SEARCH

SEARCH BY CITATION

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Supporting Information

Aliment Pharmacol Ther30, 873–880

Summary

Background  Oesophageal and gastric cancers comprise various common tumour types with possible different aetiology and historically different incidence trends.

Aim  To enhance and update evidence about the descriptive epidemiology of oesophageal and gastric cancers.

Methods  Population-based information from the East of England was available on 16 319 (65% male) incident cases of oesophago-gastric cancer (ICD-10 C150–169) diagnosed during 1995–2006. Age-standardized incidence trends by gender and deprivation groups and sex ratios were compared for four different tumour types [oesophageal squamous cell carcinoma (OSCC), oesophageal adenocarcinoma (OAC), junctional/cardia adenocarcinoma (JCA), and non-cardia gastric adenocarcinoma (NCGA)].

Results  Between 1995–1997 and 2004–2006, the age-standardized incidence of OAC and JCA increased slightly (by 4% and 6% in men and 17% and 8% in women respectively), with a sex ratio >4 for both. Conversely, OSCC and NCGA incidence decreased (−20% and −32% in men and −15% and −26% in women respectively), with sex ratio of <2 for both. In men, OSCC and NCGA incidence was associated with increasing deprivation.

Conclusions  Within the study context, there was a modest rise in OAC and JCA incidence. OAC and JCA share common incidence trends and sociodemographic features (contrasting with those of OSCC and NCGA cancers).


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Supporting Information

Upper Gastro-Intestinal (GI) cancer (a term that, in this article, excludes pancreatic cancer) is an increasingly common presentation of malignant disease in Western populations.1 In the UK, oesophageal and stomach cancer account for over 15 000 new cases per year and over 13 000 deaths.2 In men, stomach cancer is the 6th and oesophageal cancer the 8th most common type of malignancy.2 Although radical surgery could offer cure, fewer than a quarter of all new patients present at a disease stage that can be treated surgically3 and overall survival in a relatively recent time period in the UK was <15% for stomach cancer and <10% for oesophageal cancer.4, 5

The most common oesophageal and stomach cancer types include oesophageal squamous cell carcinoma (OSCC), Oesophageal Adeno-Carcinoma (OAC), junctional/cardia adenocarcinoma (JCA) and non-cardia gastric adenocarcinoma (NCGA). Different types have been known to have had different incidence trends: A very substantial (three-fold to five-fold) rise in the incidence of OAC and JCA has been observed in recent decades in several different western populations.1, 6–11 In the United States, a similar pattern of increasing OAC and JCA incidence was observed in both White and Black men, although the disease is commoner in absolute terms among Whites.9 In the UK, recent data suggest that compared with Whites, oesophageal cancer incidence in South-Asians and Blacks is lower by approximately two and one third respectively.12 In contrast to OAC and JCA, the incidence of OSCC and NGCA has been decreasing.6, 7, 9 Compared with Whites, stomach cancer incidence is lower among South-Asians, but it is higher among Blacks.12 The exact aetiology of discordant incidence trends is not fully understood. The four main types of oesophageal and stomach cancers share a number of common risk factors, including smoking and low intake of fruit and vegetables.13–15 However, other risk factors, such as obesity, gastro-oesophageal reflux disease, alcohol intake and Helicobacter pylori infection have varying effects on risk of developing specific oesophago-gastric tumour types,12, 16–19 which may account for differing incidence trends.

Epidemiological evidence suggests common pathophysiological mechanisms for both OAC and JCA cancers, which also share characteristics that are distinct compared with NCGA tumours.20–23 However, this issue remains a subject of debate.24 Accurate diagnosis and classification of JCA tumours can be challenging, as such cancers can invade both the oesophagus and the stomach and it can therefore be difficult to attribute accurately the organ origin of such tumours. Increasing trends in the population prevalence of obesity have been suggested as the main cause of the rising incidence of OAC and JCA tumours.18, 25, 26 However, changes in diagnostic practice may have also been responsible, at least in part. The incidence of ‘not otherwise classified’ oesophageal and gastric cancers has also been decreasing over recent time periods. Therefore, at least in principle, the rise in OAC and JCA incidence may reflect more accurate diagnosis and classification of previously unclassifiable tumours.6 We therefore aimed to enhance and update existing evidence, by describing recent trends in the incidence and sociodemographic features of oesophageal and stomach cancers.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Supporting Information

