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The epidemic of oesophageal carcinoma: Where are we now?
- Between 1973 and 2001, oesophageal adenocarcinoma was one of the fastest rising cancers in many developed countries.
- Although the rate of increase has slowed, incidence of oesophageal adenocarcinoma continues to rise and will constitute an increasingly large health burden in the years ahead.
- Men are seven times more likely than women to develop oesophageal adenocarcinoma; the reasons for the striking sex disparity remain unknown.
- Gastro-oesophageal reflux disease, obesity and cigarette smoking are the main risk factors for oesophageal adenocarcinoma.
- In contrast, the incidence of oesophageal squamous-cell carcinoma continues to decline in Western populations.
- 5-year survival rates for oesophageal cancer remain less than 20%.
Since the early 1970s, the incidence of oesophageal adenocarcinoma has increased dramatically in most Western populations. In contrast, the incidence of oesophageal squamous-cell carcinoma has decreased in these same populations. Epidemiological studies conducted over the past decade have provided great insights into the etiology of oesophageal cancer. These studies have identified gastro-oesophageal reflux disease, obesity and cigarette smoking as risk factors for oesophageal adenocarcinoma, while use of nonsteroidal anti-inflammatory drugs and infection with Helicobacter pylori are associated with reduced risk of oesophageal adenocarcinoma. For oesophageal squamous-cell carcinoma, alcohol and cigarette smoking are the two major risk factors underlying most cases. This review combines a synthesis of these studies with an analysis of data from the United States National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program to discuss the change in incidence of oesophageal cancer and summarize current knowledge of risk factors.
Keywords: Epidemiology, Oesophageal cancer, Barrett’s oesophagus, Obesity, Gastro-oesophageal reflux disease.
Department of Medicine and Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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© 2016 Elsevier Ltd, All rights reserved.