A risk factor is anything that increases your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer, and smoking is a risk factor for lung, colon, and many other cancers. Scientists have found several risk factors that make you more likely to develop cancer of the esophagus. Some are more likely to increase the risk for adenocarcinoma of the esophagus and others for squamous cell carcinoma of the esophagus.

Age: The incidence of esophageal cancer, or rate or frequency of occurrence, increases with age. Nearly half of all people with this cancer are older than age 70. Around three fourths of people diagnosed are between ages 55 and 85. For people younger than age 40, the chance of developing this cancer is less than 1 in 100,000.

Gender: Compared with women, men have a 3-fold higher rate of esophageal cancer.

Race: African Americans are 50% more likely to develop esophageal cancer than whites. Most esophageal cancers in African Americans are the squamous cell type. In contrast, adenocarcinomas are the most common form of esophageal cancer in whites.

Barrett esophagus: This condition, which affects the lining of the lower esophagus is often associated with long-term reflux of stomach and duodenal fluids into the lower esophagus. One estimate from a Swedish study estimates that about 1.6% of their population over age 18 had Barrett esophagus. This would mean about 3 million people in the United States. Only about 56% of these people with Barrett esophagus had symptoms of "heartburn," while the others had no symptoms at all. Barrett esophagus is a risk factor for the adenocarcinoma type of cancer of the esophagus. This is because the abnormal cells in Barrett esophagus can progress over time to become dysplasia, a pre-cancerous condition. Dysplasia is characterized by degrees, or grades, with high-grade dysplasia being the most abnormal. People with Barrett esophagus are anywhere from 30 to 125 times more likely than people without this condition to develop esophageal cancer. Although the exact risk of developing cancer in people with Barrett esophagus is not known, researchers estimate it to be only 1 in 200 per year.

Gastroesophageal reflux disease (GERD): Whether or not Barrett esophagus has been diagnosed, long-standing gastroesophageal reflux disease, also called GERD, increases the risk of adenocarcinoma of the esophagus. Heartburn is one of the main symptoms of GERD, although GERD can occur without symptoms. A recent Gallup poll found that 44% of adults in the United States have heartburn at least once per month. About 30% of esophageal cancer cases can be linked to GERD.

Tobacco: The use of tobacco products, including cigarettes, cigars, pipes, and chewing tobacco, is a major risk factor for esophageal cancer. The longer a person uses tobacco, the higher the cancer risk. The risk for the adenocarcinoma type of esophageal cancer is doubled in smokers of a pack or more a day. More than half of all squamous cell type of esophageal cancer is linked to smoking.

Alcohol: Long-term heavy drinking of alcohol is an important risk factor for esophageal cancer, mainly the squamous cell type. Although alcohol is probably not as strong a risk factor as smoking, the combination of smoking and drinking alcohol raises a person's risk much more than using either alone.

Obesity: Overweight and obesity are clearly risk factors, particularly for adenocarcinoma of the esophagus. The risk of dying from this cancer is increased by around 50% in obese men.

Diet:: Diets low in fruits and vegetables, as well as certain minerals and vitamins, particularly vitamins A, C, and riboflavin may increase the risk for esophageal cancer. Overeating, which leads to obesity, increases the risk of the adenocarcinoma type of esophageal cancer. Certain substances in the diet may increase the cancer risk and may explain the high rate of this cancer in certain parts of the world. About 15% of esophageal cancer can be linked to a diet poor in fruits and vegetables. There have been suggestions, as yet unproven, that a diet high in processed meat may also increase the chance of developing esophageal cancer.

Very hot liquids: Frequent drinking of very hot liquids may increase the risk for the squamous cell type of esophageal cancer.

Occupational exposures: Exposure to the solvents used for dry cleaning may lead to a greater risk of esophageal cancer. Dry cleaning workers have a higher rate of esophageal cancer. Exposure to other chemical fumes also may lead to an increased risk of esophageal cancer.

Lye ingestion: Lye is a chemical found in strong industrial and household cleaners such as drain cleaners. Lye is a corrosive agent, meaning it can burn and destroy cells. Children who find and accidentally swallow household chemicals have a high rate of the squamous cell type of esophageal cancer as adults. The cancers occur on average about 40 years after the lye was swallowed.

Achalasia: In this disease, the lower esophageal sphincter does not relax properly to allow food/liquid to pass into the stomach. The cause of this disease is probably a defect of nerve cells in the lower esophagus that keeps the lower esophageal sphincter from relaxing and thus makes it difficult to swallow. The esophagus above this narrowing becomes dilated (larger) and retains food. The reason that achalasia is a risk factor for esophageal cancer is not clear, but roughly 6% of all achalasia patients develop squamous cell-type esophageal cancer.

Tylosis: This is a rare, inherited disease that causes excess growth of the top layer of skin on the palms of the hands and soles of the feet. A mutation of a gene on chromosome 17 is thought to be responsible for tylosis as well as some esophageal cancers. People with this condition have a very high risk (about 40%) for squamous cell type of esophageal cancer and therefore require early and regular monitoring with an upper endoscopy (scope with camera placed to view the esophagus).

Esophageal webs: These abnormal protrusions of tissue into the esophagus can interfere with swallowing. This abnormality is sometimes present in people who also have anemia and abnormalities of the tongue, fingernails, spleen, and other organs. This combination of abnormalities is usually called the Plummer-Vinson syndrome but is sometimes also referred to as Paterson-Kelly syndrome. About 1 in 10 patients with this syndrome eventually develop squamous cell cancer of the esophagus. Last Revised: 08/04/2006