Oesophageal cancer incidence statistics

The numbers of new cases and rates for oesophageal cancer in the UK and its constituent countries are shown in Table 1.1.1-4  In the UK in 2008, 8,173 people were diagnosed with oesophageal cancer.

Table 1.1: Oesophageal Cancer (C15), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2008

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*95% LCL and 95% UCL are the lower and upper confidence limits around the AS rate

The male/female ratio is almost 2:1. However, the male/female ratio reported for adenocarcinomas (ACs) is much higher, generally around 5 to 10 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

Overall, oesophageal cancer is responsible for almost 3% of all cancers in the UK and is the ninth most common cancer in the UK. The risk of developing the disease increases with age with around 50 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 58 for men and 1 in 118 for women in the UK. These were calculated using the AMP method. 26

Figure 1.1: Oesophageal Cancer (C15), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2006-2008

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section reviewed 08/12/11
section updated 08/12/11

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

section reviewed 17/12/10
section updated 17/12/10

Each year 482,000 people are diagnosed with oesophageal cancer worldwide and 407,000 people die from it. There is more than a fifteen fold variation in male incidence rates between the different regions of the world and an almost twenty fold variation in female rates. 10

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

Figure 1.2: Oesophageal Cancer (C15), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

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Wide variation in incidence 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.10, 11

High rates have been estimated for Southern and Eastern Africa, and Eastern Asia. 12-17 Incidence rates in the UK are significantly higher than the EU average; UK men have the highest rates, followed by men from the Holland and Ireland, while UK women also have the highest reported incidence of female oesophageal cancer, fourteen times higher than the rates reported for Greek women ( Figure 1.3). 10

Figure 1.3: Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates

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section reviewed 08/12/11
section updated 08/12/11

Over the last thirty years incidence rates for oesophageal cancer have increased in Great Britain, particularly for men (Figure 1.4) 18.

Figure 1.4: Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, Great Britain, 1975-2008

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The male European age-standardised incidence rates in Britain rose from 8.8 per 100,000 population in 1975-1977 to 14.5 in 2006-2008 with the corresponding female rates rising from 4.8 to 5.6.

In Scotland, particularly, the male rates have show a substantial increase, with the male European age-standardised rates rising from 10.9 per 100,000 population in 1975-1977 to 17.5 in 2006-2008. For Scottish women, the European age-standardised rates increased from 6.5 in 1975-1977 to 8.7 in 1993-1995 but have since decreased to 6.7 in 2006-2008. 2

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

Figure 1.5: Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, UK, 1993-2008

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section reviewed 08/12/11
section updated 08/12/11

Lifetime risk is an estimation of the risk that a newborn child has of being diagnosed with cancer at some point during their life.  It is a summary of risk in the population but genetic and lifestyle factors affect the risk of cancer and so the risk for every individual is different.

In 2010, in the UK, the lifetime risk of developing oesophageal cancer is 1 in 56 for men and 1 in 110 for women.28

The lifetime risk for oesophageal cancer has been calculated by the Statistical Information Team using the ‘Adjusted for Multiple Primaries’ (AMP) method; this accounts for the possibility that someone can have more than one diagnosis of oesophageal cancer over the course of their lifetime.29

section reviewed 24/04/13
section updated 24/04/13

The oesophagus (also known as gullet or foodpipe) 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 1.6.

Figure 1.6: Diagram of oesophagus

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. 19 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. 20-22

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. 23 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. 24, 25

section reviewed 17/12/10
section updated 17/12/10

Prevalence data relates to the proportion of the UK population alive on a specific date having previously been diagnosed with cancer. The latest analysis shows that on 31st December 2006, around 10,600 people were alive up to ten years after being diagnosed with oesophageal cancer. Table 1.2 shows the one, five and ten year prevalence by sex for oesophageal cancer.27

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section reviewed 13/06/10
section updated 13/06/10