Esophageal Cancer in Brunei Darussalam over a three Decade Period: an Epidemiologic Study of Trends and Differences between Genders and Racial Groups

  • Chong, Vui Heng (Department of Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital) ;
  • Telisinghe, Pemasari Upali (Department of Pathology, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital) ;
  • Chong, Chee Fui (Department of Surgery, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital)
  • Published : 2015.05.18


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. Materials and 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 $66.9{\pm}12.9$ years, significantly younger for esophageal AC ($57.2{\pm}16.0$) compared to SCC ($68.1{\pm}12.0$, 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.


Esophageal cancer;squamous cell carcinoma;adenocarcinoma;presentations;incidence


  1. Chong VH (2008). Findings among patients referred for endoscopy in Brunei Darussalam with special reference to dyspepsia. Brunei Darussalam J Health, 3, 24-31.
  2. Chong VH, Telisinghe PU, Abdullah MS, Chong CF (2014). Gastric cancer in Brunei Darussalam: epidemiological trend over a 27 year period (1986-2012). Asian Pac J Cancer Prev. 15, 7281-5.
  3. Chong VH, Telisinghe PU, Abdullah MS, Jalihal A (2009). Colorectal cancer: incidence and trend in Brunei Darussalam. Singapore Med J, 50, 1085-9.
  4. Cook MB, Chow WH, Devesa SS (2009). Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977-2005. Br J Cancer, 101, 855-9.
  5. Coupland VH, Lagergren J, Konfortion J, et al (2012). Ethnicity in relation to incidence of oesophageal and gastric cancer in England. Br J Cancer, 107, 1908-14.
  6. De Stefani E, Deneo-Pellegrini H, Ronco AL, et al (2014). Diet patterns and risk of squamous cell oesophageal carcinoma: a case-control study in Uruguay. Asian Pac J Cancer Prev, 15, 2765-9
  7. Falk GW (2009). Risk factors for esophageal cancer development. Surg Oncol Clin N Am, 18, 469-85.
  8. Feng XS, Yang YT, Gao SG, et al (2014). Prevalence and age, gender and geographical area distribution of esophageal squamous cell carcinomas in North China from 1985 to 2006. Asian Pac J Cancer Prev, 15, 1981-7.
  9. Fernandes ML, Seow A, Chan YH, Ho KY (2006). Opposing trends in incidence of esophageal squamous cell carcinoma and adenocarcinoma in a multi-ethnic Asian country. Am J Gastroenterol, 101, 1430-6.
  10. Fitzgerald TL, Bradley CJ, Dahman B, Zervos EE (2009). Gastrointestinal malignancies: when does race matter? J Am Coll Surg. 209, 645-52.
  11. He YT, Hou J, Chen ZF, et al. Trends in incidence of esophageal and gastric cardia cancer in high-risk areas in China. Eur J Cancer Prev, 17, 71-6.
  12. Hongo M, Nagasaki Y, Shoji T. Epidemiology of esophageal cancer: Orient to Occident. Effects of chronology, geography and ethnicity. J Gastroenterol Hepatol, 24, 729-35.
  13. International Agency for Research on Cancer. Globocan 2012: Estimated cancer incidence, mortality and Prevalence Worldwide 2012. Available from (Accessed 15th August 2014).
  14. Mohammad IA, Bujang MR, Telisinghe PU, Abdullah MS, Chong CF, Chong VH (2014). Cancers of the young population in Brunei Darussalam. Asian Pac J Cancer Prev, 15, 6357-62.
  15. Murray L, Romero Y (2009). Role of obesity in Barrett's esophagus and cancer. Surg Oncol Clin N Am, 18, 439-52.
  16. Tang WR, Fang JY, Wu KS, Shi XJ, Luo JY, Lin K (2014). Epidemiological characteristics and prediction of esophageal cancer mortality in China from 1991 to 2012. Asian Pac J Cancer Prev, 15, 6929-34.
  17. Trivers KF, Sabatino SA, Stewart SL (2008). Trends in esophageal cancer incidence by histology, United States, 1998-2003. Int J Cancer, 123, 1422-8.
  18. Vega KJ, Jamal MM (2000). Changing pattern of esophageal cancer incidence in New Mexico. Am J Gastroenterol, 95, 2352-6.
  19. Wang X, Fan JC, Wang AR, et al (2013). Epidemiology of esophageal cancer in Yanting - regional report of a national screening programme in China. Asian Pac J Cancer Prev, 14, 2429-32.