Incidence of esophageal cancer subtypes vary drastically globally and by gender

1. Esophageal squamous cell carcinoma accounted for nearly 90% of all global esophageal carcinoma subtypes.

2. Men had a higher incidence of esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC), with a nearly 4.5-fold high rate of AC compared to women.

Evidence Rating Level: 3 (Average)

Study Rundown: Esophageal cancer is the eighth most common cancer worldwide, and while global, country, and gender-specific incidence estimates have been known for years, the breakdown by histological subtype has not. Differences in incidence have been attributed to dietary factors, such as drinking extremely hot beverages, smoking, and rates of gastroesophageal reflux disease, among others. The purpose of this study was to determine the incidence of esophageal cancer by histological subtype, specifically AC and SCC, in order to help health policy makers plan more appropriate cancer control measures. The authors found that of 456,000 total cases of esophageal cancer in 2012, 398,000 cases were SCC and 52,000 cases were AC. While the most common histologic subtype globally was SCC, esophageal AC was more common in Northern and Western Europe, Northern America, and Oceania. Furthermore, men had significantly higher rates of both subtypes compared to women, with the association being the strongest for AC.

This study benefited from utilizing two databases, the Cancer Incidence in Five Continents Vol. X (CI5X) and GLOBOCAN 2012, which aided in determining global incidences of disease. Additionally, the authors accounted for countries without data in these databases by using regional proportions as an estimate. However, this serves as a limitation as well in disregarding potential differences among countries within a region. Finally, histological misclassification of AC and SCC, particularly in areas with low incidences of disease where pathologists may not be adept at diagnosis, may have impacted incidence estimates. Overall, this study reveals that SCC remains the most common global subtype of esophageal cancer with AC predominating in higher-income countries and in men.

Click to read the study in Gut

Relevant Reading: Esophageal cancer incidence in the United States by race, sex, and histologic type

In-Depth: This study utilized data from CI5X in order to calculate age, gender, and country-specific proportions of AC and SCC, and then applied these proportions to data regarding all esophageal cancer cases in the GLOBOCAN 2012 database. In greater than 90% of countries represented in this study, the rate of SCC exceeded that of AC. Specifically, the global incidence of esophageal SCC was 5.2 per 100,000 and was highest in Eastern and Southeast Asia with a rate of 13.6 per 100,000 in men. In fact, China contributed over half (53%) of global SCC cases in this study. In contrast, the global incidence of esophageal AC was 0.7 per 100,000 and highest in Northern and Western Europe, Northern America, and Oceania; with a rate up to 7.2 and 7.1 per 100,000 in men from the United Kingdom and the Netherlands, respectively. In addition, with a global male-to-female ratio of 4.4 for AC and 2.7 for SCC, men had substantially higher rates of both histological subtypes.

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