42.
Wijnhoven, B.P., et al., Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity. Rotterdam Oesophageal Tumour Study Group. Br J Surg, 1999. 86(4): p. 529-35.