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Oesophageal cancer incidence statistics

Incidence statistics for oesophageal cancer by country in the UK, age and trends over time are presented here. There are also data on lifetime risk, distribution of cases, morphology, geographic variation, socio-economic variation, and prevalence. The ICD code for oesophageal cancer is ICD-10 C15.

The latest incidence statistics available for oesophageal cancer in the UK are 2010. Find out why these are the latest statistics available.

By country in the UK

Oesophageal cancer is the 9th most common cancer in the UK (2010), accounting for 3% of all new cases. In males it is the 8th most common cancer (3% of male total), whilst it is the 13th most common in females (13%).1-4

In 2010, there were 8,477 new cases of oesophageal cancer in the UK (Table 1.1): 5,637 (66%) in men and 2,840 (34%) in women, giving a male:female ratio of around 2:1.1-4 The crude incidence rate shows that there are 18.4 new oesophageal cancer cases for every 100,000 males in the UK, and 9.0 for every 100,000 females.

Males in the UK have almost three times the risk of developing oesophageal cancer compared with females; the male:female incidence ratio of European age-standardised incidence rates (AS rates), which account for differing male and female age distribution and population sizes, is 27:10.

The AS rates are significantly higher in Scotland compared with England and Northern Ireland (males and females) and Wales (females only) (Table 1.1).1-4

Table 1.1: Oesophageal Cancer (C15), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2010

England Wales Scotland Northern Ireland UK
Male Cases 4,663 307 550 117 5,637
Crude Rate 18.1 20.9 21.7 13.2 18.4
AS Rate 14.5 14.9 17.0 12.5 14.7
AS Rate - 95% LCL 14.0 13.2 15.6 10.2 14.3
AS Rate - 95% UCL 14.9 16.6 18.5 14.7 15.0
Female Cases 2,286 152 335 67 2,840
Crude Rate 8.6 9.9 12.4 7.3 9.0
AS Rate 5.2 5.4 7.4 5.1 5.4
AS Rate - 95% LCL 5.0 4.6 6.6 3.9 5.2
AS Rate - 95% UCL 5.4 6.3 8.2 6.4 5.6
Persons Cases 6,949 459 885 184 8,477
Crude Rate 13.3 15.3 16.9 10.2 13.6
AS Rate 9.5 9.8 11.8 8.7 9.7
AS Rate - 95% LCL 9.3 8.9 11.1 7.4 9.5
AS Rate - 95% UCL 9.8 10.7 12.6 9.9 9.9

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

For oesophageal cancer incidence, there was a north-south divide across England, with higher incidence in North West England, and lower incidence in the South East of England.5 Higher incidence was also seen in western Scotland, urban areas of North West England, and north Wales; all areas associated with high levels of deprivation.5 The latest analysis of oesophageal cancer incidence rates throughout the UK reports only modest variation between cancer networks, with the lowest rates being in Anglia and areas of London.6,7

section reviewed 18/06/13
section updated 18/06/13

By age

Oesophageal cancer incidence is strongly related to age, with the highest incidence rates being in older men and women. In the UK between 2008 and 2010, an average of 70% of cases were diagnosed in men and women aged 65 years and over (Figure 1.1).1-4 Age-specific incidence rates rise sharply from around age 45-49 years, and continue rising through each age group. Incidence rates are higher for males than females throughout, though the ratios vary between age groups (Figure 1.1).1-4

Figure 1.1: Oesophageal Cancer (C15), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2008-2010

cases_crude_oesophag.swf

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section reviewed 18/06/13
section updated 18/06/13

Trends over time

Oesophageal cancer incidence rates have been consistently higher in males than females over time, and have increased at a greater rate for males. Oesophageal cancer incidence rates have increased overall in Great Britain since the mid-1970s (Figure 1.2).1-3 For males, European AS incidence rates increased by 68% between 1975-1977 and 2008-2010 and the trend for males indicates that these rates are continuing to rise. The rise is smaller for females, with rates increasing by 15% overall between 1975-1977 and 2008-2010. However, incidence rates for females peaked around the turn of the century (26% increase between 1975-1977 and 1999-2001) and have since fallen by 9%.  

