BACKGROUND:
Esophageal cancer is a public health concern in Ethiopia. The first steps in determining the burden of the disease and possible etiopathological connections are determining the incidence and demographic characteristics of the two histological subtypes, ESCC and EAC.

AIM:
To identify the age and gender-specific incidence patterns of the most common subtype of esophageal cancer in a high-incidence area of Ethiopia.

METHODS:
Using retrospective cross-sectional study conducted from August 2019 to August 2022, nine hospitals' pathology registries yielded 630 cases from a high-incidence esophageal cancer area in Ethiopia. The patient records were carefully reviewed and data on age, gender, tumor location, and histological types was systematically compiled. The patient data were retrieved and descriptive statistics were used to generate results.

RESULTS:
ESCC subtype, accounted for constituting 500 (79.437%) of the cases. A gender disparity was observed, with 62.80% of cases occurring in females and 37.20% in males. This distribution of higher female ESCC incidences aligns with previous findings indicating a regional consistency and probable aetiological factor. Furthermore, ESCC incidence peaked at 40-50 years in females, highlighting an age-related incidence trend. EAC was observed in 67(51.5%) female and 63(48.5%) male showing similar prevalence. Spatial analysis revealed that the majority of ESCC cases were located in the lower esophagus, followed by the middle part, with fewer instances in the upper esophagus.

CONCLUSIONS:
This study from Ethiopia identified ESCC as the predominant subtype, with a marked female predominance and age-related gender disparities. EAC with a lesser proportion identified with consistent spatial distribution patterns in both gender genders provide valuable insights into the epidemiological landscape of this disease. These findings emphasize the urgency of targeted research to uncover the underlying factors.