Epidemiology of Esophageal Squamous Cell Carcinoma

Esophageal squamous cell carcinoma (ESCC) remains a leading global health burden, accounting for a substantial proportion of the approximately 600 000 new oesophageal cancer cases diagnosed each year. Geographical hotspots span the so-called oesophageal cancer belt from north-eastern Iran through central Asia to north-central China, as well as regions of sub-Saharan Africa. Incidence rates have declined in many high-income settings but persist at elevated levels in parts of Asia and Africa. A pronounced male predominance and higher incidence in older age groups characterise the disease, although recent reports indicate rising rates among younger adults in certain regions. Major environmental risk factors include tobacco use, alcohol consumption—particularly in combination—poor dietary patterns such as low fruit and vegetable intake or frequent consumption of very hot or preserved foods, and exposure to polycyclic aromatic hydrocarbons and related carcinogens. Familial clustering and twin studies, together with recent genetic investigations, point to a heritable component. Late diagnosis and limited screening capacity contribute to poor prognosis, with five-year survival rates typically below 20 percent. Efforts are now focused on improving early detection through endoscopic screening in high-risk populations, refining risk stratification via molecular markers, and developing targeted prevention strategies to reduce the global ESCC burden.

Research from Nature Portfolio

Large population-based investigations have clarified the interplay between tobacco and alcohol in ESCC risk. A comprehensive case–control study in a high-incidence region of China demonstrated a clear monotonic dose–response relationship between alcohol intake and ESCC, particularly among men, with risk escalating with earlier initiation, longer duration and greater intensity of consumption. Heavy smoking contributed a moderate increase in risk when adjusted for alcohol, whereas neither factor alone showed significant association among women. Importantly, combined exposure to smoking and drinking produced a synergistic effect, underlining the imperative for integrated behavioural interventions and targeted cessation programmes in high-risk male populations.

Epidemiology of Esophageal Squamous Cell Carcinoma publication trend

The graph below shows the total number of articles in epidemiology of esophageal squamous cell carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Incidence: The number of new cases of a disease in a specified population over a defined period.

Mortality: The number of deaths due to a disease in a specified population over a defined period.

Genome-wide association study (GWAS): A method that scans the genome to identify genetic variants associated with disease risk.

Odds ratio (OR): A statistical measure expressing the odds of an outcome occurring with a particular exposure compared to without that exposure.

cis-eQTL: A genomic locus where variation influences the expression level of a gene located nearby on the same chromosome.

References

1. Esophageal cancer: Epidemiology, risk factors and screening. Chinese Journal of Cancer Research (2021).
2. Global trends in the incidence and mortality of esophageal cancer from 1990 to 2017. Cancer Medicine (2020).
3. Smoking and alcohol drinking in relation to the risk of esophageal squamous cell carcinoma: A population-based case-control study in China. Scientific Reports (2017).
4. Genome-wide association study of esophageal squamous cell cancer identifies shared and distinct risk variants in African and Chinese populations. American Journal of Human Genetics (2023).
5. Exposure to polycyclic aromatic hydrocarbons, volatile organic compounds, and tobacco-specific nitrosamines and incidence of esophageal cancer. Journal of the National Cancer Institute (2023).