Continuing Rapid Increase in Esophageal Adenocarcinoma in England and Wales

BACKGROUND AND AIMS: Substantial changes have occurred in the epidemiology of esophageal adenocarcinoma. We examined trends in incidence in a large national population. METHODS: All esophageal adenocarcinomas registered in England and Wales over a 31-year period (1971-2001) were included. Incidence rates were calculated by age, sex, and socio-economic category, by 5-year period, and by birth cohort. RESULTS: A total of 43,753 esophageal adenocarcinomas were analyzed. Age-standardized (world) incidence rates rose rapidly, by an average of 39.6% (95% CI 38.6-40.6) every 5 years in men, and 37.5% (35.8-39.2) every 5 years in women. Incidence has increased about three-fold in men and women since 1971. Incidence has risen in all deprivation categories since 1986, especially in the most affluent groups. The cumulative risk of esophageal adenocarcinoma over the age range 15-74 years in men rose ten-fold, from 0.1% for those born in 1900 to 1.1% for those born in 1940. The cumulative risk rose five-fold in women. CONCLUSIONS: The incidence of esophageal adenocarcinoma has increased sharply over the past few decades, both by period and birth cohort. Etiological studies are required to explain the rapid increase of this lethal cancer.