title: Esophageal Cancer in Brunei Darussalam over a three Decade Period: an Epidemiologic Study of Trends and Differences between Genders and Racial Groups.
abstract: BACKGROUND
  Carcinoma of the esophagus is associated with significant morbidity and mortality. The most common subtype is squamous cell carcinoma (SCC). In the past three decades, the incidence of SCC has been reported to be decreasing whereas esophageal adenocarcinoma (AC) is increasing. This study assessed the trend of esophageal cancer in Brunei Darussalam over a three decades period.
  
  
  METHODS
  The National Cancer registry was searched for esophageal cancers from 1986 to 2012. Data on age, gender, racial groups (Malays, Chinese, Indigenous and foreign nationals) and histology type were collected. The rate (ASR) and Age Specific Incidence rate (ASIR) were calculated.
  
  
  RESULTS
  The predominant tumor type was SCC which accounted for 89% of all esophageal cancer. The gender ratio was 2.25: 1 (male: female) and the mean age at diagnosis was 66.9±12.9 years, significantly younger for esophageal AC (57.2±16.0) compared to SCC (68.1±12.0, p<0.05), and among the foreign nationals (p<0.05 for trend). The proportions of SCC among all esophageal cancers in the various racial groups were: Malays (87.8%), Chinese (100%), Indigenous (100%) and foreign nationals (20%). None of the Chinese and Indigenous groups were diagnosed with esophageal AC. The overall ASR for esophageal cancer was 2.1/100,000; 2.0/100,000 for SCC with a declining trend and 0.17/100,000 for esophageal AC, without any trend observed. Among the two major racial groups; the Chinese has higher ASR (3.42/100,000) compared to the Malays (ASR 0.95/100,000).
  
  
  CONCLUSIONS
  SCC is the predominant tumor type of esophageal cancer in Brunei Darussalam and more common among the Chinese. There was a declining trend in the incidence of SCC but not for esophageal AC.
authors.affiliation: Department of Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan, Brunei Darussalam E-mail : chongvuih@yahoo.co.uk.
authors.forename: Vui Heng
authors.initials: VH
authors.lastname: Chong
authors.forename: Pemasari Upali
authors.initials: PU
authors.lastname: Telisinghe
authors.forename: Chee Fui
authors.initials: CF
authors.lastname: Chong
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D000368:Aged; D002010:Brunei / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology; D016021:Epidemiologic Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009017:Morbidity; D009367:Neoplasm Staging; D011379:Prognosis; D044469:Racial Groups; D012737:Sex Factors