Oesophageal cancer incidence statistics

Oesophageal cancer is the 11th most common cancer in the UK (2012), accounting for 3% of all new cases. In males it is the eighth most common cancer (3% of male total), whilst it is the 14th most common in females (2%).[1-4]

In 2012, there were 8,755 new cases of oesophageal cancer in the UK: 5,878 (67%) in men and 2,877 (33%) in women, giving a male:female ratio of around 20:10.[1-4] The crude incidence rate Open a glossary item shows that there are 19 new oesophageal cancer cases for every 100,000 males in the UK, and 9 for every 100,000 females.

The European age-standardised Open a glossary item rates (AS rates) are significantly higher in Scotland compared with England and Wales for both sexes.[1-4] The rates do not differ significantly between the other constituent countries of the UK.

Oesophageal Cancer (C15), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2012

England Wales Scotland Northern Ireland UK
Male Cases 4,884 277 579 138 5,878
Crude Rate 18.5 18.3 22.5 15.4 18.8
AS Rate 22.8 20.2 26.8 21.7 23.0
AS Rate - 95% LCL 22.1 17.8 24.6 18.1 22.4
AS Rate - 95% UCL 23.4 22.6 29.0 25.4 23.5
Female Cases 2,359 135 308 75 2,877
Crude Rate 8.7 8.6 11.3 8.1 8.9
AS Rate 8.9 8.0 11.3 9.4 9.1
AS Rate - 95% LCL 8.6 6.7 10.0 7.2 8.8
AS Rate - 95% UCL 9.3 9.4 12.5 11.5 9.4
Persons Cases 7,243 412 887 213 8,755
Crude Rate 13.5 13.4 16.7 11.7 13.7
AS Rate 15.3 13.7 18.3 14.6 15.4
AS Rate - 95% LCL 14.9 12.3 17.1 12.7 15.1
AS Rate - 95% UCL 15.6 15.0 19.5 16.6 15.7

95% LCL and 95% UCL are the lower and upper  confidence limits Open a glossary item around the age-standardised rate Open a glossary item

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.

There was a north-south divide in oesophageal cancer incidence across England in the 1990s, with the highest rates in North West England, parts of Scotland and Wales, and lower incidence in the South East of England.[5

Similarly, the latest analyses of oesophageal cancer incidence rates across the former cancer networks throughout the UK shows significant variation between cancer networks, with some of the highest rates being in parts of Scotland and Northwest England, and the lowest in the South and East of England and areas of London.[6,7]

References

  1. Data were provided by the Office for National Statistics on request, July 2014. 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 2014. 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 2014. 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, June 2014. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/.
  5. Quinn M, Wood H, Cooper N, et al, 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 January 2014.
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Oesophageal cancer incidence is strongly related to age, with the highest incidence rates being in older men and women. In the UK between 2010 and 2012, an average of 42% of cases were diagnosed in men and women aged 75 years and over, with around 95% of cases occurring in those aged 50 and over.[1-4

Age-specific incidence rates rise sharply from around age 45-49 years, with the highest rates in the 90+ age group. Incidence rates are higher for males than females from age 25-29, with no significant differences at younger ages. This gap is widest in younger age groups and decreases with age, with the highest male:female incidence ratio of age-specific rates (to account for the different proportions of males to females in each age group) being around 65:10 in those aged 25-29.[1-4]

Oesophageal Cancer (C15), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2010-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.

References

  1. Data were provided by the Office for National Statistics on request, July 2014. 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 2014. 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 2014. 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, June 2014. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/.
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Oesophageal cancer incidence rates have increased overall for both males and females in Great Britain since the late-1970s, though in females this includes an increase followed by a decrease since the late-1990s.[1-3] For males, European age-standardised (AS) incidence rates increased by 57% between 1979-1981 and 2010-2012. The rise is smaller for females, with rates increasing by 26% between 1979-1981 and 1999-2001, and since falling by 11%.

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.[5] However, sex differences in exposure to risk factors are thought to be unlikely to explain the more rapid increase in males.[6]

Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, Great Britain, 1979-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.

