Review articleEpidemiology and risk factors for oesophageal adenocarcinoma
Introduction
The incidence of oesophageal cancers varies markedly from one country to another [1]. The epidemiology of oesophageal adenocarcinoma has evolved considerably over the last 30 years. In many countries it has become the predominant histological type [2]. In most Western countries the incidence of adenocarcinoma of the oesophagus has increased more rapidly than that of other digestive cancers. Elsewhere, the incidence has hardly changed. Certain studies have combined adenocarcinoma of the oesophagus with that of the cardia and of the proximal stomach [3], [4], [5], for which the epidemiological characteristics and risk factors are different [6]. This review will be limited to oesophageal adenocarcinoma. It is a malignant tumour that develops in the oesophagus from glandular epithelium. In most cases, this cancer develops from Barrett's oesophagus. The latter is a type I lesion according to the Siewert classification [7], that is to say the distance between the centre of the tumour and the Z line is between −5 and −1 cm in the endoscopic position.
Section snippets
Incidence of oesophageal adenocarcinoma
Because of the rapidly increasing incidence of oesophageal adenocarcinoma, incidence rates must be compared over a similar period of time. In Europe, from 1978 to 1995, the highest incidence rates were reported in Scotland with an incidence of 3.9 in men and 1.1/100,000 in women (Table 1). In other countries, the mean incidence rates ranged from 0.6 in the Netherlands to 1.8/100,000 in Iceland in men. France appears to be a medium-risk country, since adenocarcinoma of the oesophagus is a rare
Prognosis of oesophageal adenocarcinoma
The prognosis for oesophageal adenocarcinoma is dismal. In France the relative survival rate (adjusted for age of patients at diagnosis) at 1, 3, and 5 years is 34.7%, 14.4% and 9.2%, respectively [8]. The five-year survival rate for epidermoid carcinoma was similar over the same period (9.2%). The survival rates reported by other registries around the world are comparable [8], [9], [10]. Stage at diagnosis is the major prognosis factor. The 5-year relative survival rate reported in Burgundy
General factors: lifestyle and dietary factors
A very high sex-ratio (around 10 in France [8], is characteristic of cancers closely linked to smoking and/or alcohol consumption. One of the principal known risk factors of adenocarcinoma of the oesophagus is smoking [1]. In smokers, the risk of progression from non-dysplastic Barrett's oesophagus to high-grade dysplasia or oesophageal adenocarcinoma is two to four times that in patients who have never smoked [15], [16], [17], [18], [19]. Smoking should be discouraged in patients with
Aspirin, non-steroidal anti-inflammatory drugs and statins
A systematic review of seven case–control studies and two cohort studies supported a significantly lower risk of oesophageal adenocarcinoma among those who frequently used non-steroidal anti-inflammatory drugs or aspirin than in never users [56]. Four observational studies have also suggested that the regular use of aspirin and other non-steroidal anti-inflammatory drugs is associated with a reduction of about 50% in risk of oesophageal adenocarcinoma [57], [58], [59], [60]. These findings
Conclusion
Adenocarcinoma of the oesophagus will soon cease to be a rare form of cancer. The risk of developing oesophageal adenocarcinoma has multiplied tenfold in men and fivefold in women over just one generation. Intervention to reduce the prevalence of obesity and eradicate smoking habits, two independent risk factors for oesophageal adenocarcinoma, represent a good start to prevent oesophageal adenocarcinomas. Barrett's oesophagus is a precancerous lesion, but its risk of deterioration has long been
Conflict of interest statement
None declared.
References (63)
- et al.
Esophageal cancer
- et al.
Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973–1995
International Journal of Cancer
(2002) - et al.
Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries
International Journal of Epidemiology
(2000) - et al.
Increasing incidence of adenocarcinoma of the esophagus and oesophogastic junction
Gastroenterology
(1993) - et al.
Increasing incidence of adenocarcinoma of the gastric cardia and adjacent site
British Journal of Cancer
(1990) - et al.
Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA
Gut
(2002) - et al.
Carcinoma of the gastroesophageal junction-classification, pathology and extent of resection
Diseases of the Esophagus
(1996) - et al.
