Epidemiology

Oesophageal cancer is the eleventh most common type of cancer worldwide and constitutes the seventh leading cause of cancer deaths.[6]​ Cancers of the oesophagus account for over 440,000 cancer deaths annually, which represents 4.6% of all global cancer deaths.​[6]

In the US in 2024, there will have been an estimated 22,370 new cases of oesophageal cancer (median age at diagnosis 68 years) and an estimated 16,130 people will have died of this disease.[7]​​[8][9]​​​ Between 2016 and 2020, there were 4.2 new cases of oesophageal cancer per 100,000 men and women per year in the US. The age-adjusted rate of new cases of oesophageal cancer during this timeframe was 7.1 per 100,000 in men, and 1.7 per 100,000 in women.[7]

Age-standardised incidence of oesophageal cancer is higher across Eastern Asia and Eastern Africa, with the highest incidence seen in Malawi.[6]​ It is the leading cause of cancer death among men and women in Bangladesh and among men in Malawi and Botswana.[6]​ Hypotheses to explain geographical variation include genetic predisposition and disparity in the prevalence of dietary and environmental risk factors across regions.[10][11]

Oesophageal adenocarcinoma (OAC)

Rapidly becoming the most prevalent type in developed countries.[10] In the US, approximately 70% of cases are adenocarcinomas.[2] The vast majority of the increase in incidence of adenocarcinoma of the oesophagus is attributed to the rise of Barrett's oesophagus in young, otherwise healthy men - particularly in white people in the US and Western Europe.[12][13]​​ Rising rates of obesity have been identified as a likely causal factor for this increase; obesity contributes to the development of gastro-oesophageal reflux disease, a major underlying cause of Barrett's oesophagus.[14][15]​​​ Cancer registries indicate that the Netherlands, United Kingdom, and Ireland have the highest age-standardised incidence of OAC.[11]

Oesophageal squamous cell carcinoma (OSCC)

OSCC continues to be the most prevalent type worldwide; incidence of OSCC has been reported to be higher in non-white people.[16][17]​​​ In the US, squamous cell carcinoma is more common than adenocarcinoma within the black population, with the incidence rate in black men being 4.5 times higher than that of white men.[10][18]​​​ It is commonly associated with alcohol and tobacco consumption.[6]​​ OSCC has become less common in the West in recent decades due to reduced alcohol and tobacco use; it now accounts for less than 30% of all oesophageal cancers in the US and Western Europe.[14]

Malawi, Mongolia, and Kenya have the highest age-standardised incidence of OSCC.[11]

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