Carcinoma of the oesophagus: aspects of epidemiology and aetiology.

Carcinoma of the oesophagus has been recognized since the time of Galen, and in Africa and elsewhere it has in many ways the strangest distribution of any tumour (Cook & Burkitt, 1971). Since the first resection of a cervical oesophageal carcinoma by Czerney in 1871 (Wangesteen, 1956), and the successful resection of a thoracic oesophageal carcinoma by Torek in 1913 (Torek, 1913), many other therapeutic modalities have been introduced. In spite of all these advances the prognosis remains dismal-truly a disease of doom. This unfortunately is due to the invariably late presentation of all patients. Hence pessimism prevails and in many schools, palliative regimens are the order of the day rather than any consideration of cure. Thus, in the 1980s, it still remains one of the most melancholic chapters in medicine (Miller, 1981). In spite of the above situation, much work is being performed in the fields of primary and secondary prevention (Deeley, 1983). It is mandatory for epidemiologists to learn from clinicians and to focus their attention not only on the risk factors, but also on the individuals on whom these risk factors are acting (Orchard, 1980).