Risk factors for and types of oesophageal cancer
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In his Comment, Alastair Munro (Aug 14, p 566) mentions that the potential influence of histology has been largely ignored in clinical trials of oesophageal cancer. He notes that the frequency of adenocarcinoma is rising, but that only a fairly small number of patients with adenocarcinomas are included in trials. In Scotland, most oesophageal cancers are adenocarcinomas, whereas in the clinical trials most cancers (77%) were squamous cell carcinomas. 1 Munro therefore concludes that the results of the clinical trials on oesophageal cancer have limited relevance for most patients with such cancer. This conclusion might be so for Scotland, but in other regions of the world patients’ characteristics and types of oesophageal cancer might be more comparable with those reported in the clinical trials. In Uganda, for example, between 1998 and 2003, in the Kyadondo county (Kampala region), 111 histologically proven oesophageal cancers were reported; 85 (77%) of them were squamous cell carcinomas, eight (7%) adenocarcinomas, and 18 (16%) histologically unspecified; 63% were in men. These frequencies have not changed over time.