Trends in incidence and management of esophageal adenocarcinoma in a well-defined population
Gastroenterologie Clinique et Biologique
(2005) - et al.
Continuing rapid increase in esophageal adenocarcinoma in England and Wales
American Journal of Gastroenterology
(2008) - et al.
Rising incidence of adenocarcinoma of the esophagus and gastric cardia
Journal of the American Medical Association
(1991)
Continuing climb in rates of oesophageal adenocarcinoma: an update
Journal of the American Medical Association
Increased incidence of adenocarcinomas at the gastro-oesophageal junction in Dutch males since the 1990s
European Journal of Gastroenterology and Hepatology
Adenocarcinoma of the oesophagus: incidence and survival rates in New South Wales, 1972–2005
Medical Journal of Australia
Incidence of cancer of the esophagus in the US by histologic type
Cancer
Current and past smoking significantly increase risk for Barrett's esophagus
Clinical Gastroenterology and Hepatology
Tobacco smoking increases the risk of high-grade dysplasia and cancer among patients with Barrett's esophagus
Gastroenterology
Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium
Journal of the National Cancer Institute
Risk factors for Barrett's oesophagus and oesophageal adenocarcinoma: results from the FINBAR study
World Journal of Gastroenterology
Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus
Gut
The association between alcohol and reflux esophagitis, Barrett's esophagus, and esophageal adenocarcinoma
Gastroenterology
Alcohol types and sociodemographic characteristics as risk factors for Barrett's esophagus
Gastroenterology
Lifetime alcohol consumption and risk of Barrett's Esophagus
American Journal of Gastroenterology
Rising incidence of oesophageal adenocarcinoma in men in Australia
Journal of Gastroenterology and Hepatology
Cancer of the lung
Nutrient intake and risk of subtypes of esophageal and gastric cancer
Cancer Epidemiology, Biomarkers and Prevention
An inverse relation between cagA + strains of Helicobacter pylori infection and risk of esophageal and gastric cardia adenocarcinoma
Cancer Research
Helicobacter pylori infection and gastric atrophy: risk of adenocarcinoma and squamous-cell carcinoma of the esophagus and adenocarcinoma of the gastric cardia
Journal of the National Cancer Institute
Radiation therapy for breast cancer and increased risk for esophageal carcinoma
Annals of Internal Medicine
Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma
New England Journal of Medicine
Influence of obesity on the risk of esophageal disorders
Nature Reviews Gastroenterology & Hepatology
Body mass index in relation to oesophageal and oesophagogastric junction adenocarcinomas: a pooled analysis from the International BEACON Consortium
International Journal of Epidemiology
Cited by (51)
Recent developments in the significant effect of mRNA modification (M6A) in glioblastoma and esophageal cancer
2022, Scientific AfricanCitation Excerpt :The global incidence of squamous cell carcinoma has remained relatively constant, accounting for 87 percent of all occurrences of esophageal cancer in 2012 [41,147]. In contrast, ESCA has become the most prevalent histological subtype of esophageal cancer regions such as Western Europe, North America, and Australia [148]. EC is produced by many factors including genetic and epigenetic changes, which contribute significantly in the occurrence and progression of ESCC [149].
The Esophageal Microbiome : Esophageal reflux disease, barrett’s esophagus, and esophageal cancer
2019, Gastrointestinal Diseases and Their Associated InfectionsInternational Survey on the Management of Anastomotic Leakage After Esophageal Resection
2018, Annals of Thoracic SurgeryAlcohol, smoking and risk of oesophago-gastric cancer
2017, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :The highest burden of OSCC occur in developing countries, such as Eastern/South-East Asia, sub-Saharan Africa and Central Asia [4]. However, the highest burden of OAC occurs in Northern and Western Europe, Northern America and Oceania [4,5]. Over the past 40 years, there has been a dramatic shift in the epidemiology of oesophageal cancer in Western populations.
Barrett's esophagus detection: Multiple biopsies are useful, even better if you have an “X” on your map
2016, Digestive and Liver Disease