Cancer of the oesophagus: a global overview.

The geographical distribution of cancer of the oesophagus shows wide inter- and intra-national variation both in mortality and sex ratio. Numerous analytical studies have demonstrated alcohol and tobacco as important risk factors. Poor diet, particularly those lacking fresh fruit and vegetables, appears to be an equally important determinant in certain areas. In addition to alcohol and tobacco, Maté drinking in Southern South America independently increases risk. The possible role of thermal injury when Maté is drunk hot is still being investigated. Analysis of incidence data by histological subtype and site of disease has revealed rising rates for adenocarcinomas, generally of the lower third of the oesophagus, and predominantly in males. These data are paralleled by increasing rates of adenocarcinoma of the cardia of the stomach. The aetiology of these tumours in adjacent sites remains to be fully investigated but one known predisposing factor is the presence of Barrett's oesophagus. This poor prognosis disease does not appear amenable to widespread screening. Preventative measures would necessarily incorporate plans to reduce alcohol and tobacco use while improving the marginal diets of many populations.