Cancer Causes & Control

, Volume 21, Issue 2, pp 269–274 | Cite as

Increasing trend of the incidence of esophageal squamous cell carcinoma, but not adenocarcinoma, in Taiwan

  • Ching-Liang Lu
  • Hui-Chu Lang
  • Jiing-Chyuan Luo
  • Chun-Chu Liu
  • Han-Chieh Lin
  • Full-Young Chang
  • Shou-Dong Lee
Original paper


Epidemiologic data on esophageal cancer in Asia are extremely limited. We examined temporal trends in the incidence of esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EA) in Taiwan. Patients with esophageal cancer were identified from the Taiwan Cancer Registry between 1979 and 2003. Age-standardized incidences of ESCC and EA were calculated based on the national census and world standard population. Trends in incidence rates were estimated by calculating the annual percentage change (APC). The age-standardized incidence of ESCC increased progressively (from 1979–1983 to 1999–2003: 2.63 to 4.37 per 100,000-year), with an APC higher in male (3.27%, P < 0.0001) than that in female (1.23%, P = 0.03). Though the crude incidence of EA progressively increased in both gender (male: 0.28–0.49 per 100,000-year; female 0.07–0.11 per 100,000-year), the age-standardized incidence of EA is similar along the study period with an APC of 0.72% (P = 0.20) in male and 1.59% (P = 0.30) in female. In Taiwan, the incidence of ESCC significantly increased from 1979 to 2003, whereas the incidence of EA remained unchanged. Although EA incidence has not recently increased, it could in the future.


