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Cancer of the oesophagus (ICD-9 150) This category excludes adenocarcinoma of the cardia and oesophagus when it is doubtful whether oesophagus or stomach is the primary site. In males, the clearly highest incidence rate was in Russia (105/10 6); the second highest rate was in Saarland (57/106) , and the lowest rates in Norway and Sweden (around 30/106). This was also the case for females: Russia showed the highest incidence (23/106) but Finland and Iceland had an almost equally high rate. There was only little variation within the countries.The mortality rates were very much similar to the incidence rates all over Northern Europe. In some areas (most clearly Denmark), the mortality/incidence ratio exceeded 1.0. The shape of the age curve in males is similar in each of the countries. In females, the increase in incidence after the age of 60 in Russia, Finland and Iceland is steeper than in the other countries. Comment The distorted mortality/incidence ratio in many areas indicates the problem of coding cancer deaths, application of different rules in cancer registries and in national statistical offices, or the possible underregistration of incident cases. In areas of high-coverage cancer registration like Denmark, the problem certainly lies on the side of mortality statistics. The most important aetiological factor for oesophageal cancer is heavy alcohol consumption, but also smoking and dietary factors (deficiency of vitamin intake) play a role. The high and low-risk areas of oesophageal cancer are not systematically similar to those of the other cancers related to alcohol, smoking and diet. Judged from the national patterns, consumption of strong alcohol seems to be the most likely factor to explain the variation.
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