Esophageal Cancer Deaths Research Articles

COVID-19 as a barrier to attending for gastrointestinal endoscopy: weighing up the risks

COVID-19 as a barrier to attending for gastrointestinal endoscopy: weighing up the risks

Characterization of Esophageal Cancer and ItsAssociation with Influencing Factors in GuangzhouCity, China.

Epidemiological features of esophageal cancer (EC), as well as their associations with potential influencing factors in a city, have seldom been seldom explored on a fine scale. The EC death cases in Guangzhou city during 2012−2017 were collected to describe the epidemiological characteristics such as EC mortality rate (ECMR) and health-seeking behaviors of deaths. Potential influencing factors, including socioeconomic conditions (population density, gross domestic product density), medical resources, and ageing degree were also gathered for exploring their relationships with the epidemiological characteristics of EC. A total of 2,409 EC deaths were reported during 2012−2017 in Guangzhou with an age-standardized ECMR of 3.18/105. The prevalence of EC in Guangzhou was spatially featured and was divided into three regions with obvious differentiated ECMR (ECMR of 6.41/105 in region A, ECMR of 5.51/105 in region B, ECMR of 2.56/105 in region C). The street/town-level ECMR was spatially clustered in Guangzhou city, especially two clusters of streets/towns with high ECMR were highlighted in region A and B respectively. Meanwhile, demographic features including gender gap, death age, temporal interval between diagnosis and death, health-seeking behaviors were remarkably different among the three regions. Moreover, health-seeking behaviors (e.g., the proportion of hospital deaths) of the EC deaths were obviously influenced by medical institution occupancy rate and socioeconomic conditions at street/town level. In addition, the street/town-level ECMR was significantly associated with ageing degree across Guangzhou city (r = 0.466, p < 0.01), especially in region A (r = 0.565, p < 0.01). In contrast, the ECMR in region B was closely related to population density (r = −0.524, p < 0.01) and gross domestic product density (r = −0.511, p < 0.01) when the ageing degree was controlled, while these associations were weak in region C. The epidemiological characteristics of EC in Guangzhou city were spatially featured and potentially associated with socioeconomic conditions, medical resources and ageing degree on a fine scale across Guangzhou city. This study could provide scientific basis for local authorities to implement more targeted EC interventions.

Analysis of incidence and mortality of esophageal cancer in China, 2015

Objective: To estimate the incidence and mortality rates of esophageal cancer in China in 2015. Methods: Based on the data quality review and assessment, the esophageal cancer data from 368 cancer registries in 31 provinces (autonomous regions and municipalities) in China were included in this study. According to the national population data in 2015, the nationwide incidence and mortality of the esophageal cancer were estimated. Chinese standard population in 2000 and world Segi's population were used to calculate the age-standardized (ASR) incidence and mortality rates (ASR China and world, respectively). Results: The 368 cancer registries covered a total of 309 553 499 populations in China, accounting for 22.52% of the national population. There were 245 651 new esophageal cancer cases estimated in China in 2015, with a crude incidence rate of 17.87/100 000. The ASR China and ASR world were 11.14/100 000 and 11.28/100 000, respectively. The estimated number of esophageal cancer death was 188 044 in China in 2015, with a crude mortality rate of 13.68/100 000; The ASR China and ASR world mortality rates were 8.33/100 000 and 8.36/100 000, respectively. The ASR China incidence and mortality of esophageal cancer in males were higher in males (16.50/100 000 and 12.66/100 000) than those in females (5.92/100 000 and 4.17/100 000), and they were higher in rural areas (15.95/1100 000 and 11.67/100 000) than those in urban areas (7.59/100 000 and 5.87/100 000). Conclusion: The incidence and mortality of esophageal cancer in China are higher than the global average. The disparity of the incidence and mortality rates of esophageal cancer significantly differed in genders and areas.