Data source

Non-identifiable information was obtained from the Eastern Cancer Registration and Information Centre (ECRIC, one of the eight English population-based cancer registries, currently holding cancer registration information for a general population of about 5.5 million). All UK Cancer Registries have rigorous data quality assurance processes in place; ECRIC’s percentage of ‘Death Certificate Only’ registrations is 0.2% for all invasive malignant neoplasms excluding non-melanoma skin cancer, – a useful summary indicator of the high quality of the registration process.27

Case definition and data

The information relates to East of England residents aged ≥40 diagnosed with oesophageal or stomach cancer during a 12-year period between 1995 and 2006. Information was available on tumour site [International Classification of Diseases (ICD-10) codes C150–169], patient gender and age at diagnosis. No information was available on patient ethnic group. Motivated by similar approaches used by previous researchers,7, 9, 11, 28, 29 we further defined eight oesophageal and stomach cancer morphological categories based on ICD-Oncology (ICD-O) codes (Box).

Table Box..   Definitions of tumour type (and frequency of major tumour sub-types)
  1. ICD, International Classification of Diseases; ICD-O, ICD-Oncology; OSCC, oesophageal squamous cell carcinoma; OAC, oesophageal adenocarcinoma; JCA, junctional/cardia adenocarcinoma; NCGA, non-cardia gastric adenocarcinoma.

Tumour type definitions, using ICD-10 site and ICD-O morphology codes
OSCCICD-10 C150-9 and ICD-O M80703 (‘Squamous cell carcinoma’, 88% of cases in this category), or M80713, M80723, M80733, M80743, M80943, M81233, M85603).
OACICD-10 C150-9 and ICD-O M81403 (‘Adenocarcinoma’, 92% of cases in this category) or M81443, M81453, M82603, M83103, M84803, M84813 and M84903.
JCAICD-10 C160 and ICD-O M81403 (‘Adenocarcinoma’, 87% of cases in this category) or M81443, M81453, M82103, M82603, M83103, M84803, M84813 and M84903.
NCGAICD-10 C161-9 and ICD-O M81403 (‘Adenocarcinoma’, 83% of cases in this category) or M81443, M81453, M82103, M82603, M84803, M84813 and M84903.
UnspecifiedEither ICD-10 C150-9 or C160-9, separately, for oesophageal and stomach cancers, and ICD-O morphology codes M80103 (‘Carcinoma’, 83% of cases in this category), as well as M80003, M80012, M80043, and M80203.
‘Other’All other cancer types, separately, for oespophageal and stomach cancers. In the oesophagus, 53% of cases in this category were M80413 (‘Small Cell Carcinoma’).

Patient socioeconomic status was attributed indirectly, using the deprivation score [Index of Multiple Deprivation (IMD) 2004 at Lower Super-Output Area (LSOA) layer],30 of their post-code of residence. ‘IMD 2004’ is a UK Census-based (2001) small-area statistic measuring different deprivation domains. Coterminous Output Areas (the lowest small areas with aggregated Census information) of similar sociodemographic characteristics are aggregated to produce an LSOA (typically comprising five Output Areas, or about 1500 residents). This low and ‘homogenous’ aggregation level minimizes the potential for ecological fallacy (misattribution of individual socioeconomic status using the ‘average’ socioeconomic profile of a greater sample of individuals).31 Quintile groups using the distribution of LSOA deprivation scores in England were used in subsequent analysis (groups 1 to 5: ‘least’ to ‘most’ deprived respectively).

