Predicting the Future Burden of Esophageal Cancer by Histological Subtype: International Trends in Incidence up to 2030

Objectives: Rapid increases in the incidence of esophageal adenocarcinoma (EAC) in high-income countries in the past decades have raised public health concerns. This study is the first to predict the future burden of esophageal cancer by histological subtype using international incidence data. Methods: Data on esophageal cancer incidence by year of diagnosis, sex, histology, and age group were extracted from 42 registries in 12 countries included in the last three volumes (VIII–X) of Cancer Incidence in Five Continents, contributing at least 15 years of consecutive data. Numbers of new cases and incidence rates were predicted up to 2030 by fitting and extrapolating age–period–cohort models; the differential impact of demographic vs. risk changes on future cases were examined. Results: The number of new AC cases is expected to increase rapidly 2005–2030 in all studied countries as a combined result of increasing risk and changing demographics. In contrast, the incidence of esophageal squamous cell carcinoma (ESCC) is predicted to continue decreasing in most countries. By 2030, 1 in 100 men in the Netherlands and the United Kingdom are predicted to be diagnosed with EAC during their lifetime. Conclusions: The burden from EAC is expected to rise dramatically across high-income countries and has already or will surpass ESCC incidence in the coming years, especially among men. Notwithstanding the inherent uncertainties in trend-based predictions and in subtype misclassification, these findings highlight an ongoing transition in the epidemiology of esophageal cancer that is highly relevant to future cancer control planning and clinical practice.