Area socioeconomic status is independently associated with esophageal cancer mortality in Shandong, China

Esophageal cancer (EC) is a leading cause of cancer death in China. Within Shandong Province, a geographic cluster with high EC mortality has been identified, however little is known about how area-level socioeconomic status (SES) is associated with EC mortality in this province. Multilevel models were applied to EC mortality data in 2011–13 among Shandong residents aged 40+ years. Area-level SES factors consisted of residential type (urban/rural) of the sub-county-level units (n = 262) and SES index (range: 0–10) of the county-level units (n = 142). After adjustment for age and sex, residents living in rural areas had a 22% (95% CI: 13–32%) higher risk of dying from EC than those in urban areas. With each unit increase in the SES index, the average risk of dying from EC reduced by 10% (95% CI: 3–18%). The adjustment of area-level SES variables had little impact on the risk ratio of EC mortality between the high-mortality cluster and the rest of Shandong. In conclusion, rural residence and lower SES index are strongly associated with elevated risks of EC death. However, these factors are independent of the high mortality in the cluster area of Shandong. The underlying causes for this geographic disparity need to be further investigated.

RETRACTED: Overexpression of macrophage stimulating 1 enhances the anti-tumor effects of IL-24 in esophageal cancer via inhibiting ERK-Mfn2 signaling-dependent mitophagy

Although cytokine-based therapy is a promising tool to control the progression of esophageal cancer, low therapeutic responses largely compromise treatment efficacy through unidentified mechanisms. The goal of our study was to explore the roles of macrophage stimulating 1 (Mst1) and mitophagy in enhancing IL-24-based cytokine therapy in esophageal cancer. Our data demonstrated that IL-24 application promoted cancer death by inducing mitochondrial stress, as manifested by mitochondrial ROS overproduction, mitochondrial potential dissipation, cellular ATP deprivation and mitochondrial death activation. Overexpression of Mst1 enhanced IL-24-mediated mitochondrial damage and further augmented IL-24-induced death in esophageal cancer. Molecular investigations illustrated that the IL-24-activated mitochondrial response is accompanied by activation of mitophagy, a protective mechanism to attenuate mitochondrial damage. However, Mst1 overexpression inhibited mitophagy activity, which was achieved by inactivating the ERK-Mfn2 signaling pathway. The re-activation of mitophagy abolished the cancer-killing effects of Mst1 overexpression on esophageal cancer. Altogether, our data demonstrate that IL-24-related therapeutic resistance is associated with mitophagy activation. Mst1 overexpression inhibits mitophagy activity via suppressing the ERK-Mfn2 pathway, ultimately augmenting IL-24-inducd esophageal cancer death via enhanced mitochondrial stress.

Spatial Analysis of Esophageal Cancer Mortality in a High-risk Population in China: Consistent Clustering Pattern in 1970-74 and 2011-13

Purpose:Almost half of the global esophageal cancer (EC) deaths occurred in China. This study aims to examine the geographic spread of EC mortality in two periods in a large Chinese population.Methods:Age-standardized mortality rates (ASMRs) for 140 county-level units in Shandong Province during the periods 1970-74 and 2011-13 were derived using data from the First National Cause-of-Death Survey and the Shandong Death Registration System, respectively. ASMRs were smoothed using Area-to-Area Poisson kriging technique. Spatial scan statistics were used to detect spatial clusters with higher EC mortality and clusters with greater temporal changes in EC mortality.Results:The provincial average ASMR decreased from 13.0 per 100,000 in 1970-74 to 5.8 in 2010-13. Almost all counties or districts have experienced a decrease in EC mortality, while the reduction was particularly pronounced in the mid-west region. This study has identified a geographical cluster with much higher EC mortality rates and the clustering pattern has largely unchanged over the past 40 years. Residents living in the cluster during 1970-74 were 2.7 (95%CI: 2.2-3.4) times more likely to die from EC than the rest of the province. The corresponding risk ratio for the 2011-13 cluster was 3.7 (95%CI: 2.8-5.0).Conclusions:This study detected a geographically defined subpopulation in Shandong, China with much higher risk of dying from EC. This spatial pattern has been consistent over the past few decades. The results suggest the key drives for geographic variations in esophageal cancer may not have changed.

