Adenocarcinoma of the oesophagus: incidence and survival rates in New South Wales, 1972-2005

Objective: To investigate trends in the incidence of adenocarcinoma (AC) of the oesophagus in New South Wales, factors associated with a diagnosis of AC, and factors associated with survival of patients with AC. Design and setting: We examined all cases of invasive oesophageal cancer recorded in the NSW Central Cancer Registry from 1972 to 2005. The Accessibility/Remoteness Index of Australia was used to assess geographical remoteness and the Index of Relative Socio-Economic Disadvantage to assess socioeconomic status. Main outcome measures: Incidence of AC; factors associated with diagnosis of AC and survival of patients with AC. Results: The overall incidence of oesophageal AC in NSW increased in both males and females (annual percentage change, 4.2% [95% CL, 2.7%, 5.8%] in males [1988-2005] and 4.3% [95% CL, 1.8%, 7.0%] in females [1983-2005]). A diagnosis of AC was significantly associated with being male (adjusted odds ratio [AOR], 4.37 [95% CL, 3.84, 4.98]; P<0.001); a younger age at diagnosis (P trend <0.001); having distant rather than localised disease spread (AOR, 2.12 [95% CL, 1.82, 2.48]; P<0.001); higher socioeconomic status (P trend <0.001); and living in an inner regional area (AOR, 1.26 [95% CL, 1.11, 1.43]; P<0.001) or outer regional area (AOR, 1.19 [95% CL, 1.00, 1.41]; P=0.05) compared with a major city. Early diagnosis of AC was associated with substantial improvement in survival outcomes: patients with metastatic disease at diagnosis had a three times greater risk of dying than those with localised AC at diagnosis. Conclusion: The incidence of AC is increasing in NSW. Possible contributing factors include increasing obesity, which is associated with increased incidence of gastro-oesophageal reflux disease. Survival may be improved by diagnosis at an earlier stage and changes in modifiable risk factors (eg, smoking, diet, exercise).