Changing pattern of oesophageal cancer incidence in France.

Abstract

Data from several Western countries suggest a rapid increase in the incidence of adenocarcinoma of the oesophagus, as well as variations in the sex ratio and the subsite distribution of oesophageal cancer. Although France has a high incidence rate of oesophageal cancer in males, no information was available on trends in its occurrence. The purpose of this study was to report changes in the pattern of oesophageal cancer incidence in three regions of France. Data from the three population-based cancer registries of Calvados, Côte d'Or and Haute-Garonne were used to study time trends of oesophageal cancer by sex, age, subsite and histological type between 1978 and 1987. Annual incidence rates have been standardized by the direct method using the world standard population. To test the trend in cancer incidence, either an exponential curve of the form y = aekt was fitted to the annual incidence rates by means of a regression technique, or incidence rates were compared between two 5-year periods after age standardization by Mantel-Haenszel test. The mean annual variation of oesophageal cancer in males was -2.9% in Calvados (P < 0.05), + 0.5% in Côte d'Or (NS) and + 12.4% in Haute-Garonne (P < 0.05). The corresponding figures in females were + 7.9% (NS), + 19.6% (P < 0.05) and + 50.7% (NS). The significant variations in males (decrease in Calvados and increase in Haute-Garonne) were confined to the oldest age group (> or = 65 years). With regard to subsite, incidence in males increased in Haute-Garonne for the upper and the middle third, while there was a significant decrease in Calvados only for the middle third. For histological type, no increase in adenocarcinoma was noticed in males while there was a slight increase in incidence in females (statistically significant in Calvados). In France, the incidence of oesophageal cancer has decreased in the high-risk region (Calvados) in males, while there was a slight increase in the three studied regions in females. The important rise in incidence of oesophageal adenocarcinomas observed in some Western countries has yet to be seen in France.