The observed trends may be associated with changing exposure to oesophageal cancer risk factors, which include tobacco use, insufficient intake of fruit and vegetables, overweight and obesity, and alcohol consumption.8 However, sex differences in exposure to risk factors are thought to be unlikely to explain the more rapid increase in males.9

Figure 1.2: Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, Great Britain, 1975-2010

inc_asr_gb_oesophag.swf

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Oesophageal cancer incidence trends for the UK are shown in Figure 1.3.1-4 Over the decade from 1999-2001 to 2008-2010, European AS incidence rates increased significantly by 7% in males, whilst they decreased significantly by 9% in females.

Figure 1.3: Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, UK, 1993-2010

inc_asr_uk_oesophag.swf

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Oesophageal cancer incidence rates in Great Britain have increased overall for all of the broad age groups in males since the mid-1970s.1-3 The largest increase in rates for males is for those diagnosed aged in their 60s, with European AS incidence rates increasing by 78% between 1975-1977 and 2008-2010. For males diagnosed at 70-79 or 80+, rates increased between the 1970s and the early 2000s, but have remained stable since then (Figure 1.4).

Figure 1.4: Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, Males by Age, Great Britain, 1975-2010

inc_asr_age_m_oesophag.swf

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Oesophageal cancer incidence rates in Great Britain have also increased overall for most of the broad age groups in females since the mid-1970s.1-3 The exception is the 0-49 age group, in which rates have not changed significantly during this period. All other age groups saw rates increase from the 1970s to peak in the 1990s, since which they have stabilised (women in their 50s and 60s) or decreased (women in their 70s and older). Overall, the largest increase in females was for those aged 70-79 years and 80+ years, with European AS incidence rates increasing by 19% in both groups between 1975-1977 and 2008-2010 (Figure 1.5).

Figure 1.5: Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, Females by Age, Great Britain, 1975-2010

inc_asr_age_f_oesophag.swf

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section reviewed 18/06/13
section updated 18/06/13

Lifetime risk

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.10

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.11

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

Distribution of cases

The oesophagus (also known as gullet or foodpipe) extends from the back of the mouth to the stomach and in adults is approximately 26cm long and 2cm wide. In the chest region it lies between the trachea and spinal cord which need to be protected during treatment. The oesophagus is traditionally divided into three sections as shown in Figure 1.6. The part of the stomach adjacent to the oesophagus is the gastric 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 an acquired medical condition called Barrett’s oesophagus, in which reflux of acid from the stomach causes lesions in the oesophageal lining.12 It has been suggested that adenocarcinoma (AC) of the GOJ and gastric cardia, which share aetiological and clinico-pathological features, should be classified as a distinct subsite from the proximal (upper) parts of the oesophagus and distal (lower) stomach.13,14

Figure 1.6: Oesophageal Cancer (C15), Percentage Distribution of Cases, UK, 2008-2010

inc_dist_oesophagus.jpeg

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Around 4 in 10 (41%) of all oesophageal cancer cases in the UK between 2008 and 2010 occurred in the lower section of the oesophagus (ICD-10 C15.2 and C15.5), though the proportion was much higher for males (46%) than females (32%). The middle section (ICD-10 C15.1 and C15.4) contributed 12% of cases, with the proportions higher for females (19%) than males (9%). The upper section (ICD-10 C15.0 and C15.3) contributed 4% of cases, with the proportions higher for females (6%) than for males (3%). 1% of cases were classified as overlapping more than one section of the oesophagus (ICD-10 C15.8). More than four in ten (41%) of the cases did not have the specific part of the oesophagus affected recorded in cancer registry data (ICD-10 C15.9), with a slightly higher proportion for females (42%) than males (40%).