Deaths attributable to alcohol use and its impact on life expectancy in China, 2013

Objective: To analyze the deaths attributable to alcohol use and its impact on people's life expectancy in China in 2013. Methods: The mortality data from the Disease Surveillance Points System and alcohol use data from China Chronic Disease Surveillance (2013) were used. The deaths attributed to alcohol use and its impact on the life expectancy of Chinese residents were estimated based on the principle of comparative risk assessment by calculating population attributable fraction. Results: In 2013, alcohol use resulted in 381 200 deaths, including 97 100 hemorrhagic stroke deaths, 88 200 liver cancer deaths, 61 400 liver cirrhosis deaths and 48 700 esophageal cancer deaths, and prevented 76 500 deaths, including 68 500, 4 900 and 3 100 deaths which might be caused by ischemic heart disease, hemorrhagic stroke and diabetes respectively. If risk factor of alcohol use is removed, the people's life expectancy would rise by an average of 0.43 years, especially in western China by 0.52 years, which was 0.12 years higher than that in eastern and central China, and the life expectancy of the population in rural and urban areas would rise by 0.48 years and 0.31 years respectively. Conclusions: Although alcohol has a protective effect on reducing ischemic heart disease, stroke and diabetes deaths, alcohol use is still a risk factor influencing the mortality and life expectancy of residents in China. It is necessary to take targeted measures to reduce the health problems caused by harmful use of alcohol.

Highlights of This Issue

Although coffee drinking is associated with reduced risk of all-cause mortality, associations with cancer death overall and from specific types are unclear, in part due to confounding by smoking. In our large, prospective study of U.S. men and women, there was a nonlinear, U-shaped association between coffee consumption and overall cancer mortality among current and former smokers, and no association among never smokers. Among nonsmokers, coffee consumption was associated with reduced risk of death from head and neck, colorectal, liver, and female breast cancers, and higher risk of esophageal cancer death. These findings underscore the importance of examining associations between coffee drinking and cancer risk by smoking status.To prevent cervical cancer, World Health Organization guidelines support human papillomavirus (HPV) testing alone (followed by treatment with cryotherapy) or in conjunction with visual inspection with acetic acid (VIA) triage testing. This study by Campos and colleagues used mathematical simulation modeling to evaluate the cost-effectiveness of HPV testing alone versus HPV testing with VIA triage in India, Nicaragua, and Uganda. In all three countries, HPV testing alone was more effective than HPV followed by VIA triage, and was also very cost-effective. VIA triage of HPV-positive women is not likely to be cost-effective in settings with a high burden of cervical cancer.Inflammation and tissue injury/regeneration have been proposed to drive the development of prostate cancer. Prior studies to examine whether the presence of inflammation correlates with prostate cancer in biopsy tissues have been cross-sectional. To test the inflammation–prostate cancer hypothesis prospectively, Platz and colleagues linked two clinical trials, such that men with negative biopsies in the PCPT trial who subsequently joined the SELECT trials were studied. Using men in SELECT found to have cancer as cases, and a matched set of men in SELECT that were negative on biopsy (controls), risk of prostate cancer (Gleason grade &lt; 4 + 3 = 7) increased with percent tissue area with inflammation. Taken together, these and the authors' prior findings support the role of intraprostatic inflammation in the development of prostate cancer.Both colon cancer and dementia are prevalent among the elderly and have a high risk of co-occurrence. Limited studies have examined the relationship between dementia and survival after diagnosis of nonmetastatic colon cancer, with treatment choice as a possible mediating factor. In this study, we provide the first estimate of the mediating effect of diminished chemotherapy in patients with stage III colon cancer and dementia, simultaneously demonstrating the cancer-specific survival benefit of chemotherapy in the presence of dementia. Adherence to cancer care guidelines generated from populations with normal cognition may yield limited survival benefits for elderly with advanced dementia.