Analysis

We used four 3-year diagnosis periods (1995–1997, 1998–2000, 2001–2003, and 2004–2006) and focused on four major cancer types (OSCC, OAC, JCA, and NCGA). We calculated deprivation group specific age-standardized incidence trends, by tumour type and gender, using (deprivation group stratified) 5-year age band denominators relating to 2003 resident population estimates for the East of England Government Office region (Office for National Statistics) and the World Standard Population. In supplementary analysis we have also used the European Standard Population standard, and report results separately. Furthermore, for the four major cancer types, we calculated incidence sex ratios (male:female) and examined their significance with logistic regression models (for diagnosis year), adjusting for age.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Supporting Information

In total, there were 16 319 incident cases of oesophageal and gastric cancer during this study. Of those, 12 841 (78.7%) had one of the four main tumour types, of whom 2,242 (13.7%) had OSCC, 3,726 (22.8%) OAC, 2,108 (12.9%) JCA and 4765 (29.2%) NCGA (Table S1). The proportion of tumours with unspecified or other morphology decreased during the study period, from over a quarter (27.6%) during 1995–1997 to under a fifth (18.1%) during 2004–2006.

Incidence trends over time, by cancer type

Comparing the last with the first 3 years of the study period, there was a modest increase in both OAC and JCA incidence in both genders (Table 1, and Figures 1–2):

Table 1.   Age-standardized incidence (World Population Standard) per 100 000 person-years and number of cases of oesophageal and stomach cancer types, 1995–2006 (n = 16 319)
   1995–1997 (era 1) 1998–2000 2001–2003 2004–2006 (era 4)Percentage change (eras 1 to 4)
  1. M, men; W, women; OSCC, oesophageal squamous cell carcinoma; OAC, oesophageal adeno-carcinoma; JCA, junctional/cardia adenocarcinoma; NGCA, non-cardia gastric adenocarcinoma; O, oesophageal; G, gastric.

Four main types
  MWRatioMWRatioMWRatioMWRatioMW
OSCCRate2.002.140.942.111.961.081.751.820.961.601.830.88−19.9%−14.6%
N233321 258334 223313 222338   
OACRate5.401.114.885.881.095.405.751.204.775.591.294.33+3.5%+16.6%
N632198 726194 746221 774235   
JCARate3.130.595.293.330.645.183.650.695.263.300.645.14+5.5%+8.4%
N36389 410102 464116 450114   
NCGARate6.902.652.606.362.432.625.492.162.544.681.972.38−32.2%−25.7%
N842452 821432 756400 693369   
Other types
O ‘Other’Rate0.080.110.780.070.080.940.180.092.110.200.131.56133.0%16.8%
N1017 914 2415 2925   
O unspecifiedRate1.870.852.211.330.691.921.080.492.191.130.442.60−39.3%−48.4%
N231174 171147 147112 16299   
G ‘Other’Rate0.650.193.490.560.311.770.450.241.860.510.271.89−22.0%43.7%
N6632 6547 7140 5441   
G unspecifiedRate2.941.282.301.710.852.001.220.641.910.960.511.87−67.3%−59.9%
N372278 230190 178137 148134   
image

Figure 1.  Age-standardized incidence trends (/100 000 person-years, World Standard Population) by oesophageal and stomach cancer type, men. OAC: oesophageal adenocarcinoma; JCA: junctional/cardia adenocarcinoma; OSCC: oesophageal adenocarcinoma; NCGA: non-cardia gastric adenocarcinoma; O: oesophageal.

Download figure to PowerPoint

image

Figure 2.  Age-standardized incidence trends (/100 000 person-years, World Standard Population) by oesophageal and stomach cancer type, women. OAC: oesophageal adenocarcinoma; JCA: junctional/cardia adenocarcinoma; OSCC: oesophageal adenocarcinoma; NCGA: non-cardia gastric adenocarcinoma; O: oesophageal.

Download figure to PowerPoint

  • (i)
     For OAC, incidence rose from 5.4 to 5.6/100 000 person-years (or +3.5%), in men; and from 1.1 to 1.3/100 000 person-years (or +5.5%) in women.
  • (ii)
     For JCA, incidence rose from 3.1 to 3.3/100 000 person-years (or +16.6%) in men; and from 0.59 to 0.64/100 000 person-years (or +8.4%) in women.

