The changing epidemiology of upper gastrointestinal cancers in Israel: clinical and screening implications

Western countries and now developing countries have noted a decreasing incidence of upper gastrointestinal (UGI) (esophageal and gastric) cancers, but increasing distal esophageal adenocarcinoma and a shift to fundal-sited gastric cancer. We examined these trends in Israeli Jewish and non-Jewish populations, drawing conclusions on the need to promote prevention and/or screening. Israel Cancer Registry UGI cancer data were computed by ethnicity, immigration after 1990, sex, sites and histology, examining age-standardized rates (ASR)/10 for 2000-2005 and incidence trends during 1980-2005. In Jews, male esophageal cancer incidence has increased (P<0.01) and is highest in European-American-born males (ASR/10, 1.98), but decreasing in the upper two-thirds of esophagus so that in men 89% now occur in the lower one-third. In both sexes this was associated with decreasing squamous cell carcinoma (P<0.01) but increased adenocarcinoma to cause 72.6% of esophageal cancers in men. Gastric cancer incidence is highest in European-American-born males (ASR/10, 11.75); there is a decreasing incidence in both sexes (P<0.01) and gastric site trends are stable. In non-Jews, esophageal cancer incidence is three times higher in men (ASR/10, 0.82); they are only squamous cell cancers and incidence trends are stable. Gastric cancer incidence is twice as high in men (ASR/10, 8.45) and gastric site trends are stable. UGI cancer incidence in Jews and non-Jews, men and women, is low as compared with most developing countries. The important findings are the low but prominent incidence of distal esophageal and gastric adenocarcinoma in male immigrants. This requires attention to possible preventive measures in at-risk groups.