Estimated of esophageal cancer incidence and mortality in China, 2013

Objective: The National Central Cancer Registry (NCCR) collected esophageal data of local cancer registries in 2013 to estimate the incidence and mortality in China. Methods: Data submitted from 347 registries were evaluated and 255 registries' data are qualified by NCCR. Data of incidence and mortality were stratified with areas (urban/rural), gender and age group. Chinese population census in 2000 and Segi's population were used for age-standardized incidence/mortality. Results: All of 255 cancer registries covered a total of 226 494 490 population (111 595 772 in urban areas and 114 898 718 in rural areas). The morphology verified cases (MV%) of esophageal cancer accounted for 75.51% and 1.64% of incident cases were identified through death certifications only (DCO%) with mortality to incidence ratio of 0.75. The estimates of new esophageal cancer cases and deaths were 277 thousand and 206 thousand in China, respectively. The crude incidence rate of esophageal cancer in Chinese cancer registration areas was 20.35/10(5) (28.15/10(5) in male, 12.15/10(5) in female), age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population were 13.64/10(5) and 13.82/10(5) with the cumulative incidence rate (0-74 age years old) of 1.77%. The esophageal cancer incidence and ASIRC were 13.38/10(5) and 8.74/10(5) in urban areas whereas in rural areas, they were 28.44/10(5) and 19.56/10(5,) respectively. In rural areas, the crude incidence rate of esophageal cancer was 2.13 times higher than that in urban areas, and after age-standardized it remained 2.24 times higher. The esophageal cancer mortality in Chinese cancer registration areas was 15.17/10(5) (20.86/10(5) in male and 9.20/10(5) in female), age-standardized mortality by Chinese standard population (ASMRC) and by world standard population were 9.95/10(5) and 9.98/10(5,) with the cumulative mortality rate (0-74 age years old) of 1.20%. The esophageal cancer mortality and ASMRC were 10.12/10(5) and 6.46/10(5) in urban areas, whereas in rural areas, they were 21.05/10(5) and 14.16/10(5,) respectively. In rural areas, the esophageal cancer mortality and ASMRC were 2.08 and 2.19 times higher than those in urban areas. Esophageal cancer was the sixth common cancer and the fourth leading causes of cancer death, accounting for about 7.52% of all cancer cases and 9.26% of all cancer deaths. Conclusions: Esophageal cancer is one of the most common cancers in China. Screening and early detection are important to reduce the incidence and mortality.

Fresh Fruit Intake May Decrease Long-term Risk of Esophageal Cancer Death among Smokers Based on Results from the Linxian Nutrition Intervention Trail

Fresh Fruit Intake May Decrease Long-term Risk of Esophageal Cancer Death among Smokers Based on Results from the Linxian Nutrition Intervention Trail

Mortality and survival analysis of esophageal cancer in China

To estimate the nationwide mortality of esophageal cancer in China in 2012, to investigate the trends of the disease, and to provide support data for esophageal cancer prevention and control in China. Data of population-based cancer registry of China were extracted by sex and geographical area. Joinpoint software was used to analyze the trends of esophageal cancer from 2000 to 2011 using the continuous data of 22 cancer registries. Average annual percentage change rates (AAPC) were calculated, and 17 cancer registries data during 2003-2005 were analyzed. In 2012, there were estimated 210.9 thousand new cases of esophageal cancer death in China, with 149 thousand in males and 61.9 thousand in females, accounting for 9.65% of overall cancer death. The crude mortality rate of esophageal cancer in 2012 was 15.58 per 100 000, accounting for the fourth-leading cause of overall cancer deaths. The age-standardized mortality rates by world population and China population were 10.67 per 100 000 and 10.62 per 100 000, respectively. The cumulative mortality rate for age 0-74 was 1.28%. The age-specific mortality rates were increasing with age, and there was a sharp increase after 50 years of age. From 2000 to 2011, there was a slight decreasing trend for crude mortality rate, with the AAPC of -1.1% (95% CI: -1.8% to -0.5%). However, the age standardized mortality rates were decreasing significantly with the AAPC of -4.6% (95% CI: -5.7% to -3.6%). The AAPCs for age-standardized esophageal cancer mortality were -3.8% in urban areas and -2.4% in rural areas. For combined 5-year age standardized relative survival was 20.9% (95%CI: 20.2% to 21.7%) and the 1-, 3- and 5-year observed survival rates were 54.0%, 25.5%, 18.4%, respectively. There is still a heavy burden of esophageal cancer in China. Prevention and early diagnosis of the disease in esophageal cancer high-risk areas is very essential.

