Aims: There is some evidence to indicate that the incidence of gastric and oesophageal carcinoma is changing rapidly in the West. However, to study the true magnitude of the problem (to help in planning health and cancer strategies over the next decades), this epidemiological study was performed. METHODS: The Thames Cancer Registry database for the years 1960-1995 was searched for all oesophageal and gastric cancers in the South Thames region, and was analysed for all subsites for both sexes separately. Statistical analysis using the age-standardized ratio (ASR) (world) and chi2 test for trend for each subgroup was performed. RESULTS: The overall incidence of carcinoma of the oesophagus for both sexes saw a marked rise in the period studied, while the overall incidence of gastric cancer fell. In the upper two-thirds of the oesophagus, the increase in incidence was more dramatic for women (from 0.30 in 1960 to 0.70 in 1996; chitrend2 = 18.7, P = 0.00015) than men (from 0.59 in 1960 to 1.09 in 1996; chitrend2 = 4.4, P = 0.0354). In the lower third of the oesophagus, there was a rise in men (ASR from 0.93 in 1960 to 3. 43 in 1996; chitrend2 = 466.3, P < 0.0001) as well as in women (ASR from 0.42 in 1960 to 0.91 in 1996; chitrend2 = 51.4, P < 0.0001). For the gastric cardia, the incidence in men increased (ASR from 1. 24 in 1960 to 2.41 in 1996; chitrend2 = 109.8, P < 0.0001), while in women it remained unchanged (ASR from 0.33 in 1960 to 0.55 in 1996; chitrend2 = 0.0, P = 0.8281). The incidence of distal gastric carcinoma has decreased in men (ASR from 2.47 in 1980 to 0.63 in 1996; chitrend2 = 264.7, P < 0.0001) and women (from 1.14 in 1980 to 0.43 in 1996, chitrend2 = 131.8, P < 0.0001). For cancers of other subsites of the stomach (fundus, lesser and greater curvature, and body), there was a fall in incidence in both sexes. CONCLUSION: There has been a twofold to threefold increase over 36 years in the incidence of cancer of the oesophagogastric junction with a decreasing incidence in the distal stomach. There was also an increase in the incidence of upper oesophageal cancers, and a decrease in the incidence of cancers of other subsites of the stomach. Studies to cope with this increase and resources to cope with the treatment of these patients are required.