section reviewed 18/06/13
section updated 18/06/13

Morphology

There are two main histological types of oesophageal cancer: squamous cell carcinoma (SCC) and adenocarcinoma (AC). While ICD-10 codes specify the anatomical location of the tumour, histological types within that location are distinguished using ICD-O morphology codes: SCC is ICD-O M805-M808, and AC is ICD-O M814-M838. SCC accounted for more than a quarter (28%) of all oesophageal cancer cases, while AC accounted for more than half (55%) in England in 2008-2010.1 In the upper and middle sections of the oesophagus most cases (62%) were SCC, while in the lower section most cases (70%) were AC, in England in 2008-2010. Tobacco use increases the risk of both SCC and AC. SCC is also strongly linked with alcohol consumption, while AC is linked with excess body weight, and long-term acid reflux (which can lead to the pre-cancerous condition Barrett’s oesophagus).

The male:female incidence rate ratio for oesophageal cancer as a whole is 27:10. However, the male:female incidence rate ratio for AC is higher, around 52:10 and the male:female incidence rate ratio for SCC is lower, around 11:10.1

European AS incidence rates for SCC have remained stable for both males and females in England between 1995-1997 and 2008-2010. For males, AC rates have increased by 52% in this period, from 6.2 to 9.4 per 100,000 males. For females the rise in this period is smaller, with rates increasing by 32%, from 1.4 to 1.8 per 100,000 females.1 This reflects the incidence trends observed in most western countries since the 1970s, where SCC rates have remained stable or decreased, while AC rates have increased, particularly in men.15

section reviewed 18/06/13
section updated 18/06/13

In Europe and worldwide

Although cancer registration has a long history in many countries of the world, particularly in the more affluent regions such as the UK, nearly 80% of the world’s populations live in regions that are not covered by such systems.17 Nonetheless, with a view to characterising the global burden of the disease, the International Agency for Research on Cancer routinely uses the available data to estimate worldwide cancer incidence.18

Oesophageal cancer is the 8th most common cancer worldwide, with an estimated 481,645 new cases diagnosed in 2008 (4% of the total). Oesophageal cancer incidence rates are highest in Southern Africa for both males and females, and are lowest in Western Africa (males) and Southern Europe (females). There is around 16-fold variation in World AS incidence rates between the regions of the world, in both males and females (Figure 1.7).18

Figure 1.7: Oesophageal Cancer (C15), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

world_inc_oesophag.swf

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The majority of cases (83%) are estimated to be diagnosed in less developed regions of the world where oesophageal cancer is the fifth most common cancer in men. SCC accounts for the vast majority of oesophageal cancers diagnosed in low- and middle-income countries (Figure 1.7).18,19

Wide variation in incidence has been reported both between countries and in different ethnic groups and populations within countries. For example, in the USA, the incidence of SCC is more than four times higher in black men than in white men, while the incidence of AC is around five times higher in white men than in black men.20

These differences in histological distribution may reflect variation in exposure to risk factors. SCC and AC are associated with different risk factors: smoking, alcohol and (perhaps particularly in developing countries) some infectious and inherited conditions increase SCC risk; whilst AC risk is linked primarily with Barrett’s oesophagus and obesity.

Within the 27 countries of the European Union (EU-27), the highest oesophageal cancer European AS incidence rates for 2008 are estimated to be in the UK for both men and women (more than 14 and more than 5 cases per 100,000, respectively); the lowest rates are estimated to be in Cyprus for men and Greece for women (around 1 case and less than 1 case per 100,000, respectively) (Figure 1.8).21

Figure 1.8: Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates

EU27_inc_oesophag.swf

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section reviewed 18/06/13
section updated 18/06/13