Hierarchical multivariate mixture generalized linear models for the analysis of spatial data: An application to disease mapping.

Disease mapping of a single disease has been widely studied in the public health setup. Simultaneous modeling of related diseases can also be a valuable tool both from the epidemiological and from the statistical point of view. In particular, when we have several measurements recorded at each spatial location, we need to consider multivariate models in order to handle the dependence among the multivariate components as well as the spatial dependence between locations. It is then customary to use multivariate spatial models assuming the same distribution through the entire population density. However, in many circumstances, it is a very strong assumption to have the same distribution for all the areas of population density. To overcome this issue, we propose a hierarchical multivariate mixture generalized linear model to simultaneously analyze spatial Normal and non-Normal outcomes. As an application of our proposed approach, esophageal and lung cancer deaths in Minnesota are used to show the outperformance of assuming different distributions for different counties of Minnesota rather than assuming a single distribution for the population density. Performance of the proposed approach is also evaluated through a simulation study.

Esophageal cancer statistics in China, 2011: Estimates based on 177 cancer registries.

Esophageal cancer has been a common cancer in China for many years. Using the most recent data collected from the National Central Cancer Registry, we present estimates of the esophageal cancer burden in China in 2011. Age-specific incidence and mortality rates by gender and area for 18 age groups were calculated based on data from 177 qualified population-based cancer registries. The number of new cases of esophageal cancer and cancer deaths were computed by multiplying these rates by the 2011 population. Crude incidence and mortality rates of esophageal cancer were estimated. The estimated number of new esophageal cancer cases and deaths were 291 238 and 218 957, respectively. The crude incidence and mortality rates for esophageal cancer were 21.62/100 000 and 16.25/100 000, respectively. The age-standardized incidence and mortality rates by world population were 15.83/100 000 and 11.62/100 000, respectively. Both the incidence and mortality rates of esophageal cancer were higher in rural areas than in urban areas, and in men than in women. The age-specific esophageal cancer incidence and mortality rates increased with age. In China, squamous cell cancer was the most common pathological type of the disease. Esophageal cancer remains a major public health issue in China. Primary and secondary prevention are essential for disease control.

Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province, China.

Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province. Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group (0, 1-4, 5-9, 10-14…80+). Incidence and mortality rates were age-standardized to World Segi's population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county. The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 (males, 42.18/100,000 and females, 24.31/100,000). The age-standardized rate by world standard population (ASRW) was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 (males, 31.40/100,000 and females, 18.45/100,000), ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 (ASRW =48.69/100,000) to 2004-2005 (ASRW =28.02/100,000), with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes (APC) of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011. Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.

Estimates of alcohol-related oesophageal cancer burden in Japan: systematic review and meta-analyses.

