The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Authors: Farin Kamangar, Dariush Nasrollahzadeh, Saeid Safiri, Sadaf G Sepanlou, Christina Fitzmaurice, Kevin S Ikuta, Catherine Bisignano, Farhad Islami, Gholamreza Roshandel, Stephen S Lim, Hassan Abolhassani, Eman Abu-Gharbieh, Rufus Adesoji Adedoyin, Shailesh M Advani, Muktar Beshir Ahmed, Miloud Taki Eddine Aichour, Tomi Akinyemiju, Chisom Joyqueenet Akunna, Fares Alahdab, Vahid Alipour, Amir Almasi-Hashiani, Abdulaziz M Almulhim, Nahla Hamed Anber, Alireza Ansari-Moghaddam, Jalal Arabloo, Morteza Arab-Zozani, Atalel Fentahun Awedew, Alaa Badawi, Kathleen S Sachiko Berfield, Kidanemaryam Berhe, Krittika Bhattacharyya, Antonio Biondi, Tone Bjørge, Antonio Maria Borzì, Cristina Bosetti, Giulia Carreras, Felix Carvalho, Clara Castro, Dinh-Toi Chu, Vera Marisa Costa, Baye Dagnew, Jiregna Darega Gela, Ahmad Daryani, Feleke Mekonnen Demeke, Gebre Teklemariam Demoz, Mostafa Dianatinasab, Iffat Elbarazi, Mohammad Hassan Emamian, Arash Etemadi, Pawan Sirwan Faris, Eduarda Fernandes, Irina Filip, Florian Fischer, Mohamed M Gad, Silvano Gallus, Abadi Kahsu Gebre, Tsegaye Tewelde Gebrehiwot, Gebreamlak Gebremedhn Gebremeskel, Begashaw Melaku Gebresillassie, Fatemeh Ghasemi-kebria, Ahmad Ghashghaee, Nermin Ghith, Mahaveer Golechha, Giuseppe Gorini, Rahul Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, James D. Harvey, Maryam Hashemian, Hamid Yimam Hassen, Simon I Hay, Andualem Henok, Chi Linh Hoang, H Dean Hosgood, Mowafa Househ, Olayinka Stephen Ilesanmi, Milena D. Ilic, Seyed Sina Naghibi Irvani, Charvi Jain, Spencer L James, Sun Ha Jee, Ravi Prakash Jha, Farahnaz Joukar, Ali Kabir, Amir Kasaeian, Mesfin Wudu Kassaw, Supreet Kaur, Andre Pascal Kengne, Esma Kerboua, Yousef Saleh Khader, Rovshan Khalilov, Ejaz Ahmad Khan, Abdullah T Khoja, Jonathan M Kocarnik, Hamidreza Komaki, Vivek Kumar, Carlo La Vecchia, Savita Lasrado, Bingyu Li, Alan D Lopez, Azeem Majeed, Navid Manafi, Ana Laura Manda, Fariborz Mansour-Ghanaei, Manu Raj Mathur, Varshil Mehta, Dhruv Mehta, Walter Mendoza, Prasanna Mithra, Karzan Abdulmuhsin Mohammad, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Jemal Abdu Mohammed, Farnam Mohebi, Ali H Mokdad, Lorenzo Monasta, Delaram Moosavi, Mahmood Moosazadeh, Ghobad Moradi, Farhad Moradpour, Rahmatollah Moradzadeh, Gurudatta Naik, Ionut Negoi, Haruna Asura Nggada, Huong Lan Thi Nguyen, Rajan Nikbakhsh, Molly R Nixon, Andrew T Olagunju, Tinuke O Olagunju, Jagadish Rao. Padubidri, Keyvan Pakshir, Shanti Patel, Mona Pathak, Hai Quang Pham, Akram Pourshams, Navid Rabiee, Mohammad Rabiee, Amir Radfar, Alireza Rafiei, Kiana Ramezanzadeh, Goura Kishor Rath, Priya Rathi, Salman Rawaf, David Laith Rawaf, Nima Rezaei, Elias Merdassa Roro, Anas M Saad, Hamideh Salimzadeh, Abdallah M Samy, Benn Sartorius, Arash Sarveazad, Mario Sekerija, Feng Sha, Morteza Shamsizadeh, Sara Sheikhbahaei, Reza Shirkoohi, Sudeep K Siddappa Malleshappa, Jasvinder A Singh, Dhirendra Narain Sinha, Catalin-Gabriel Smarandache, Sergey Soshnikov, Hafiz Ansar Rasul Suleria, Degena Bahrey Tadesse, Berhe Etsay Tesfay, Bhaskar Thakur, Eugenio Traini, Khanh Bao Tran, Bach Xuan Tran, Irfan Ullah, Marco Vacante, Yousef Veisani, Isidora S Vujcic, Girmay Teklay Weldesamuel, Rixing Xu, Vahid Yazdi-Feyzabadi, Deniz Yuce, Vesna Zadnik, Zoubida Zaidi, Zhi-Jiang Zhang, Reza Malekzadeh, Mohsen Naghavi
Journal: The Lancet. Gastroenterology & hepatology (2020)