Esophagus cancer Squamous cell carcinoma Adenocarcinoma Taiwan 


  1. 1.
    Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053CrossRefPubMedGoogle Scholar
  2. 2.
    Newnham A, Quinn MJ, Babb P, Kang JY, Majeed A (2003) Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971–1998/1999. Aliment Pharmacol Ther 17:655–664CrossRefPubMedGoogle Scholar
  3. 3.
    Brown LM, Devesa SS, Chow WH (2008) Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst 100:1184–1187CrossRefPubMedGoogle Scholar
  4. 4.
    Whiteman DC, Sadeghi S, Pandeya N et al (2008) Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus. Gut 57:173–180CrossRefPubMedGoogle Scholar
  5. 5.
    Lagergren J, Bergstrom R, Lindgren A, Nyren O (1999) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831CrossRefPubMedGoogle Scholar
  6. 6.
    Trivers KF, Sabatino SA, Stewart SL (2008) Trends in esophageal cancer incidence by histology, United States, 1998–2003. Int J Cancer 123:1422–1428CrossRefPubMedGoogle Scholar
  7. 7.
    Fernandes ML, Seow A, Chan YH, Ho KY (2006) Opposing trends in incidence of esophageal squamous cell carcinoma and adenocarcinoma in a multi-ethnic Asian country. Am J Gastroenterol 101:1430–1436CrossRefPubMedGoogle Scholar
  8. 8.
    Yee YK, Cheung TK, Chan AO, Yuen MF, Wong BC (2007) Decreasing trend of esophageal adenocarcinoma in Hong Kong. Cancer Epidemiol Biomarkers Prev 16:2637–2640CrossRefPubMedGoogle Scholar
  9. 9.
    Shibata A, Matsuda T, Ajiki W, Sobue T (2008) Trend in incidence of adenocarcinoma of the esophagus in Japan, 1993–2001. Jpn J Clin Oncol 38:464–468CrossRefPubMedGoogle Scholar
  10. 10.
    Chang SS, Lu CL, Chao JY et al (2002) Unchanging trend of adenocarcinoma of the esophagus and gastric cardia in Taiwan: a 15-year experience in a single center. Dig Dis Sci 47:735–740CrossRefPubMedGoogle Scholar
  11. 11.
    Fwu CW, Chien YC, Kirk GD et al (2009) Hepatitis B virus infection and hepatocellular carcinoma among parous Taiwanese women: nationwide cohort study. J Natl Cancer Inst 101:1019–1027CrossRefPubMedGoogle Scholar
  12. 12.
    Chang MH, Chen CJ, Lai MS et al (1997) Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan childhood hepatoma study group. N Engl J Med 336:1855–1859CrossRefPubMedGoogle Scholar
  13. 13.
    Chen MC, Feng IJ, Lu CH et al (2008) The incidence and risk of second primary cancers in patients with nasopharyngeal carcinoma: a population-based study in Taiwan over a 25-year period (1979–2003). Ann Oncol 19:1180–1186CrossRefPubMedGoogle Scholar
  14. 14.
    Chen YY, You SL, Chen CA et al (2009) Effectiveness of national cervical cancer screening programme in Taiwan: 12-year experiences. Br J Cancer 101:174–177CrossRefPubMedGoogle Scholar
  15. 15.
    Huang SY, Yao M, Tang JL et al (2007) Epidemiology of multiple myeloma in Taiwan: increasing incidence for the past 25 years and higher prevalence of extramedullary myeloma in patients younger than 55 years. Cancer 110:896–905CrossRefPubMedGoogle Scholar
  16. 16.
    Parkin D, Whelan S, Ferlay J (2003) Cancer incidence in five continents Volume VIII. IARC Scientific Publications; IARC press, LyonGoogle Scholar
  17. 17.
    Walther C, Zilling T, Perfekt R, Moller T (2001) Increasing prevalence of adenocarcinoma of the oesophagus and gastro-oesophageal junction: a study of the Swedish population between 1970 and 1997. Eur J Surg 167:748–757CrossRefPubMedGoogle Scholar
  18. 18.
    Vainio H, Wilbourn J (1992) Identification of carcinogens within the IARC monograph program. Scand J Work Environ Health 18(Suppl 1):64–73PubMedGoogle Scholar
  19. 19.
    Hsu CC, Levy DT, Wen CP et al (2005) The effect of the market opening on trends in smoking rates in Taiwan. Health Policy 74:69–76CrossRefPubMedGoogle Scholar
  20. 20.
    Freedman ND, Abnet CC, Leitzmann MF et al (2007) A prospective study of tobacco, alcohol, and the risk of esophageal and gastric cancer subtypes. Am J Epidemiol 165:1424–1433CrossRefPubMedGoogle Scholar
  21. 21.
    Yang MJ (2002) The Chinese drinking problem: a review of the literature and its implication in a cross-cultural study. Kaohsiung J Med Sci 18:543–550PubMedGoogle Scholar
  22. 22.
    Chou Q, Hong J, Chou P (1997) Prevalence of cigarettes smoking and betel nut chewing in Taiwan. Chin J Dent 16:28–36Google Scholar