ObjectiveTo refine estimates of the burden of alcohol-related oesophageal cancer in Japan.MethodsWe searched PubMed for published reviews and original studies on alcohol intake, aldehyde dehydrogenase polymorphisms, and risk for oesophageal cancer in Japan, published before 2014. We conducted random-effects meta-analyses, including subgroup analyses by aldehyde dehydrogenase variants. We estimated deaths and loss of disability-adjusted life years (DALYs) from oesophageal cancer using exposure distributions for alcohol based on age, sex and relative risks per unit of exposure.FindingsWe identified 14 relevant studies. Three cohort studies and four case-control studies had dose–response data. Evidence from cohort studies showed that people who consumed the equivalent of 100 g/day of pure alcohol had an 11.71 fold, (95% confidence interval, CI: 2.67–51.32) risk of oesophageal cancer compared to those who never consumed alcohol. Evidence from case-control studies showed that the increase in risk was 33.11 fold (95% CI: 8.15–134.43) in the population at large. The difference by study design is explained by the 159 fold (95% CI: 27.2–938.2) risk among those with an inactive aldehyde dehydrogenase enzyme variant. Applying these dose–response estimates to the national profile of alcohol intake yielded 5279 oesophageal cancer deaths and 102 988 DALYs lost – almost double the estimates produced by the most recent global burden of disease exercise.ConclusionUse of global dose–response data results in an underestimate of the burden of disease from oesophageal cancer in Japan. Where possible, national burden of disease studies should use results from the population concerned.

Esophageal cancer incidence and mortality in China, 2010.

The National Central Cancer Registry of China (NCCR) is responsible for cancer surveillance. Local cancer registries in each province submit data for annual publication.. The incidence and mortality of esophageal cancer in China in 2010 by age, gender, and area is reported in this article. There were data from 145 out of 219 qualified cancer registries. Esophageal cancer cases and deaths (ICD 10 code as C15) were stratified by location, gender, age, and cancer site. The 2000 Chinese census and Segi's population were used for age-standardized incidence/mortality rates. The rank in all cancer types and cumulative rate were also calculated. It was estimated that 287 632 new cases were diagnosed and 208 473 patients died from esophageal cancer in 2010 in China. Esophageal cancer incidence ranked fifth of all cancer types with a rate of 21.88/100 000. Age-standardized rates by Chinese population (CASR) and World population (WASR) for incidence and mortality were 16.71/100 000 and 16.97/100 000, respectively. The mortality of esophageal cancer ranked fourth in all cancer types with a rate of 15.85/100 000. The CASR and WASR for mortality were 11.95/100 000 and 12.02/100 000, respectively. For both incidence and mortality, the rates of esophageal cancer were much higher in men than that in women, in rural areas than in urban areas, and peaked at age 80-84. Esophageal cancer is still a major cancer type in rural areas of China. Effective prevention and control should be emphasized, including health education, chemoprevention, and early detection in high-risk groups.

Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost in the United States

Our goal was to provide current estimates of alcohol-attributable cancer mortality and years of potential life lost (YPLL) in the United States. We used 2 methods to calculate population-attributable fractions. We based relative risks on meta-analyses published since 2000, and adult alcohol consumption on data from the 2009 Alcohol Epidemiologic Data System, 2009 Behavioral Risk Factor Surveillance System, and 2009-2010 National Alcohol Survey. Alcohol consumption resulted in an estimated 18,200 to 21,300 cancer deaths, or 3.2% to 3.7% of all US cancer deaths. The majority of alcohol-attributable female cancer deaths were from breast cancer (56% to 66%), whereas upper airway and esophageal cancer deaths were more common among men (53% to 71%). Alcohol-attributable cancers resulted in 17.0 to 19.1 YPLL for each death. Daily consumption of up to 20 grams of alcohol (≤ 1.5 drinks) accounted for 26% to 35% of alcohol-attributable cancer deaths. Alcohol remains a major contributor to cancer mortality and YPLL. Higher consumption increases risk but there is no safe threshold for alcohol and cancer risk. Reducing alcohol consumption is an important and underemphasized cancer prevention strategy.