Socio-economic variation

Oesophageal cancer incidence is strongly related to deprivation and there is a clear trend of increasing rates with increasing levels of deprivation.22 The most recent England-wide data for 2000-2004 shows European AS incidence rates are 43% higher for men living in the most deprived areas compared with the least deprived, and 44% higher for women.23 It has been estimated that there would have been 1,000 fewer new oesophageal cancer cases each year in England during 2000-2004 if all men and women had experienced the same rates as the most affluent.23

A study in Scotland for 2006-2010 showed that the gap in oesophageal cancer incidence by deprivation is higher with the most deprived having 74% higher rates, compared with the least deprived.27 Comparable associations with deprivation have also been reported in Wales and Northern Ireland.28,29

However, there is evidence that this gradient between the most deprived and least deprived areas differs for the main histological groups, suggestive of different aetiological backgrounds.16,24,25 A study by the West Midlands Cancer Intelligence Unit found that the incidence of SCC is highest the most socially deprived quintile, whereas the incidence of AC was found to have no association with differences in deprivation.24

An analysis of Scottish data showed a clear association between deprivation and non-adenocarcinoma but no clear association with deprivation for adenocarcinoma,16 However data from the East of England for 1995-2006 provide some evidence for an effect of deprivation in both AC and SCC, with the association stronger in SCC and in males.26

The association with deprivation is unsurprising, given that smoking causes around 66% of oesophageal cancers in the UK, and is more prevalent in those with routine and manual occupations, compared with those in managerial or professional occupations.30,31 In addition, consumption of fruit and vegetables, which has been shown to protect against oesophageal cancer, is lower in those living in more deprived areas.8,32

section reviewed 18/06/13
section updated 18/06/13

Prevalence

Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not.

In the UK around 10,700 people were still alive at the end of 2006, up to ten years after being diagnosed with oesophageal cancer (Table 1.2).33

Table 1.2: Oesophageal Cancer (C15), One, Five and Ten Year Cancer Prevalence, UK, 31st December 2006

1 Year Prevalence 5 Year Prevalence 10 Year Prevalence
Male 2,864 5,727 6,978
Female 1,418 2,868 3,674
Persons 4,282 8,595 10,652

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Worldwide, it is estimated that there were around 482,000 men and women still alive in 2008, up to five years after their diagnosis.18

section reviewed 18/06/13
section updated 18/06/13

 

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References for oesophageal cancer incidence

