Esophageal cancer: Cases and causes (Part I)

The worldwide burden of esophageal cancer (for both sexes) was estimated in 2002 [1] as 462 000 new cases and 386 000 deaths; the high ratio (0.83) of mortality to incidence confirms a poor prognosis. Asiatic countries share most of the burden with 362 000 new cases annually and 293 000 deaths. Using an age-standardized rate (ASR), incidence is estimated worldwide at 11.5 per 100 000 in men and 4.7 per 100 000 in women. Much higher rates occur in certain regions of Asia, such as Cixian in China ([Table 1]), and of Africa [2].

Table 1 Incidence (age-standardized rate [ASR] per 100 000, world population) of esophageal cancer in registries in China for the period 1993 - 97. (From Parkin et al., Cancer incidence in five continents. IARC publication no.155, Lyon: IARC Press; 2002 2) Men Women Beijing 10.2 4.0 Changle 30.1 8.9 Cixian 183.8 123.1 Hong Kong 11.7 2.5 Jiashan 20.7 5.3 Qidong 13.2 3.9 Shanghai 8.2 4.2 Taiwan 7.9 0.8 Tianjin 11.0 4.1 Wuhan 13.3 4.9

Most cases are squamous cell carcinomas (SCC); adenocarcinoma (ADC) in Barrett esophagus is less frequent, although its incidence is on the rise in several high-resource countries. Reliable data on histology are found in registries in which the proportion of unspecified cases is small ([Tables 2] and [3]). Tumors at the esophagogastric junction are often misclassified between the distal esophagus or the gastric cardia.

Table 2 Percentage distribution of tumor types of microscopically verified cases of esophageal carcinoma, (both sexes), in registries for the period 1993 - 97. In the USA the data are reported for black and white ethnic groupings. Other tumors are not listed here. (From Parkin et al., Cancer incidence in five continents. IARC publication no.155, Lyon: IARC Press; 2002 2) Carcinoma type SCC, % ADC, % Unspecified, % Africa Zimbabwe 93 2.3 4.7 America Brazil, Campinas 90.1 4.5 4.5 USA SEER, black, 9 registries 88.2 5.7 4.0 Canada, all 53.3 40.5 3.6 USA, SEER, white, 9 registries 41.7 52.0 4.2 Asia China, Cixian 99.0 0 1.0 China, Taiwan 89.6 6.2 2.4 Japan, Osaka 89.5 4.2 0.5 Korea, Seoul 89.1 5.4 1.7 China, Hong Kong 86.1 8.6 3.7 Europe France, Bas Rhin 87.0 9.5 2.6 Slovakia, all 84.6 10.9 3.2 Italy, north-east 78.8 9.6 6.2 Germany, Saarland 77.8 12.8 3.2 Sweden, all 63.5 27.0 8.0 Norway, all 60.7 29.6 5.6 Ireland, all 52.8 38.3 5.6 Denmark, all 49.3 42.5 5.9 Netherlands, all 48.8 44.0 4.5 UK, all 44.9 47.8 5.0 Australia New South Wales 57.0 35.2 5.6 SCC, squamous cell carcinoma; ADC, adenocarcinoma; SEER, Surveillance, Epidemiology and End Results

Table 3 Percentage distribution of types of microscopically verified cases of esophageal carcinoma according to race (both sexes) in the Los Angeles registry,in the USA, for the period 1993 - 97. Other tumors are not listed here. (From Parkin et al., Cancer incidence in five continents. IARC publication no.155, Lyon: IARC Press; 2002 2) Carcinoma SCC, % ADC, % Unspecified, % Black 89.4 7.1 2.8 Chinese 77.8 14.8 3.7 Japanese 69.7 27.3 - Hispanic White 45.8 47.9 3.2 Nonhispanic White 43.0 50.5 2.9

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