Conversely, the incidence of OSCC and NGCA decreased:

  • (i)
     For OSCC, from 2.0 to 1.6/100 000 person-years (or −19.9%) in men; and from 2.1 to 1.8/100 000 person-years (or −14.6%) in women.
  • (ii)
     For NCGA, from 6.9 to 4.7/100 000 person-years (or −32.2%) in men; and from 2.7 to 2.0/100 000 person-years (or −25.7%) in women.

Overall, there was a reduction of −2.7/100 000 person-years in men and −1.1/100 000 person-years in women in both unspecified and other oesophageal and stomach cancers during the study period, which exceeds the observed modest increases in OAC and JCA incidence reported above.

European standardization increases the incidence rates of all tumour types by a similar proportion but does not otherwise alter the above findings (Table 2).

Table 2.   Deprivation group specific incidence (and incidence ratios between most and least deprived groups) by upper GI tumour type (n = 16 139)
 MenWomen
Affluent234DeprivedRatio ‘D’/’A’Affluent234DeprivedRatio ‘D’/’A’
  1. OAC, oesophageal adenocarcinoma; JCA, junctional/cardia adenocarcinoma; OSCC, oesophageal adenocarcinoma; NCGA, non-cardia gastric adenocarcinoma; ‘D’, deprived; ‘A’, affluent.

World Standard Population
 OSCC1.31.81.72.13.22.41.71.81.82.22.61.5
 OAC4.75.35.76.16.91.50.91.11.11.51.51.6
 JCA2.93.03.33.93.91.30.60.60.60.70.71.2
 NCGA4.05.05.87.28.82.21.92.02.42.53.31.7
European Standard Population
 OSCC1.82.32.22.84.22.42.22.42.42.93.41.5
 OAC6.26.97.58.008.91.51.21.41.42.02.01.6
 JCA3.93.94.35.15.21.30.80.80.90.90.91.2
 NCGA5.36.77.69.411.82.32.52.63.13.34.31.7

Sex ratio and sex ratio over time

Throughout the study period, there was a clear pre-ponderance of male patients for both OAC and JCA tumours, with sex ratios >4 (Table 1). Conversely, sex ratios were approximately 2.5 for NCGA and 1 for OSCC. There was no evidence of change over time in sex ratios for any of the four tumour types. More specifically, using logistic regression and adjusting for age, for OAC, JCA, NCGA and OSCC, Odds Ratio (OR) values of 1.00 (95% CI: 0.97–1.02, P = 0.758), 1.00 (95% CI: 0.96–1.03, P = 0.780), 0.99 (95% CI: 0.98–1.01, P = 0.438) and 1.01 (95% CI: 0.98–1.03, P = 0.457) were obtained for diagnosis era respectively, indicating no change over time in sex ratios for any of the four cancer types.

Incidence by deprivation group

Overall, for all of OSCC, OAC, JCA and NCGA, incidence was greater with increasing deprivation for both genders, with the exception of JCA in women, with no apparent effect of deprivation (Table 2 and Figures 3–4). In men, incidence ratios between most and least deprived groups were particularly pronounced (>2) for OSCC and NCGA, where those were <1.5 for OAC and JCA. In women, deprivation gradients in incidence were overall less pronounced and there was little difference between the four different tumour types.

image

Figure 3.  Age-standardized incidence (/100 000 person-years, World Standard Population) by oesophageal and stomach cancer type, by deprivation group, men. OAC: oesophageal adenocarcinoma; JCA: junctional/cardia adenocarcinoma; OSCC: oesophageal adenocarcinoma; NCGA: non-cardia gastric adenocarcinoma.

Download figure to PowerPoint

image

Figure 4.  Age-standardized incidence (/100 000 person-years, World Standard Population) by oesophageal and stomach cancer type, by deprivation group, women. OAC: oesophageal adenocarcinoma; JCA: junctional/cardia adenocarcinoma; OSCC: oesophageal adenocarcinoma; NCGA: non-cardia gastric adenocarcinoma; O: oesophageal.

