Oesophageal cancer is the eighth most common cancer in the world, with striking geographical variations in incidence (Parkin, 2001). It accounts for approximately 1 in 40 of all cancers among adults in England and Wales, with an average of some 6000 new cases a year, of which some 60% occur in men (Quinn et al, 2001). Incidence has increased steadily in both sexes since the 1970s. Lifetime risks up to the age of 74 years are currently approximately 1% in men and 0.4% in women (Parkin et al, 2002). Trends in mortality are similar to those for incidence, because survival has been poor for many years. The incidence of adenocarcinoma of the lower third of the oesophagus and the gastric cardia has been increasing for 20 years in England (Powell and McConkey, 1990; Newnham et al, 2003) and in other countries (Bollschweiler et al, 2001). More than 90% of squamous cell carcinomas can be attributed to alcohol and tobacco in Europe and North America, whereas the main risk factor for adenocarcinoma is Barrett's oesophagus. Oesophageal cancer has an extremely poor prognosis: the average 5-year relative survival rate among adults diagnosed in 22 European countries during the early 1990s was approximately 10% (Sant et al, 2003).
We analysed data for 65 591 patients diagnosed with oesophageal cancer in England and Wales during the period 1986–1999, approximately 84% of those eligible, with follow-up to the end of 2001. Exclusions from analysis were mainly of patients whose recorded survival was zero (10.8%) or whose cancer of the oesophagus was not their first primary malignancy (3.6%). A third (34%) of tumours were squamous carcinomas, but the proportion classified as adenocarcinoma rose from 32 to 44% during the 1990s, continuing a steady increase from 15% in the early 1970s (Coleman et al, 1999). Annual incidence rates increased by about one-third in men and women during the period 1986–1999. Trends were similar for all deprivation groups in both sexes, and incidence was lowest in the most affluent groups throughout (Figure 1).
Survival trends
Relative survival at 1 year increased significantly from the late 1980s to the late 1990s in both sexes, from 23.8 to 29.6% in men (fitted, deprivation-adjusted average increase 3.7% every 5 years) and from 24.4 to 26.8% in women (+1.4% every 5 years) (Table 1, Figure 2). Five-year survival increased from 6.3 to 7.6% in men over the same period (average increase +1.7% every 5 years), but there was no change in 5-year survival for women: 7.4% for those diagnosed during 1986–1990 and 7.2% for those diagnosed during 1996–1999. Short-term predictions of survival for patients diagnosed during 2000–2001, using hybrid analysis (Brenner and Rachet, 2004), suggest a small continuing increase in survival at 1, 5 and 10 years after diagnosis (Table 1).
Deprivation
The deprivation gap was more marked in men (Table 2, Figure 3). For 1-year survival, the deprivation gap remained unchanged at approximately −5% (lower for the most deprived group than for the most affluent), but for survival at 5 and 10 years, the deprivation gap widened significantly every 5 years by −1.4% for 5-year survival and by −2.7% for 10-year survival. For women, the deprivation gap in survival was less marked, and did not change significantly over time.
Comment
Survival from oesophageal cancer in England and Wales remains very poor, with 5-year relative survival approximately 7.5%, and no major improvement for patients diagnosed between 1986 and 1999. Five-year survival was already 6–7% for patients diagnosed in 1971–1975 (Coleman et al, 1999). This suggests a lack of substantial progress in diagnostic or therapeutic management over the last 30 years. However, the slight improvement in 1-year survival for both sexes suggests a decrease in postoperative mortality (Faivre et al, 1998). There was a trend towards higher 5-year survival for men, accompanied by a significant increase in the deprivation gap; this was not seen for women. As stage at diagnosis is the main prognostic factor for oesophageal cancer, and incidence trends were similar in all deprivation groups, these trends in 5-year survival may suggest a trend towards earlier stage at diagnosis for men in the more affluent groups, with a higher proportion being referred for potentially curative resection.
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Bollschweiler E, Wolfgarten E, Gutschow C, Holscher AH (2001) Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 92: 549–555
Brenner H, Rachet B (2004) Hybrid analysis for up-to-date long-term survival rates in cancer registries with delayed recording of incident cases. Eur J Cancer 40: 2494–2501
Coleman MP, Babb P, Damiecki P, Grosclaude PC, Honjo S, Jones J, Knerer G, Pitard A, Quinn MJ, Sloggett A, De Stavola BL (1999) Cancer Survival Trends in England and Wales 1971–1995: Deprivation and NHS Region. Studies on Medical and Population Subjects No. 61. The Stationery Office: London
Faivre J, Forman D, Estève J, Gatta G, EUROCARE Working Group (1998) Survival of patients with oesophageal and gastric cancers in Europe. Eur J Cancer 34: 2167–2175
Newnham A, Quinn MJ, Babb P, Kang YJ, Majeed A (2003) Trends in the subsite and morphology of oesophageal and gastric cancer in England and Wales 1971–1998. Alim Pharmacol Ther 17: 665–676
Parkin DM (2001) Global cancer statistics in the year 2000. Lancet Oncol 2: 533–543
Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB (eds) (2002) Cancer Incidence in Five continents, Volume VIII (IARC Scientific Publications No. 155). International Agency for Research on Cancer: Lyon
Powell J, McConkey CC (1990) Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer 62: 440–443
Quinn MJ, Babb P, Brock A, Kirby L, Jones J (2001) Cancer Trends in England and Wales 1950–1999. Studies on Medical and Population Subjects No. 66. Office for National Statistics: London
Rachet B, Woods LM, Mitry E, Riga M, Cooper N, Quinn MJ, Steward J, Brenner H, Estève J, Sullivan R, Coleman MP (2008) Cancer survival in England and Wales at the end of the 20th century. Br J Cancer 99(Suppl 1): S2–S10
Sant M, Aareleid T, Berrino F, Bielska Lasota M, Carli P-M, Faivre J, Grosclaude PC, Hédelin G, Matsuda T, Møller H, Moller T, Verdecchia A, Capocaccia R, Gatta G, Micheli A, Santaquilani M, Roazzi P, Lisi D, EUROCARE Working Group (2003) EUROCARE-3: survival of cancer patients diagnosed 1990–94 – results and commentary. Ann Oncol 14 (Suppl 5): 61–118
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Mitry, E., Rachet, B., Quinn, M. et al. Survival from cancer of the oesophagus in England and Wales up to 2001. Br J Cancer 99 (Suppl 1), S11–S13 (2008). https://doi.org/10.1038/sj.bjc.6604572
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bjc.6604572
This article is cited by
-
Screening for Barrett’s Oesophagus: Are We Ready for it?
Current Treatment Options in Gastroenterology (2021)
-
Feasibility study of endoscopic thermal coagulation with circumferential laser irradiation for treating esophageal tissue
Lasers in Medical Science (2020)
-
Occupational cancer in Britain
British Journal of Cancer (2012)
-
Trends and variation in the management of oesophagogastric cancer patients: a population-based survey
BMC Health Services Research (2009)
-
Cancer survival in England and the influence of early diagnosis: what can we learn from recent EUROCARE results?
British Journal of Cancer (2009)