Adeno- And Squamous Cell Carcinoma of the Esophagus and the Esophagogastric Junction

Long-Term Incidence Trends in Saarland (Germany), 1986–2024

In many countries the incidence of squamous cell carcinoma (SCC) on the esophagus has fallen, whereas the incidence of adenocarcinoma (AC) of the esophagus has increased. Furthermore, an increase in adenocarcinoma of the esophagogastric junction has been described internationally (1). International studies have shown that the prognosis for adenocarcinoma is generally better than that for squamous cell carcinoma of the esophagus (2).

Long term trends in the incidence of these histology-specific cancers can be validly studied in Germany only in cancer registries that have had complete registration over a long period of time and also from the start included a high proportion of pathology notifications. This ensures that for cancers of the esophagus and the esophagogastric junction, histologic subtyping is possible in cancer registries too.

In Germany, the Cancer Registry Saarland (population 1 million in 2025) is the only registry to meet these criteria. Neither of the two other long-term cancer registries (administrative region Münster, later North Rhine-Westphalia; and Hamburg) had an option in the 1990s for pathologists to notify cancers, which means the proportion of notified cancers of the esophagus whose histology was no further specified was high and a time trend analysis is difficult to interpret.

This study therefore aimed to use the data of the Cancer Registry Saarland to investigate age-standardized, sex-specific incidence time trends of adenocarcinoma and squamous cell carcinoma of the esophagus, including the esophagogastric junction, for the 39-year period 1986–2024.

Methods

We extracted all data on primary malignant cancers of the esophagus (ICD-10: C15) including the esophagogastric junction (ICD-10: C16.0) from 1986 to 2024 from the dataset of the comprehensive, population-based Cancer Registry Saarland. Completeness estimates of cancer registration in Saarland have consistently yielded a high degree of completeness over the study period (3). We categorized the cancers into adenocarcinoma (AC), squamous cell carcinoma (SCC), and other or no further specified cancers on the basis of the ICD-O-3 coded histology results. We used the old European standard to calculate age-standardized incidence rates and undertook all analyses sex-specifically. We used log-linear models to estimate annual percentage—that is, relative—changes in incidence rates.

Results

A total of 4997 tumors were registered in the study period (AC: 2546, SCC: 1905, other specified histology: 301 and no further specified histology: 245); for 94.8% of these tumors it was known that the diagnosis was confirmed by histology or cytology results. Altogether 3.4% of all tumors of the esophagus were notified to the cancer registry by death certificate only.

The age-standardized incidence of esophageal SCC in men rose slightly from 1986 to 2003 (+0.3% per year, [95% confidence interval: −1.2; 4.1]) and fell continuously from 2003 to 2024 (−4.1% per year, [−6.5; −3.0]), whereas the incidence of esophageal AC continuously increased over the period 1986–2024 (1986–1998: +6.3% per year, [3.3; 24.9]; 1998–2024: 2.1% per year, [–0.3; 2.8]). Owing to the opposing time trends, the age-standardized incidence of all primary malignant tumors of the esophagus increased in the period 1986–1991 (5.9% per year, [0.8; 19.9]) and has barely changed since 1991 (0.3% per year, [–0.6; 0.5]).

With rates at a much lower level, the incidence of esophageal SCC in women also rose slightly (+0.6% per year, [–0.4; 1.8]) and the incidence of esophageal AC rose more notably (+2.3% per year, [1.3; 3.4]). The age-standardized incidence of all primary malignant tumors of the esophagus in women rose by 1.4% [0.6; 2.2] per year over the study period (Figure).

Figure

Squamous cell carcinoma, adenocarcinoma, and overall incidence rate of primary malignant tumors of the esophagus including the esophagogastric junction; annual incidence rates were smoothed by using LOESS (non-parametric locally weighted smoothing). Color ribbons show the widths of the 95% confidence intervals for the annual incidence rates

Discussion

We were able to analyze for the first time in Germany sex-specific and histology-specific incidence trends over almost 40 years and are able to confirm with our results the international observations in countries of the global North. While the incidence of esophageal SCC fell over time, that of esophageal AC increased. These temporal changes are seen more clearly in men than in women, in whom the risks for these cancers are generally notably lower.

Risk factors for esophageal SCC include smoking, alcohol consumption, intake of hot foods and beverages (≥65°C), diet, low social stratum, overweight, and atrophic gastritis, whereas risk factors for esophageal AC include gastro-esophageal reflux disease, Barrett’s esophagus, overweight and obesity, low social stratum, and smoking.

Data from the USA show that about 70% of AC of the esophagus and esophagogastric junction can be ascribed to overweight and obesity, smoking, alcohol consumption, diabetes, and reflux disease. Some 40% of all esophageal squamous cell cancers are due to smoking (4), which means that for these diseases, the potential for prevention is great. A detailed analysis from the Netherlands (5) of the incidence trend and projection of the incidence of esophageal AC postulated that the incidence will rise further until 2037–2041.

Andreas Stang, Ina Wellmann, Hiltraud Kajüter, Bernd Holleczek

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 17 March 2026, revised version accepted on 4 May 2026.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as
Stang A, Wellmann I, Kajüter H, Holleczek B:
Adeno- and squamous cell carcinoma of the esophagus and the esophagogastric junction: long-term incidence trends in Saarland (Germany), 1986–2024. Dtsch Arztebl Int 2026; 123: 455–6; DOI: 10.3238/arztebl.m2026.0082

References

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3. Robert Koch-Institut (Hrsg.) und Deutsche Krebsregister e.V. (Hrsg.). Krebs in Deutschland für 2021–2023. 15. Ausgabe. Robert Koch-Institut, Berlin, 2025. www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/krebs_in_deutschland_2025.pdf?__blob=publicationFile (last accessed on 18 May 2026).

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5. De Vegt F, Gommers JJJ, Gronewoud H, et al.: Trends and projections in the incidence of oesophageal cancer in the Netherlands: An age-period-cohort analysis from 1989 to 2041. Int J Cancer 2021; 150: 420–30