Download figure to PowerPoint

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Supporting Information

Using population-based data of over 16 000 patients diagnosed over a recent 12-year period in a UK region, for OAC and JCA, we observed modestly increasing incidence trends, a pronounced sex ratio and a relatively small deprivation group gradient in incidence (in men only). In contrast, for OSCC and NCGA, we observed decreasing incidence trends, lower sex ratios and pronounced deprivation group gradients in incidence (particularly in men).

Our findings are largely concordant with previous studies reporting on the incidence of different oesophageal and stomach cancers, but extend the observation period to more recent years. In UK populations, rising incidence trends in OAC and JCA and decreasing trends in OSCC and NCGA have been previously reported.6, 8, 10, 11 However, our findings suggest that although the decrease in the incidence of OSCC and NCGA cancers is continuing, the rise in OAC and JCA may be ‘levelling off’ in more recent periods. Further surveillance of trends in the future, and in different populations, will be useful to elucidate this question further and to examine whether decreasing incidence trends for OSCC and NCGA will continue into the future.

Previous research has also highlighted the relatively high male:female sex ratio relating to OAC and JCA cancers, in contrast to lower ratios for NCGA and ratios close to parity for OSCC.6, 8, 11, 32 A remarkable lack of deprivation group differences in rising OAC incidence, in both genders, has been reported recently in a UK population.8 This complements previous evidence indicating absence of discernible socioeconomic patterning of OAC and JCA incidence, as well as a positive association of incidence with increasing deprivation for OSCC and NCGA cancers.11 Although our findings are in overall concordance with the existing body of evidence, in our population, a deprivation gradient in incidence was apparent in men for OAC and JCA; however, this was not as pronounced as the gradient for OSCC and NCGA.

Overall, the concordance of incidence trends, sex ratios and, in men only, deprivation group profiling for OAC and JCA, observed in our study, is suggestive of a common aetiology between these two cancers. Unlike some previous research,3 we have used a relatively stricter anatomical definition of JCA, i.e. ICD-10 topography code C160, with relevant adenocarcinoma morphology codes. However, description of the junctional and cardia tumours could potentially be ‘mapped’ to different topography codes, such as ‘unspecified site’ codes for either oesophageal or stomach cancers. Further refinement of international classification systems to reflect these considerations better will be welcome to help standardize and enhance comparability of future research about junctional/cardia tumours.

A strength of our study is that there was a lower than previously reported proportion of patients with unspecified or other morphology. The high proportion of such cases in previous research has raised doubts on whether the reported rising incidence of OAC and JCA cancers could at least in part be reflecting the decreasing over time proportion of cancers in these categories. For example, Newhnam et al., in their review of 1971–1998 incidence trends of oesophageal and stomach cancers, report that in the most recent period of their study, up to 25% of oesophageal and 31% of junctional/cardia tumours were of unspecified or other morphology (even greater such proportions were reported for earlier periods).6 In our study, this proportion was about 21% and 28% for oeophsageal and stomach cancer sites respectively at the first 3-year period, reducing to about 15% and 18% in the last period respectively. These percentages are lower than previously reported, but still substantial. However, independent of the above considerations, the reduction in the number of cancers in the unspecified or other categories was in excess of the modest observed increase in OAC and JCA incidence; therefore, in our population, one cannot (at least fully) account for the other. It is also notable that the reduction in OSCC and NCGA incidence took place in spite of a similar reduction in unspecified or other cancers, which therefore cannot be explained by changing diagnostic and coding practice and is likely to be genuine.

A limitation of our study is the lack of data on patient ethnic group. In principle, the observed changes over time in the incidence of oesophageal and gastric cancers may be reflecting changes in the ethnic group composition of the population at risk. However, we believe, this factor alone is unlikely to have influenced the results substantially for two reasons. First, the proportion of individuals belonging to ethnic minority groups in the geographically defined population of this study was relatively small during the study period. In the 2001 Census (near the study period midpoint), the proportion of the East of England Government Office region general population in the White, South-Asian and Black ethnic groups was 95.1%, 2.3% and 0.9% respectively.33 Second, the White population subgroup tends to be ‘older’ in terms of average age compared with other ethnic groups. For example, in 2001, the proportion of East of England White men aged 65 and over was 97.0%, whereas the same proportion for White women aged 60 and over was 96.4%.34 For this reason, and as cancer risk is very strongly associated with increasing age, Whites tend to be over-represented among cancer cases. Taking these two factors in combination, we conclude that in major part, observed time trends in this study reflect time trends in the incidence of different types of oesophageal and gastric cancer among mainly White individuals.

