Can cancer of the esophagus be prevented?

Not all cases of esophageal cancer can be prevented, but the risk of developing this disease can be greatly reduced by avoiding certain risk factors.

In the United States, the most important lifestyle risk factors for cancer of the esophagus are the use of tobacco and alcohol. Each of these factors alone increases the risk of esophageal cancer many times, and the risk is even greater if they are combined. Avoiding tobacco and alcohol is one of the best ways of limiting your risk of esophageal cancer.

Eating a healthy diet and maintaining a healthy weight are also important. A diet rich in fruits and vegetables may help protect against esophageal cancer. Obesity has been linked with esophageal cancer, particularly the adenocarcinoma type, so maintaining a healthy weight may also help limit the risk of this disease.

Some studies have found that the risk of cancer of the esophagus is lower in people who take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. However, taking these drugs every day can lead to problems, such as kidney damage and bleeding in the stomach. For this reason, most doctors do not advise the use of NSAIDs to try to prevent cancer. If you are thinking of using an NSAID regularly, you first should discuss the potential benefits and risks with your doctor.

Some studies have also found a lower risk of esophageal cancer in patients with Barrett’s esophagus who take a type of drug called statins. Statins are used to treat high cholesterol, and examples include atorvastatin (Lipitor^®) and rosuvastatin (Crestor^®). While taking one of these drugs to lower cholesterol may also help some patients lower esophageal cancer risk, doctors don’t advise taking them to prevent cancer. These drugs can have serious side effects.

People at increased risk for esophageal cancer, such as those with Barrett's esophagus, are often followed closely by their doctors to look for signs that the cells lining the esophagus have become more abnormal (see "Can cancer of the esophagus be found early?"). If dysplasia (a pre-cancerous condition) is found, the doctor may recommend treatments to keep it from progressing to esophageal cancer.

Treating people with reflux may help prevent Barrett's esophagus and esophageal cancer. Often, reflux is treated using drugs called proton pump inhibitors (PPIs), such as omeprazole (Prilosec^®), lansoprazole (Prevacid^®), or esomeprazole (Nexium^®). Surgery is also an option for treating reflux.

For those who already have Barrett's esophagus, treatment with a high dose of a PPI may lower the risk of developing cell changes that can turn into cancer (dysplasia). If you have chronic heartburn (or reflux), you should tell your doctor. Treatment can often improve symptoms and may prevent future problems.