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Summary Data in a regional cancer registry covering a population of 5 million and with an efficiency of registration of over 95% have been used to examine incidence trends in oesophageal and gastric carcinoma. In the West Midlands Region of the UK, during the period 1962 to 1981 the age standardised incidence of gastric carcinoma decreased by 20%. However, an analysis by both histological type and detailed site reveals that while the incidence of distal lesions is diminishing, the incidence of adenocarcinoma of the oesophagus and cardia is increasing. The proximal and distal lesions also exhibit marked differences in social class distribution and sex ratio. The results strongly suggest that the aetiological factors involved for cardia and adjoining sites are different from those for pyloric antrum.The morbidity and mortality rates of gastric carcinoma have been decreasing in the West Midlands Region of England as they have generally throughout the world. However, mortality rates usually refer to all histological types and all sites combined, and there have been a number of reports (Yang & Davis, 1988;Moller & Moller Jensen, 1988;Antonioli & Cady, 1984;Storm, 1983) (Waterhouse, 1974). As part of a comprehensive epidemiological and clinical study of the data in the registry (Fielding et al., 1989), trends in both histological and site distribution were examined for the period 1957-1981. Registration was known to be incomplete during the earliest years and, for this reason, the results given here are restricted to the period [1962][1963][1964][1965][1966][1967][1968][1969][1970][1971][1972][1973][1974][1975][1976][1977][1978][1979][1980][1981] except, for reasons given later, in the analysis by type of first symptom. As part of the original study the data had already been subjected to intensive validity checks and assessments which are described in the monographs on oesophageal and stomach cancer (Matthews et al., 1987;Fielding et al., 1989) of endoscopies. Endoscopy here includes both rigid oesophagoscopy and the flexible tubes which became prevalent in the early 1970s, since the two types cannot be distinguished in the Registry code used. The effect of the rise in patients undergoing endoscopy was examined within each sub-site, these are likely to be underestimates because not all investigations will have been routinely reported to the Registry. The size of this error is not known but is unlikely to have changed substantially over the study period.Another factor used to assess the validity of the changes in sub-site incidence was the type of first symptom, although this was only available for the period 1957-76. Cardia patients have a very much higher rate of dysphagia than others and an increase in dysphagia rate would, therefore, imply an increase in lesions involving the cardia. However, since the number of all recorded symptoms had increased, a standardised rate based on the all symptoms rate in 1972-76 was calculated for each 5-year period.Other factors examined were mean age, sex ratio and social class. Th...

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Our study provides an update of the incidence of oesophageal cancer in the West Midland region of England and Wales from 1992-96. A total of 2,671 cases of oesophageal cancer were identified during the 5-year study period, with an age-standardised annual incidence (ASR) of 5.24 per 100,000 (95% CI: 5.02, 5.45). Similar numbers of adenocarcinoma and squamous cell carcinoma were found. Only 152 (5.6%) had no histology. There was a 5-fold difference in age-standardised annual incidence rates between males and females for adenocarcinoma of oesophagus, but no gender difference for squamous cell carcinoma. The parallel but higher ASR in males compared to females for adenocarcinoma of both oesophagus and cardia merits further investigation. The similarities in the patterns of age-and sex-specific rates and in the socioeconomic profiles could indicate a common aetiology for adenocarcinoma of oesophagus and gastric cardia. Quality control in Cancer Registries needs to focus on the accuracy and consistency of subsite classification to ensure that trends in incidence are identified. In the absence of accurate subsite classification of stomach cancers, the proportions of adenocarcinoma and squamous cell carcinoma of oesophagus (or the absolute rate of adenocarcinoma of oesophagus) may provide a useful tool in indicating whether adenocarcinoma of gastric cardia is likely to be increasing in incidence.Key words: oesophageal cancer; oesophageal squamous cell carcinoma; oesophageal adenocarcinoma; gastric cardia adenocarcinoma; cancer incidenceThe reported incidence of carcinoma of the oesophagus has been rising steeply in the UK since around 1970, particularly in males. [1][2][3] There have also been reports of rises in other parts of Europe including Denmark 4,5 and Norway 6 as well as in the United States 7 and Australia. 8 Our study provides a reliable update of oesophageal cancer incidence in the West Midlands region of England up to 1996. It also compares squamous cell carcinoma of the oesophagus, adenocarcinoma of the oesophagus and gastric cardia with respect to incidence and socioeconomic deprivation. MATERIAL AND METHODSThe West Midlands region of England and Wales is broadly representative of the country as a whole, with a mix of rural communities and urban conurbations. The population has increased from 4.76 million in 1961, 5.11 in 1971 and 1981 to 5.30 million in 1991. The external boundary has remained the same but as a result of immigration, there has been a change in the ethnic make-up of the region. In the 1991 census, which was the first to include a question on ethnic group, the proportion of nonwhite residents was 8%, of these 37% were Indian, 24% were black, 23% were Pakistani and 10% were of other Asian origin. 9 For the 5-year period 1992-96, a retrospective audit was undertaken of all patients with a reported diagnosis of cancer of oesophagus or gastric cardia. 10 Patients with diagnoses ICD-O C15, C16.0, D00.1 and D00.2 were identified from hospital discharge coding or by local Medical Records Departme...