Oesophageal cancer (OC) is an important public health problem among the Xhosa-speaking people of the Transkei region in the Eastern Cape Province, South Africa, with incidence rates for males among the highest in the world. To record the occurrence of cancer among men and women of all ages in four districts in the Transkei during the period 1991-1995, to identify common cancers and to compare the variations in cancer incidences in this region with incidences in Africa and the rest of the world. Cancer registration of cases reported from all clinics and hospitals was conducted in the four selected districts. The districts included Centane (Kentani), Butterworth, Bizana and Lusikisiki in the Transkei region. Active and passive methods were used to collect data, which were analysed using the Statistical Analyses Systems (SAS) package. The mean annual number of all cancer cases reported was 310, with age-standardised incidence rates (ASIRs, world standard) of 98.2/100,000 and 74.3/100,000 for males and females, respectively. The most frequently reported cancer was OC, with mean annual ASIRs of 76.6/100,000 and 36.5/100,000 for males and females, respectively, with a male/female ratio of 2:1. The present data confirm previous reports that OC rates in Centane have consistently remained very high, whereas time-dependent changes in the incidence of OC have occurred in Butterworth, Bizana and Lusikisiki suggesting changes in the risk determinants in these districts.