Previous studies have shown that oesophageal and
gastric cancers are the most common causes of
cancer death in the Golestan Province, Iran. In 2001, we established Atrak Clinic, a referral clinic for gastrointestinal (GI) diseases in Gonbad, the major city of eastern Golestan, which has permitted, for the first time in this region, endoscopic localisation and histologic examination of upper GI
cancers. Among the initial 682 patients seen at Atrak Clinic, 370 were confirmed histologically to have
cancer, including 223 (60%) oesophageal
squamous cell cancers (ESCC), 22 (6%) oesophageal
adenocarcinomas (EAC), 58 (16%) gastric cardia
adenocarcinomas (GCA), and 58 (16%) gastric noncardia
adenocarcinomas. The proportional occurrence of these four main site-cell type subdivisions of upper GI
cancers in Golestan is similar to that seen in Linxian, China, another area of high ESCC incidence, and is markedly different from the current proportions in many Western countries. Questioning of patients about exposure to some known and suspected risk factors for squamous cell oesophageal
cancer confirmed a negligible history of consumption of alcohol, little use of cigarettes or nass (tobacco,
lime and ash), and a low intake of
opium, suggesting that the high rates of ESCC seen in northeastern Iran must have other important risk factors that remain speculative or unknown. Further studies are needed to define more precisely the patterns of upper GI
cancer incidence, to test other previously suspected risk factors, and to find new significant risk factors in this high-risk area.