  23. 23.
    Yen L, Lu D, Lee L, Huang M, Teng H (1995) An investigation of healthy behaviors in Taiwanese adult: distribution, factor structure, and related factors. Chin J Public Health 14:358–368Google Scholar
  24. 24.
    Ho PS, Ko YC, Yang YH, Shieh TY, Tsai CC (2002) The incidence of oropharyngeal cancer in Taiwan: an endemic betel quid chewing area. J Oral Pathol Med 31:213–219CrossRefPubMedGoogle Scholar
  25. 25.
    Wu IC, Lu CY, Kuo FC et al (2006) Interaction between cigarette, alcohol and betel nut use on esophageal cancer risk in Taiwan. Eur J Clin Invest 36:236–241CrossRefPubMedGoogle Scholar
  26. 26.
    Wu MT, Lee YC, Chen CJ (2001) Risk of betel chewing for oesophageal cancer in Taiwan. Br J Cancer 85:658–660CrossRefPubMedGoogle Scholar
  27. 27.
    Wen CP, Tsai SP, Cheng TY et al (2005) Uncovering the relation between betel quid chewing and cigarette smoking in Taiwan. Tob Control 14(Suppl 1):i16–i22CrossRefPubMedGoogle Scholar
  28. 28.
    Hwu HG, Yeh EK, Yeh YL, Chang LY (1988) Alcoholism by Chinese diagnostic interview schedule: a prevalence and validity study. Acta Psychiatr Scand 77:7–13CrossRefPubMedGoogle Scholar
  29. 29.
    Wong BC, Kinoshita Y (2006) Systematic review on epidemiology of gastroesophageal reflux disease in Asia. Clin Gastroenterol Hepatol 4:398–407CrossRefPubMedGoogle Scholar
  30. 30.
    Lu CL, Lang HC, Chang FY et al (2005) Social and medical impact, sleep quality and the pharmaceutical costs of heartburn in Taiwan. Aliment Pharmacol Ther 22:739–747CrossRefPubMedGoogle Scholar
  31. 31.
    Lee YC, Wang HP, Chiu HM et al (2006) Comparative analysis between psychological and endoscopic profiles in patients with gastroesophageal reflux disease: a prospective study based on screening endoscopy. J Gastroenterol Hepatol 21:798–804CrossRefPubMedGoogle Scholar
  32. 32.
    Chen PC, Wu CS, Chang-Chien CS, Liaw YF (1979) Comparison of Olympus GIF-P2 and GIF-K panendoscopy. Taiwan Yi Xue Hui Za Zhi 78:136–140PubMedGoogle Scholar
  33. 33.
    Mold JW, Reed LE, Davis AB, Allen ML, Decktor DL, Robinson M (1991) Prevalence of gastroesophageal reflux in elderly patients in a primary care setting. Am J Gastroenterol 86:965–970PubMedGoogle Scholar
  34. 34.
    Vaughan TL, Davis S, Kristal A, Thomas DB (1995) Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 4:85–92PubMedGoogle Scholar
  35. 35.
    Deurenberg P, Yap M, van Staveren WA (1998) Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 22:1164–1171CrossRefPubMedGoogle Scholar
  36. 36.
    Rokkas T, Pistiolas D, Sechopoulos P, Robotis I, Margantinis G (2007) Relationship between Helicobacter pylori infection and esophageal neoplasia: a meta-analysis. Clin Gastroenterol Hepatol 5: 1413–1417, 1417 e1–1417 e12Google Scholar
  37. 37.
    Teh BH, Lin JT, Pan WH et al (1994) Seroprevalence and associated risk factors of Helicobacter pylori infection in Taiwan. Anticancer Res 14:1389–1392PubMedGoogle Scholar
  38. 38.
    Yang JC, Wang TH, Wang HJ, Kuo CH, Wang JT, Wang WC (1997) Genetic analysis of the cytotoxin-associated gene and the vacuolating toxin gene in Helicobacter pylori strains isolated from Taiwanese patients. Am J Gastroenterol 92:1316–1321PubMedGoogle Scholar
  39. 39.
    Dooley CP, Cohen H, Fitzgibbons PL et al (1989) Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 321:1562–1566PubMedCrossRefGoogle Scholar
  40. 40.
    Crabtree JE, Taylor JD, Wyatt JI et al (1991) Mucosal IgA recognition of Helicobacter pylori 120 kDa protein, peptic ulceration, and gastric pathology. Lancet 338:332–335CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Ching-Liang Lu
    • 1
    • 4
    • 5
  • Hui-Chu Lang
    • 3
  • Jiing-Chyuan Luo
    • 1
    • 5
  • Chun-Chu Liu
    • 2
    • 5
  • Han-Chieh Lin
    • 1
    • 5
  • Full-Young Chang
    • 1
    • 5
  • Shou-Dong Lee
    • 1
    • 5
  1. 1.Division of GastroenterologyTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Department of MedicineKoo Foundation Sun Yat-Sen Cancer CenterTaipeiTaiwan
  3. 3.Institute of Hospital and Health Care AdministrationNational Yang-Ming UniversityTaipeiTaiwan
  4. 4.Institute of Brain ScienceNational Yang-Ming UniversityTaipeiTaiwan
  5. 5.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan

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