title: Oesophageal cancer: with special reference to deaths in Scotland in 1970-1974
Creators: name: Blythe, Colin Richard
Publisher: name: The Open University
Year: 1986

description: '...why oesophageal cancer in Scotland?'* Oesophageal cancer intrigues epidemiologists: probably no other cancer has a greater range of known and suspected risk factors, nor such elusive links with any of them. In the United Kingdom, studies of the disease in Wales in the 1960s produced tantalising associations with anaemia and Plummer-Vinson disease, metals in the soil and even 'degree of Welshness' (see Chapter One, section 1.5.3). When this study was proposed, oesophageal cancer rates in Scotland were twice those in England and Wales and rising: those in England and Wales were falling. The intrinsic interest of the subject, the growing Scottish death rate and the fact that almost nothing had been published on the subject in Scotland, all suggested that a geography of oesophageal cancer in Scotland might be rewarding. In the event it was frustrating. Since little was known of the mortality pattern, the study had to begin with a basic description of the situation - and a hope that the pattern disclosed might have aspects worthy of further investigation. The author defends this approach, dismissed as 'dredging' by Jones and Rushton (1982), on grounds that to describe a hitherto unknown situation is always useful, provided it is done well. However, the fact that so many good epidemiologists had failed to establish an incontrovertible link between risk factors and spatial distribution of the disease should have warned against the investment of too much time! Such geographical patterns as emerged might, of course, have more significance were they to re-emerge when mapped at different time periods. As the sequel narrates, an attempt at this had to be abandoned because of lack of funds to buy census material for a second period: however, the appearance of the Cancer Atlas of Scotland (Kemp et al, 1985) as the present study was approaching completion permits some consideration of this possibility. For the most part the Atlas shows very different spatial patterns to those found by the author. Thus, on the evidence assembled by the author, there are no geographical correlates of oesophageal cancer in Scotland and the distribution of the disease is almost entirely random. The author hypothesises that the distribution of this cancer in Scotland reflects random occurrence within the population of a particular personality type, and that at the end of a long development period small clusters will generally crop up randomly in various unrelated parts of the country (though one possible exception is discussed later). Needless to say, this hypothesis is exceedingly difficult to verify. Authors of research studies that after strenuous efforts produce such tenuous results must console themselves with the truism that negative results are nevertherless results, and that if well founded and well argued they are value to future researchers on the topic. A tinge of disappointment must and does remain, though the challenge and fascination of the subject have to some extent offset the many moments of frustration. * Paula Cook-Mozaffari, personal communication, 1981.