Trends in incident esophageal cancer by histologic subtypes in Germany 2003 – 2013

Objectives:

The incidence of esophageal cancer has substantially changed in Western populations in the last few decades, with striking differences between the two main histological subtypes – squamous cell carcinoma (ESCC) and adenocarcinoma (EA). Several studies reported increases in the incidence of EA and stable or decreasing rates of ESCC. This analysis aimed to evaluate trends in the incidence of esophageal cancer by histologic subtype in Germany using national data over a 11-year period.

Methods:

We analyzed esophageal cancer incidence using pooled data from population-based cancer registries stratified by sex, age and histologic subtype: squamous cell carcinoma and adenocarcinoma. Rates were age-standardized using the old European standard population (1976). We calculated incidence rates only among individuals aged 35 years or older for the period from 2003 to 2013. The Average Annual Percentage Change (AAPC) was calculated in a joinpoint regression model using Joinpoint Trend Analysis Software.

Results:

Squamous cell carcinomas account for 55% to 60% of all esophageal cancer cases. The proportion of adenocarcinomas increased to more than one third of cases in recent years. Age-standardized rates for total esophageal cancer were relatively stable over the last 10 years for both men and women. The rates for EA increased from 4.3 to 6.9 per 100 000 among men and from 0.5 to 1.1 per 100 000 among women. This corresponds to an AAPC of 4.4% (95% CI: 3.1 – 5.7) among men and 6.3% (4.3 – 8.3) among women. The rates for ESCC decreased among men from 10.5 to 8.7 per 100 000 but remained stable among women, corresponding to an AAPC of -1.8% (-2.4 – (-1.1)) among men and 0.9% (-1.0 – 2.7) among women.

Conclusions:

Esophageal adenocarcinoma incidence has increased in Germany as well as in other countries. The rise in this histologic subtype may be caused by increasing trends in obesity and reflux disease, known risk factors for EA.