UK Oesophageal Cancer incidence statistics

In the UK in 2006, 7,824 people were diagnosed with oesophageal cancer. The male/female ratio of UK is 1.8:1 ( Table 1.1) 1-4.

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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 cancer 5. In 1998 the male/female ratio for adenocarcinomas in England and Wales was 4.8:1 6.

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 shows 1-,4.

It has been estimated that the lifetime risk of developing oesophageal cancer is 1 in 64 for men and 1 in 116 for women in the UK. These were calculated in February 2009 using incidence and mortality data for 2001-2005. 31

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Overall there is a clear positive association with social deprivation. Data for England in 1995-99 and 2000-04 reported rates in the most deprived quintile 22% and 14% higher, respectively, compared to the least deprived 7. 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 adenocarcinoma 8,9.

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).

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Wide variation in incidence 10 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.

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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 Wales 22. Scotland currently has some of the highest rates in Europe 8.

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

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The male European age-standardised incidence rates in Britain rose from 8.8 per 100,000 population in 1975 to 14.1 in 2006 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 2006. For Scottish women, the European age-standardised rates increased from 6.6 in 1975 to 9.2 in 1993 but have since decreased to 6.9 in 2006. 2

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

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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