Obesity, smoking, and acid reflux are behind doubling in incidence of oesophageal cancer

BMJ 2013; 346 doi: (Published 18 June 2013) Cite this as: BMJ 2013;346:f3959
  1. Jacqui Wise
  1. 1 London

The charity Cancer Research UK is calling for better diagnosis of oesophageal cancer, as the latest figures show that its incidence nearly doubled in the 15 years to 2010.

The data also show that men are almost three times as likely as women to develop oesophageal cancer. Each year more than 5600 men and 2800 women in the United Kingdom are given a diagnosis of oesophageal cancer.

In UK men the incidence of oesophageal cancer rose from 8.8 cases per 100 000 in 1975-77 to 14.5 per 100 000 in 2006-08. In women it rose from 4.8 to 5.6 per 100 000 in the same period.

There are two main types of oesophageal cancer. The incidence of squamous cell carcinoma (about a quarter of cases) has remained fairly constant, but that of adenocarcinoma (just over half of cases) rose by half from 6.2 per 100 000 men in 1995-97 to 9.4 per 100 000 in 2008-10.

Tim Underwood, an oesophageal surgeon at the University of Southampton, said that the incidence of oesophageal cancer has been rising, whereas the incidence of bowel and stomach cancer has been fairly level or falling (figure).

“The rise in obesity is probably one of the main causes of this increase,” he said. Other risk factors were smoking and long term acid reflux, he said.

Underwood added, “The overall five year survival rate is only 13% for oesophageal cancer, compared to 85% for breast cancer. We need to do much more for oesophageal cancer patients.”

Cancer Research UK said that early diagnosis was the key to improving the chance of survival. It is calling on patients to go to their GP if food became stuck when they swallowed or if they experienced persistent heartburn (three weeks or more). It also called on GPs to refer patients to a specialist early so that cancer could be ruled out.

Underwood said, “I say to GPs: if you see a middle aged man you have not seen before with acid reflux you need to refer them for investigation.”

Rebecca Fitzgerald, a gastroenterologist at the Medical Research Council’s Cancer Cell Unit at the University of Cambridge, is leading a trial to improve the diagnosis of oesophageal cancer. This involves a cytosponge or “sponge on a string” that can be easily swallowed by the patient and then pulled out. The sponge can then be sent to a laboratory to look for early precursors of oesophageal cancer.

Fitzgerald said, “Endoscoping every patient with heartburn is not a reality for our health service; we need a much easier test. The cytosponge is a 5 minute test which is less invasive and much cheaper than endoscopy. Hopefully, in the future it will transform early diagnosis of oesophageal cancer.”

She said that her team was currently carrying out a second trial in primary care. The test had just been licensed to a US company, she said, which hopes to get it to market in the next year. If the results continued to be promising, it could be available to NHS patients within five years.

Cancer Research UK’s Catalyst Club is also working with the International Cancer Genome Consortium to unravel the genetic basis of oesophageal cancer.


Cite this as: BMJ 2013;346:f3959