  1. Data were provided by the Office for National Statistics on request, June 2012. Similar data can be found here: http://www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/index.html.
  2. Data were provided by ISD Scotland on request, April 2012. Similar data can be found here: http://www.isdscotland.org/Health-Topics/Cancer/Publications/index.asp.
  3. Data were provided by the Welsh Cancer Intelligence and Surveillance Unit on request, April 2012. Similar data can be found here: http://www.wales.nhs.uk/sites3/page.cfm?orgid=242&pid=59080.
  4. Data were provided by the Northern Ireland Cancer Registry on request, October 2012. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/CancerData/OnlineStatistics/.
  5. Quinn M, Wood H, Cooper N, Rowan S, eds. Cancer Atlas of the United Kingdom and Ireland 1991–2000. Studies on Medical and Population Subjects No. 68. London: ONS; 2005.
  6. National Cancer Intelligence Network (NCIN). Cancer Incidence and Mortality by Cancer Network, UK, 2005. London: NCIN; 2008.
  7. National Cancer Intelligence Network (NCIN). Cancer e-Atlas. Accessed April 2013.
  8. Parkin DM, Boyd L, Walker LC. 16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Summary and conclusions. Brit J Cancer 6 Dec 2011; 105 (S2):S77-S81.
  9. Rutegård M, Nordenstedt H, Lu Y, et al. Sex-specific exposure prevalence of established risk factors for oesophageal adenocarcinoma. Brit J Cancer 2010;103(5):735-40.
  10. Lifetime risk was calculated by the Statistical Information Team at Cancer Research UK, 2012.
  11. Sasieni PD, Shelton J, Ormiston-Smith N, Thomson CS, Silcocks PB What is the lifetime risk of developing cancer?: The effect of adjusting for multiple primaries. Brit J Cancer 2011;105(3):460-5.
  12. Barrett NR. Chronic peptic ulcer of the oesophagus and 'oesophagitis'. Brit J Surg 1950;38(150:)175-82.
  13. Dolan K, Sutton R, Walker SJ, et al. New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology. Brit J Cancer 1999;80(5-6:)834-42.
  14. Wijnhoven BP, Siersema PD, Hop WC, et al. Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity. Rotterdam Oesophageal Tumour Study Group. Brit J Surg 1999;86(4:)529-35.
  15. Vizcaino AP, Moreno V, Lambert R, et al. Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973-1995. Int J Cancer 2002;99(6)860-8.
  16. Gilbert FJ, Park K, Thompson AM (eds), Scottish Audit of Gastric and Oesophageal Cancer. Report 1997-2000. A prospective audit. Scottish Audit of Gastric and Oesophageal Cancer Steering Group: Edinburgh; 2002.
  17. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
  18. Ferlay J, Shin HR, Bray F, et al. GLOBOCAN 2008 v1.2, Cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from http://globocan.iarc.fr.
  19. International Agency for Research on Cancer. World Cancer report 2008. Lyon: International Agency for Research on Cancer; 2008.
  20. Cook MB, Chow WH, Devesa SS. Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005. Brit J Cancer. 2009 September 1; 101(5): 855–859.
  21. European Age-Standardised rates calculated by the Cancer Research UK Statistical Information Team, 2011, using data from GLOBOCAN 2008 v1.2, IARC, version 1.2. http://globocan.iarc.fr.
  22. Rowan S. Trends in cancer incidence by deprivation, England and Wales, 1990-2002. Health Stat Q 2007:24-35.
  23. National Cancer Intelligence Network (NCIN). Cancer Incidence by Deprivation, England, 1995-2004. London: NCIN; 2008.
  24. Cooper SC, Day R, Brooks C, Livings C, Thomson CS, Trudgill NJ. The influence of deprivation and ethnicity on the incidence of esophageal cancer in England. Epub 2009 Jun 17. Cancer Causes Control. 2009 Oct;20(8):1459-67.
  25. Brown LM, Devesa SS. Epidemiology and risk of esophageal cancer: Clinical. In: Jobe BA, Thomas CR Jr, Hunter JG, eds. Esophageal Cancer: Principles and Practice. New York, United States of America: DEMOSmedical, 2009.
  26. Gajperia C, Barbiere JM, Greenberg D, et al. Recent incidence trends and sociodemographic features of oesophageal and gastric cancer types in an English region. Aliment Pharmacol Ther 2009;30(8):873-80.
  27. Information Services Division Scotland (ISD). Cancer Statistics: Cancer of the oesophagus. Accessed May 2013.
  28. Welsh Cancer Intelligence and Surveillance Unit. Cancer in Wales, 1995-2009: A Comprehensive Report. Cardiff: Welsh Cancer Intelligence and Surveillance Unit; 2011.
  29. Donnelly DW, Gavin AT, Comber H. Cancer in Ireland 1994-2004: A comprehensive report. Northern Ireland Cancer Registry/National Cancer Registry; Ireland, 2009.
  30. Office for National Statistics (ONS). General lifestyle survey overview: A report on the 2010 general lifestyle survey. London: ONS; 2012.
  31. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. JNCI 2011;103(24):1827-39.
  32. Lakshman R, McConville A, How S, et al. Association between area-level socioeconomic deprivation and a cluster of behavioural risk factors: cross-sectional, population-based study. J Public Health 2011;33(2):234-45.
  33. National Cancer Intelligence Network (NCIN). One, Five and Ten Year Cancer Prevalence by Cancer Network, UK, 2006. London: NCIN; 2010.
Updated: 18 June 2013