Oesophageal cancer is the eighth most common cancer in the world, with striking geographical variations in incidence (Parkin, 2001). It accounts for approximately 1 in 40 of all cancers among adults in England and Wales, with an average of some 6000 new cases a year, of which some 60% occur in men (Quinn et al, 2001). Incidence has increased steadily in both sexes since the 1970s. Lifetime risks up to the age of 74 years are currently approximately 1% in men and 0.4% in women (Parkin et al, 2002). Trends in mortality are similar to those for incidence, because survival has been poor for many years. The incidence of adenocarcinoma of the lower third of the oesophagus and the gastric cardia has been increasing for 20 years in England (Powell and McConkey, 1990; Newnham et al, 2003) and in other countries (Bollschweiler et al, 2001). More than 90% of squamous cell carcinomas can be attributed to alcohol and tobacco in Europe and North America, whereas the main risk factor for adenocarcinoma is Barrett's oesophagus. Oesophageal cancer has an extremely poor prognosis: the average 5-year relative survival rate among adults diagnosed in 22 European countries during the early 1990s was approximately 10% (Sant et al, 2003). We analysed data for 65 591 patients diagnosed with oesophageal cancer in England and Wales during the period 1986–1999, approximately 84% of those eligible, with follow-up to the end of 2001. Exclusions from analysis were mainly of patients whose recorded survival was zero (10.8%) or whose cancer of the oesophagus was not their first primary malignancy (3.6%). A third (34%) of tumours were squamous carcinomas, but the proportion classified as adenocarcinoma rose from 32 to 44% during the 1990s, continuing a steady increase from 15% in the early 1970s (Coleman et al, 1999). Annual incidence rates increased by about one-third in men and women during the period 1986–1999. Trends were similar for all deprivation groups in both sexes, and incidence was lowest in the most affluent groups throughout (Figure 1). Figure 1 Trends in the age-standardised incidence of oesophageal cancer in adults aged 15–99 years, by sex and deprivation group: England and Wales, 1986–1999.