From a population health perspective, the findings of our study are welcome. There is a continuous decrease in the incidence of OSCC and NCGA, whereas the rise in OAC and JCA may be reaching a ‘plateau’. Much of this disease burden is, however, avoidable, as indicated by both international comparisons and by observed deprivation gradients in incidence.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Supporting Information

Declaration of personal interests: We acknowledge the help of all staff working for Eastern Cancer Registration and Information Centre. The work in part relates to part-fulfilment (dissertation) of the MPhil in Epidemiology course of the Department of Public Health and Primary Care, University of Cambridge, by C Gajperia, who was a beneficiary of Cancer Research UK studentship scheme endowed to the Department. Declaration of funding interests: None.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Supporting Information
  • 1
    Brown LM, Devesa SS, Chow WH. Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst 2008; 100: 11847.
  • 2
    Westlake S. Report: Cancer incidence and mortality in the United Kingdom and constituent countries, 2003–05. Office for National Statistics. Health Stat Q 2008; 40: 917. http://www.statistics.gov.uk/downloads/theme_health/HSQ40CancerUK2003-05.pdf (accessed July 2009).
  • 3
    National Oesophago-Gastric Cancer Audit. An audit of the care received by people with Oesophago-Gastric Cancer in England and Wales. First Annual Report 2008. The Information Centre. NHS. http://www.ic.nhs.uk/webfiles/Services/NCASP/Cancer/New%20web%20documents%20(OG)/28010208-NHSIC-OGAuditReport-FV-HR.pdf (accessed July 2009).
  • 4
    Mitry E, Rachet B, Quinn MJ, Cooper N, Coleman MP. Survival from cancer of the stomach in England and Wales up to 2001. Br J Cancer 2008; 99(Suppl. 1): S168.
  • 5
    Mitry E, Rachet B, Quinn MJ, Cooper N, Coleman MP. Survival from cancer of the oesophagus in England and Wales up to 2001. Br J Cancer 2008; 99(Suppl 1): S113.
  • 6
    Newnham A, Quinn MJ, Babb P, Kang JY, Majeed A. Trends in the subsite and morphology of oesophageal and gastric cancer in England and Wales 1971-1998. Aliment Pharmacol Ther 2003; 17: 66576.
  • 7
    Botterweck AA, Schouten LJ, Volovics A, Dorant E, Van Den Brandt PA. Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries. Int J Epidemiol 2000; 29: 64554.
  • 8
    Lepage C, Rachet B, Jooste V, Faivre J, Coleman MP. Continuing Rapid Increase in Esophageal Adenocarcinoma in England and Wales. Am J Gastroenterol 2008; 103: 26949.
  • 9
    Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998; 83: 204953.
  • 10
    Powell J, McConkey CC. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev 1992; 1: 2659.
  • 11
    Brewster DH, Fraser LA, McKinney PA, Black RJ. Socioeconomic status and risk of adenocarcinoma of the oesophagus and cancer of the gastric cardia in Scotland. Br J Cancer 2000; 83: 38790.
  • 12
    National Cancer Intelligence Network. Cancer Incidence and Survival By Major Ethnic Group, England, 2002–2006. http://www.ncin.org.uk/docs/090625-NCIN-Incidence_and_Survival_by_Ethnic_Group-Report.pdf (accessed July 2009).
  • 13
    Navarro Silvera SA, Mayne ST, Risch H, et al. Food group intake and risk of subtypes of esophageal and gastric cancer. Int J Cancer 2008; 123: 85260.
  • 14
    Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst 2003; 95: 140413.
  • 15
    Vaughan TL, Davis S, Kristal A, Thomas DB. Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 1995; 4: 8592.
  • 16
    Helicobacter and Cancer Collaborative Group. Gastric cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts. Gut 2001; 49: 34753.