Over the last decade (between 2001-2003 and 2010-2012), European AS incidence rates remained stable in males, but decreased by 7% in females.[1-4]

Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, UK, 1993-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.

Oesophageal cancer incidence rates in Great Britain have increased overall for all of the broad age groups in males since the late-1970s.[1-3] The largest increase has been in the 25-49, 50-59 and 60-69 age groups, with European AS incidence rates increasing by 68%, 66% and 61%, respectively, between 1979-1981 and 2010-2012. For males aged 70-79 or 80+, rates increased between the late-1970s and early 2000s, but have remained stable since then.

Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, Males by Age, Great Britain, 1979-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.

Oesophageal cancer incidence rates in Great Britain have remained stable for most of the broad age groups in females since the late-1970s, though in most age groups this includes an increase until the 1990s, followed by a decrease or stability.[1-3] In women aged 70-79 , European AS incidence rates peaked in 1998-2000 (increase of 40% between 1979-1981 and 1998-2000) and have since fallen by 16%. For women in the 80+ age group, rates peaked in 1999-2001, having increased by 30% from 1979-1981, and have since fallen by 24%. In women aged 25-49, 50-59 and 60-69, rates have remained stable overall (though in the 60-69 age group this includes an increase followed by stability).

Oesophageal Cancer (C15), European Age-Standardised Incidence Rates, Females by Age, Great Britain, 1979-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.

References

  1. Data were provided by the Office for National Statistics on request, July 2014. 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 2014. 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 2014. 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, June 2014. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/.
  5. 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.
  6. 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.
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The lifetime risk of developing oesophageal cancer is 1 in 55 for men and around 1 in 115 for women, in 2012 in the UK.[1]

The lifetime risk for oesophageal cancer has been calculated on the assumption that the possibility of having more than one diagnosis of oesophageal cancer over the course of a lifetime is very low (‘Current Probability’ method).[2]

References

  1. Lifetime risk estimates calculated by the Statistical Information Team at Cancer Research UK. Based on data provided by the Office of National Statistics, ISD Scotland, the Welsh Cancer Intelligence and Surveillance Unit and the Northern Ireland Cancer Registry, on request, December 2013 to July 2014.
  2. Esteve J, Benhamou E and Raymond L. Descriptive epidemiology. IARC Scientific Publications No.128, Lyon, International Agency for Research on Cancer, pp 67-68 1994.
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The largest proportion of oesophageal cancer cases occur in the lower third of the oesophagus, with much smaller proportions in the middle and upper thirds (2010-2012).[1-4]

The proportion of cases in the lower third is higher in males (49.0%) than females (33.7%), whereas in the middle third there is a higher proportion in females (20.8%) than in males (10.7%). There are no marked sex differences in other parts of the oesophagus.[1-4]

A large proportion of cases did not have the specific part of the oesophagus recorded in cancer registry data, or overlapped more than one part.[1-4]

Oesophageal Cancer (C15), Percentage Distribution of Cases Diagnosed By Anatomical Site, by Sex, UK, 2010-2012

Male Female
Cancer site (ICD-10 code) Average Cases % Average Cases %
Upper Third (C15.0, C15.3) 209 3.7% 183 6.5%
Middle Third (C15.1, C15.4) 612 10.7% 589 20.8%
Lower Third (C15.2, C15.5) 2,804 49.0% 956 33.7%
Oesophagus, Overlapping and Unspecified (C15.8-C15.9) 2,095 36.6% 1,108 39.1%
Total 5,719 100.0% 2,836 100.0%

References

  1. Data were provided by the Office for National Statistics on request, July 2014. 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 2014. 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 2014. 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, June 2014. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/CancerInformation/.
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There are two main histological types of oesophageal cancer: squamous cell carcinoma (SCC) Open a glossary item and adenocarcinoma (AC) Open a glossary item. 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 age-standardised Open a glossary item (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.[2]