Oesophageal cancer is a common and often fatal cancer that has two main histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Updated statistics on the incidence and mortality of oesophageal cancer, and on the disability-adjusted life-years (DALYs) caused by the disease, can assist policy makers in allocating resources for prevention, treatment, and care of oesophageal cancer. We report the latest estimates of these statistics for 195 countries and territories between 1990 and 2017, by age, sex, and Socio-demographic Index (SDI), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD).We used data from vital registration systems, vital registration-samples, verbal autopsy records, and cancer registries, combined with relevant modelling, to estimate the mortality, incidence, and burden of oesophageal cancer from 1990 to 2017. Mortality-to-incidence ratios (MIRs) were estimated and fed into a Cause of Death Ensemble model (CODEm) including risk factors. MIRs were used for mortality and non-fatal modelling. Estimates of DALYs attributable to the main risk factors of oesophageal cancer available in GBD were also calculated. The proportion of oesophageal squamous cell carcinoma to all oesophageal cancers was extracted by use of publicly available data, and its variation was examined against SDI, the Healthcare Access and Quality (HAQ) Index, and available risk factors in GBD that are specific for oesophageal squamous cell carcinoma (eg, unimproved water source and indoor air pollution) and for oesophageal adenocarcinoma (gastro-oesophageal reflux disease).There were 473 000 (95% uncertainty interval [95% UI] 459 000-485 000) new cases of oesophageal cancer and 436 000 (425 000-448 000) deaths due to oesophageal cancer in 2017. Age-standardised incidence was 5·9 (5·7-6·1) per 100 000 population and age-standardised mortality was 5·5 (5·3-5·6) per 100 000. Oesophageal cancer caused 9·78 million (9·53-10·03) DALYs, with an age-standardised rate of 120 (117-123) per 100 000 population. Between 1990 and 2017, age-standardised incidence decreased by 22·0% (18·6-25·2), mortality decreased by 29·0% (25·8-32·0), and DALYs decreased by 33·4% (30·4-36·1) globally. However, as a result of population growth and ageing, the total number of new cases increased by 52·3% (45·9-58·9), from 310 000 (300 000-322 000) to 473 000 (459 000-485 000); the number of deaths increased by 40·0% (34·1-46·3), from 311 000 (301 000-323 000) to 436 000 (425 000-448 000); and total DALYs increased by 27·4% (22·1-33·1), from 7·68 million (7·42-7·97) to 9·78 million (9·53-10·03). At the national level, China had the highest number of incident cases (235 000 [223 000-246 000]), deaths (213 000 [203 000-223 000]), and DALYs (4·46 million [4·25-4·69]) in 2017. The highest national-level age-standardised incidence rates in 2017 were observed in Malawi (23·0 [19·4-26·5] per 100 000 population) and Mongolia (18·5 [16·4-20·8] per 100 000). In 2017, age-standardised incidence was 2·7 times higher, mortality 2·9 times higher, and DALYs 3·0 times higher in males than in females. In 2017, a substantial proportion of oesophageal cancer DALYs were attributable to known risk factors: tobacco smoking (39·0% [35·5-42·2]), alcohol consumption (33·8% [27·3-39·9]), high BMI (19·5% [6·3-36·0]), a diet low in fruits (19·1% [4·2-34·6]), and use of chewing tobacco (7·5% [5·2-9·6]). Countries with a low SDI and HAQ Index and high levels of indoor air pollution had a higher proportion of oesophageal squamous cell carcinoma to all oesophageal cancer cases than did countries with a high SDI and HAQ Index and with low levels of indoor air pollution.Despite reductions in age-standardised incidence and mortality rates, oesophageal cancer remains a major cause of cancer mortality and burden across the world. Oesophageal cancer is a highly fatal disease, requiring increased primary prevention efforts and, possibly, screening in some high-risk areas. Substantial variation exists in age-standardised incidence rates across regions and countries, for reasons that are unclear.Bill & Melinda Gates Foundation.