  • 17
    Lagergren J, Bergström R, Lindgren A, Nyrén O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999; 340: 82531.
  • 18
    Lagergren J, Bergström R, Nyrén O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 1999; 130: 88390.
  • 19
    Cheng KK, Sharp L, McKinney PA, et al. A case-control study of oesophageal adenocarcinoma in women: a preventable disease. Br J Cancer 2000; 83: 12732.
  • 20
    Marsman WA, Tytgat GN, Ten Kate FJ, Van Lanschot JJ. Differences and similarities of adenocarcinomas of the esophagus and esophagogastric junction. J Surg Oncol 2005; 92: 1608.
  • 21
    Wijnhoven BP, Siersema PD, Hop WC, Van Dekken H, Tilanus HW. Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity. Rotterdam Oesophageal Tumour Study Group. Br J Surg 1999; 86: 52935.
  • 22
    Derakhshan MH, Malekzadeh R, Watabe H, et al. Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gastric cardia cancer. Gut 2008; 57: 298305.
  • 23
    Dolan K, Sutton R, Walker SJ, Morris AI, Campbell F, Williams EMI. New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology. Br J Cancer 1999; 80: 83442.
  • 24
    El-Serag HB, Mason AC, Petersen N, Key CR. Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA. Gut 2002; 50: 36872.
  • 25
    Brown LM, Swanson CA, Gridley G, et al. Adenocarcinoma of the esophagus: role of obesity and diet. J Natl Cancer Inst 1995; 87: 1049.
  • 26
    Lindblad M, Rodríguez LA, Lagergren J. Body mass, tobacco and alcohol and risk of esophageal, gastric cardia, and gastric non-cardia adenocarcinoma among men and women in a nested case-control study. Cancer Causes Control 2005; 16: 28594.
  • 27
    Eastern Cancer Registration and Information Centre (ECRIC) Annual Report 2007-8 (2008) http://www.ecric.org.uk/docs/AnnualReport0708.pdf (accessed July 2009).
  • 28
    Van Blankenstein M, Looman CW, Siersema PD, Kuipers EJ, Coebergh JW. Trends in the incidence of adenocarcinoma of the oesophagus and cardia in the Netherlands 1989-2003. Br J Cancer 2007; 96: 176771.
  • 29
    Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the Cancer Incidence in Five Continents database. Int J Epidemiol 2001; 30: 141525.
  • 30
    Communities and Local Government. Indices of Multiple Deprivation 2004. http://www.communities.gov.uk/archived/general-content/communities/indicesofdeprivation/216309/ (accessed July 2009).
  • 31
    Woods LM, Rachet B, Coleman MP. Choice of geographic unit influences socioeconomic inequalities in breast cancer survival. Br J Cancer 2005; 92: 127982.
  • 32
    Powell J, McConkey CC, Gillison EW, Spychal RT. Continuing rising trend in oesophageal adenocarcinoma. Int J Cancer 2002; 102: 4227.
  • 33
    Office for National Statistics. Resident population: by ethnic group, 2001: Regional Trends 38. http://www.statistics.gov.uk/StatBase/ssdataset.asp?vlnk=7666&Pos=&ColRank=1&Rank=272 (accessed July 2009).
  • 34
    Office for National Statistics. Past Estimates – Population Estimates by Ethnic Group Mid-2001–2006 (experimental). File name. ‘Tables EE1 to EE4–2001. http://www.statistics.gov.uk/statbase/Product.asp?vlnk=14238 (accessed July 2009).

Supporting Information

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Supporting Information

Table S1. Number and percentage of oesophageal and stomach cancer types, 1995–2006 (n = 16 319).

Please note: Wiley-Blackwell are not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article.

FilenameFormatSizeDescription
APT_4100_sm_supplementary file.doc46KSupporting info item

Please note: Wiley Blackwell is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.