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The changing epidemiology of esophageal adenocarcinoma.

The incidence of esophageal adenocarcinoma has risen rapidly over the past 3 decades. This increase had been most dramatic among white men. It has supplanted squamous cell carcinoma as the predominant histologic type of esophageal cancer in the United States. The reasons underlying this phenomenon are not readily apparent. Improvements in diagnostic techniques and changes in cancer classification may explain some of the rise in reported incidence rates, but detection bias and misclassification bias do not appear adequate to explain the increase entirely. Risk factors for esophageal adenocarcinoma are reviewed, with particular emphasis on their role in underlying the rising cancer incidence. The etiologic factors most likely to explain the current epidemic of esophageal adenocarcinoma are the parallel epidemic of obesity, rising use of lower esophageal sphincter-relaxing medications, decreasing Helicobacter pylori infection, changes in the Western diet, and distant smoking habits.