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Oesophageal cancer is the 19th most common cancer in Europe, with around 45,900 new cases diagnosed in 2012 (1% of the total). In Europe (2012), the highest World age-standardised Open a glossary item (AS) incidence rates for oesophageal cancer are in the Netherlands for men and the UK for women; the lowest rates are in Macedonia for men and the Republic of Moldova for women. UK oesophageal cancer incidence rates are estimated to be the second highest in males in Europe.[1] These data are broadly in line with Europe-specific data available elsewhere.[2]

Oesophageal cancer is the eighth most common cancer worldwide, with nearly 456,000 new cases diagnosed in 2012 (3% of the total). Oesophageal cancer incidence rates are highest in Eastern Asia and lowest in Western Africa, but this partly reflects varying data quality worldwide.[1]

Variation between countries may reflect different prevalence of risk factors, use of screening, and diagnostic methods.

References

  1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from:http://globocan.iarc.fr, accessed December 2013.
  2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al.Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. European Journal of Cancer (2013) 49, 1374-1403.
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Oesophageal cancer incidence is strongly related to deprivation and there is a clear trend of increasing rates with increasing levels of deprivation.[1] The most recent England-wide data for 2000-2004 shows European age-standardised (AS) Open a glossary item incidence rates are 43% higher for men living in the most deprived areas compared with the least deprived, and 44% higher for women.[2] 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.[2]

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.[3] Comparable associations with deprivation have also been reported in Wales and Northern Ireland.[4,5]

However, there is evidence that this gradient between the most deprived and least deprived areas differs for the main histological groups, suggestive of different.[6-8] A study by the West Midlands Cancer Intelligence Unit found that the incidence of squamous cell carcinoma (SCC) Open a glossary item is highest the most socially deprived quintile, whereas the incidence of adenocarcinoma (AC) Open a glossary item was found to have no association with differences in deprivation.[7]

An analysis of Scottish data showed a clear association between deprivation and non-adenocarcinoma but no clear association with deprivation for adenocarcinoma,[6] 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.[9]

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.[10,11] 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.[12,13]

References

  1. Rowan S. Trends in cancer incidence by deprivation, England and Wales, 1990-2002. Health Stat Q 2007:24-35.
  2. National Cancer Intelligence Network (NCIN). Cancer Incidence by Deprivation, England, 1995-2004. London: NCIN; 2008.
  3. Information Services Division Scotland (ISD). Cancer Statistics: Cancer of the oesophagus. Accessed May 2013.
  4. Welsh Cancer Intelligence and Surveillance Unit. Cancer in Wales, 1995-2009: A Comprehensive Report. Cardiff: Welsh Cancer Intelligence and Surveillance Unit; 2011.
  5. Donnelly DW, Gavin AT, Comber H. Cancer in Ireland 1994-2004: A comprehensive report. Northern Ireland Cancer Registry/National Cancer Registry; Ireland, 2009.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Office for National Statistics (ONS). General lifestyle survey overview: A report on the 2010 general lifestyle survey. London: ONS; 2012.
  11. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. JNCI 2011;103(24):1827-39.
  12. 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.
  13. 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.
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Age-standardised rates Open a glossary item for White males with oesophageal cancer range from 13.9 to 14.4 per 100,000. Rates for Asian males are significantly lower, ranging from 3.6 to 6.1 per 100,000 and the rates for Black males are also significantly lower, ranging from 6.0 to 10.2 per 100,000. For females there is a similar pattern - the age-standardised rates for White females range from 5.5 to 5.7 per 100,000, and rates for Asian and Black females are also significantly lower, ranging from 2.5 to 4.5 per 100,000 and 2.1 to 4.5 per 100,000 respectively.[1]

Ranges are given because of the analysis methodology used to account for missing and unknown data. For oesophageal cancer, 31,517 cases were identified; 16% had no known ethnicity.

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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.[1]

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

Worldwide, it is estimated that there were around 482,000 men and women still alive in 2008, up to five years after their diagnosis.[2]

References

  1. National Cancer Intelligence Network (NCIN). One, Five and Ten Year Cancer Prevalence by Cancer Network, UK, 2006. London: NCIN; 2010.
  2. 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.
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