AbstractBackgroundGastric cancer (GC) and esophageal cancer (EC) are among the most fatal cancers and improving survival in them is a major clinical challenge. Nordic cancer data were recently released up to year 2019. These data are relevant for long‐term survival analysis as they originate from high‐quality national cancer registries from countries with practically free access to health care, thus documenting ‘real‐world’ experience for entire populations.Patients/MethodsData were obtained for Danish (DK), Finnish (FI), Norwegian (NO), and Swedish (SE) patients from the NORDCAN database from years 1970 through 2019. Relative 1‐ and 5‐year survival were analyzed, and additionally the difference between 1‐ and 5‐year survival was calculated as a measure of trends between years 1 and 5 after diagnosis.ResultsRelative 1‐year survival for Nordic men and women in GC was 30% in period 1970–74 and it increased close to 60%. Early 5‐year survival ranged between 10 and 15% and the last figures were over 30% for all women and NO men while survival for other men remain below 30%. Survival in EC was below that in GC, and it reached over 50% for 1‐year survival only for NO patients; 5‐year survival reached over 20% only for NO women. For both cancers, the difference between 1‐ and 5‐year survival increased with time. Survival was worst among old patients.ConclusionGC and EC survival improved over the 50‐year period but the increase in 5‐year survival was entirely explained by gains in 1‐year survival, which improved at an accelerated pace in EC. The likely reasons for improvements are changes in diagnosis, treatment, and care. The challenges are to push survival past year 1 with attention to old patients. These cancers have a potential for primary prevention through the avoidance of risk factors.