Previous studies have shown that upper gastrointestinal cancers are the most common cancers in Caspian Littoral, and rate of esophageal cancer (EC) in Iranian Turkmens residing in the Eastern part of littoral are among the highest in the world. Our aim was to reassess the rate 30 years later and following socioeconomic changes in the region. A comprehensive retrospective search was undertaken to find all new cancer cases during the 1996-2000 period. Diagnosis of cancer was based on histopathological reports in 68.2%, clinical and/or radiological evidence in 29.7% and death certificate only (DCO) in 2.1% of the cases. A total of 5143 new cancer cases were registered of whom 3063 (59.6%) were males. The median (IQR) age was 60 (44-69) years. Age-standardized rates (ASR) for all cancers in males and females were 134.7 and 104.5 per 100,000, respectively. Based on ASR, the top five common cancers in males (excluding skin cancer) were cancers of esophagus (43.4), stomach (27.8), colorectal (10.7), bladder (7.8) and oral cavity (6.3), while in females cancer of esophagus (36.3) was followed by cancers of breast (15.7), stomach (8.3) colorectal (6.6) and cervix (3.6). We conclude that EC incidence rate has decreased to less than half the rate reported 30 years ago, while the incidence rates of colorectal and breast cancers have increased significantly.