Epidemiology of Esophageal Cancer

The epidemiology of esophageal cancer has radically changed in the last fifty-years in the Western world. Changes in the predominant type of squamous cell carcinoma to adenocarcinoma, disparities between different ethnicities, and the exponential increase in incidence rates of adenocarcinoma have established esophageal cancer as a major public health problem requiring urgent attention.

The epidemiology of esophageal cancer is fascinating, yet remains very poorly understood. Advances in data collection and surveillance, not to mention the development of national cancer registries to collect incidence data in developed and developing countries, have provided more accurate monitoring of this disease over the last few decades. Currently, esophageal cancer is the eighth most common incident cancer in the world and, because of its extremely aggressive nature and poor survival rate, it ranks sixth among all cancers in mortality. Despite these facts, esophageal cancer receives very little mention when compared with other cancers such as lung, breast, and colon in terms of health promotion and education. Special note, however, should be given to the fact that esophageal cancer is one of the very few cancers that is contributing to increasing death rates (20%) among males in the United States. Understanding and delineating the epidemiology of esophageal cancer will be the key to elucidating the causes and risk factors for esophageal cancer and thus the cornerstone of developing any prevention strategies.



The incidence of esophageal cancer increases with age. This pattern is similar in developing and developed countries. On average, adenocarcinoma generally is acquired 10 years earlier than squamous cell carcinoma ( Table 1 ).

Table 1

Comparison of squamous cell carcinoma and adenocarcinoma of the esophagus

Squamous Cell Carcinoma Adenocarcinoma
Age 60–70 years; median 62.7 years 50–60 years; median 53.4 years
Gender Male Male
Socioeconomic status Low Middle to upper
Locations 75% midesophagus 94% distal esophagus
Symptoms Progressive dysphagia, odynophagia, halitosis, unintentional weight loss, chest pain Progressive dysphagia, odynophagia, halitosis, unintentional weight loss, chest pain
Environmental factors Alcohol, cigarette smoking, mate-tea ingestion, betel-nut chewing, caustic ingestion, esophageal radiation exposure, high-fat diet, low vitamin diet [vitamin C, folate, beta-carotene, vitamin E], drinking hot liquids (>70°C) Cigarette smoking, high-fat diet, low vitamin diet [vitamin C, folate, beta-carotene, vitamin E]
Medical conditions Head/neck squamous cell carcinoma,Plummer-Vinson [Patterson-Kelly] syndrome, achalasia, tylosis, celiac disease, human papilloma virus infection, Helicobacter pylori infection Barrett’s metaplasia, Zollinger-Ellison syndrome, scleroderma, prior esophageal dilations, gastroesophageal reflux disease, obesity


In terms of gender differences, for squamous cell carcinoma in the Western world it occurs three to four times more often in males than females, although in the esophageal cancer belt, it is approximately a one to one ratio. for adenocarcinoma, however, males are six to eight times more likely to develop this particular form of esophageal cancer than females.


Esophageal cancer is an uncommon cancer. In terms of new (incident) cases of cancer, esophageal cancer is ranked as the eighth most common cancer in the world. At this point, it is important to differentiate esophageal cancer into its two histopathological subtypes (squamous cell carcinoma and adenocarcinoma), as the epidemiology between the two groups is vastly different. Surprisingly, over the last 30 years, there has been a major shift in the dominating histologic subtype of esophageal cancer in the Western world; previously, it was squamous cell carcinoma, and now it is adenocarcinoma. It is important to note that the classification of esophago–cardial adenocarcinomas also may explain the increase in this lesion. The wide geographic variation in incidence of esophageal cancer is marked, as is the mortality rates ( Fig. 1 ). The variation in incidence for esophageal cancer can differ as much as 500-fold from one part of the world to another. It is known that Asian countries, in particular China, India, Pakistan, and Japan, have the highest rates of esophageal cancer in the world; therefore countries mentioned in the following sections highlight those that have changed substantially over time or those that may not be well known as having high incidence of esophageal cancer.

Fig. 1

( A–D ) Geographic variation in the incidence and mortality of esophageal cancer.

United States

It is surprising to find that in the United States the incidence of esophageal cancer among both males and females ranks in the top 20 countries. Disturbingly, African American males from the District of Columbia rank number five and African American females from the state of Connecticut rank number 14 ( Tables 2 and 3 ). Moreover, African Americans from two additional states (South Carolina and Georgia) also are listed in the top 20 locations for esophageal cancer in the world. In the United States, squamous cell carcinoma remains the predominant subtype among African Americans, who have esophageal cancer rates six times higher than whites.

Table 2

World age standard rates (per 100,000 population) for males with esophageal cancer (GLOBOCAN 2002, International Agency for Research on Cancer)

Country, State/Province Cases Age Standard Rate
1. China, Jiashan 254 20.2
2. China, Zhongshan 532 16.5
3. Japan, Miyagi 1656 15.4
4. Zimbabwe, Harare: African 219 15.1
5. USA, District of Columbia: black 149 14.8
6. France, Calvados 327 14.6
7. United States, South Carolina: black 377 14.4
8. France, Somme 271 14.1
9. Uganda, Kyadondo 125 14.1
10. France, Manche 268 13.1
11. Brazil, Brasilia 262 13.1
12. Japan, Yamagata 892 13.0
13. France, Loire-Atlantique 503 12.7
14. Japan, Hiroshima 503 12.1
15. Brazil, Sao Paulo 2406 12.0
16. Brazil, Cuiaba 72 11.7
17. United Kingdom, Scotland 2391 11.7
18. United States, Georgia: Black 470 11.1
19. France, Bas-Rhin 370 10.9
20. United States, District of Columbia 179 10.8

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Feb 26, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Epidemiology of Esophageal Cancer

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