Magnesium in Drinking Water Modifies the Association Between Nitrate Ingestion and Risk of Death from Esophageal Cancer

The objective of this study was to explore whether magnesium (Mg) levels in drinking water modified the effects of nitrate on esophageal cancer risk occurrence. A matched cancer case-control study was used to investigate the relationship between the risk of death from esophageal cancer and exposure to nitrate in drinking water in Taiwan. All esophageal cancer deaths of Taiwan residents from 2006 through 2010 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to cancer cases by gender, year of birth, and year of death. Information on the levels of nitrate-nitrogen (NO3-N) and Mg in drinking water were collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cancer cases and controls was presumed to be the source of the subject's NO3-N and Mg exposure via drinking water. Evidence of an interaction was noted between drinking water NO3-N and Mg intake. This is the first study to report effect modification by Mg intake originating from drinking water on an association between NO3-N exposure and increased risk mortality attributed to esophageal cancer.

Esophageal cancer incidence and mortality in China, 2009.

Esophageal cancer incident cases and deaths in 2009 were retrieved from national database of population based cancer registry to describe esophageal cancer burden in registration areas. In 2012, 104 population-based cancer registries reported cancer incidence and mortality data of 2009 to Chinese National Central Cancer Registry. Total 72 registries' data met the national criteria to be pooled and analyzed. The crude incidence and mortality rates of esophageal cancer were calculated by age, gender and area. China sensus in 1982 and Segi's world population were applied for age standardized rates. The crude incidence of esophageal cancer ranked fifth in all cancer sites with rate of 22.14/100,000 (30.44/100,000 for male and 13.64/100,000 for female, 14.21/100,000 in urban and 38.44/100,000 in rural). Age-standardized rates by China population (CASR) and World population (WASR) for incidence were 10.88/100,000 and 14.81/100,000 respectively. The crude mortality of esophageal cancer ranked fourth in all cancer sites with rate of 16.77/100,000 (23.29/100,000 for male and 10.11/100,000 for female, 10.59/100,000 in urban and 29.47/100,000 in rural). The CASR and WASR for mortality were 7.75/100,000 and 10.76/100,000 respectively. For both of incidence and mortality, the rates of esophageal cancer were much higher in males than in females, in rural areas than in urban areas. The overall age-specific incidence and mortality rates showed that both rates were relatively low before 45 years old, and then gradually increased, reaching peak in age group of 80-84. The burden of esophageal cancer remained high in China, especially for males in rural areas. Effective prevention and control action, such as health education, nutrition intervention and screening should be enhanced in the future.

Attributable Causes of Esophageal Cancer Incidence and Mortality in China

BackgroundTo estimate the contribution of tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake to esophageal cancer mortality and incidence in China.Methodology/Principal FindingsWe calculated the proportion of esophageal cancer attributable to four known modifiable risk factors [population attributable fraction (PAF)]. Exposure data was taken from meta-analyses and large-scale national surveys of representative samples of the Chinese population. Data on relative risks were also from meta-analyses and large-scale prospective studies. Esophageal cancer mortality and incidence came from the 3rd national death cause survey and population-based cancer registries in China. We estimated that 87,065 esophageal cancer deaths (men 67,686; women: 19,379) and 108,206 cases (men: 83,968, women: 24,238) were attributable to tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake in China in 2005. About 17.9% of esophageal cancer deaths among men and 1.9% among women were attributable to tobacco smoking. About 15.2% of esophageal cancer deaths in men and 1.3% in women were caused by alcohol drinking. Low vegetable intake was responsible for 4.3% esophageal cancer deaths in men and 4.1% in women. The fraction of esophageal cancer deaths attributable to low fruit intake was 27.1% in men and 28.0% in women. Overall, 46% of esophageal cancers (51% in men and 33% in women) were attributable to these four modifiable risk factors.Conclusions/SignificanceTobacco smoking, alcohol drinking, low vegetable intake and low fruit intake were responsible for 46% of esophageal cancer mortality and incidence in China in 2005. These findings provide useful data for developing guidelines for esophageal cancer prevention and control in China.