Risk Factors for Esophageal Cancer

Scientists have found several factors that can affect your risk of esophageal (esophagus) cancer. A risk factor is anything that increases your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

But having a risk factor, or even many, does not mean that you will get esophageal cancer. And some people who get the disease may have few or no known risk factors.

Older age

The chance of getting esophageal cancer increases with age. About 9 in 10 esophageal cancers are found in people age 55 or older.

Being male

Men are more likely than women to get esophageal cancer.

Tobacco and alcohol use

The use of tobacco products, including cigarettes, cigars, pipes, and, to a lesser extent, chewing tobacco, is a major risk factor for esophageal cancer. The more a person uses tobacco and the longer it is used, the higher the cancer risk.

Drinking alcohol also increases the risk of esophageal cancer. The more alcohol someone drinks, the higher their chance of getting esophageal cancer.

Smoking combined with drinking alcohol raises the risk of esophageal cancer much more than using either alone.

Gastroesophageal reflux disease

The stomach normally makes strong acid and enzymes to help digest food. In some people, acid can escape upward from the stomach into the lower part of the esophagus. The medical term for this is gastroesophageal reflux disease (GERD), or just reflux. In many people, reflux causes symptoms such as heartburn or pain in the middle of the chest. In some, though, reflux doesn’t cause any symptoms.

People with GERD have a slightly higher risk of getting adenocarcinoma of the esophagus. But GERD is very common, and most of the people who have it do not go on to develop esophageal cancer.

GERD can also cause Barrett’s esophagus (see below), which is linked to a higher risk of esophageal cancer.

Barrett’s esophagus

If reflux of stomach acid into the lower esophagus goes on for a long time, it can damage the inner lining of the esophagus. This causes the squamous cells that normally line the esophagus to be replaced with cells more like those that are normally in the stomach or intestines, including gland cells. These cells secrete substances that make them more resistant to stomach acid. This condition is known as Barrett’s (or Barrett) esophagus.

The longer someone has reflux, the more likely it is that they will develop Barrett’s esophagus. Most people with Barrett’s esophagus have had symptoms of heartburn, but some have no symptoms.

People with Barrett’s esophagus are at higher risk of developing adenocarcinoma of the esophagus. Still, most people with Barrett’s esophagus do not get esophageal cancer.

The gland cells in Barrett’s esophagus can become more abnormal over time. This can result in dysplasia, a precancerous condition. Dysplasia is graded by how abnormal the cells look under the microscope:

• Low-grade dysplasia still somewhat resembles normal cells.
• High-grade dysplasia appears more abnormal and is linked to the highest risk of esophageal cancer.

Excess body weight

People with excess body weight have a higher chance of getting adenocarcinoma of the esophagus. At least part of this is probably because people with excess body weight are more likely to have GERD (see above).

Dietary factors

Certain substances in a person’s diet may increase esophageal cancer risk. For example, there have been suggestions that diets high in processed meats or other foods that contain nitrates may increase the chance of developing esophageal cancer. This may help explain the high rate of this cancer in certain parts of the world.

On the other hand, a diet high in fruits and vegetables might lower the risk of esophageal cancer. The exact reasons for this are not clear, but fruits and vegetables have a number of vitamins and minerals that may help prevent cancer.

Frequently drinking very hot liquids (temperatures of 149° F or 65° C, which is much hotter than a typical cup of coffee) may increase the risk for squamous cell esophageal cancer. This might be the result of long-term damage to the cells lining the esophagus from the hot liquids.

Physical inactivity

People who engage in regular physical activity may have a lower risk of adenocarcinoma of the esophagus.

Achalasia

In this condition, the muscle at the lower end of the esophagus (the lower esophageal sphincter) doesn’t relax properly. Food and liquid that are swallowed have trouble passing into the stomach and tend to collect in the lower esophagus, which[DI3]  becomes stretched out (dilated) over time. The cells lining the esophagus in that area can become irritated from being exposed to foods for longer than normal amounts of time.

People with achalasia have a much higher risk of esophageal cancer.

Plummer-Vinson syndrome

People with this rare syndrome (also called Paterson-Kelly syndrome) have webs in the upper part of the esophagus, typically along with anemia (low red blood cell counts) due to low iron levels, tongue inflammation (glossitis), brittle fingernails, and sometimes a large spleen.

A web is a thin piece of tissue extending out from the inner lining of the esophagus that causes an area of narrowing. Most esophagus webs do not cause any problems, but larger ones can cause food to get stuck in the esophagus, which can lead to problems swallowing and chronic irritation in that area from the trapped food.

People with this syndrome are at higher risk for developing squamous cell esophageal cancer or cancer in the lower part of the throat (hypopharynx).

Injury to the esophagus

Lye is a chemical found in strong industrial and household cleaners such as drain cleaners. Lye is a corrosive agent that can burn and destroy cells. Accidentally drinking a lye-based cleaner can cause a severe chemical burn in the esophagus. As the injury heals, the scar tissue can cause an area of the esophagus to become very narrow (called a stricture). People with these strictures have an increased risk of squamous cell esophageal cancer, which often occurs many years (even decades) later.

Certain genetic syndromes

Although not common, inherited changes in certain genes can lead to syndromes that increase a person’s risk for esophageal cancer. Examples of such syndromes include:

• Tylosis with esophageal cancer (Howel-Evans syndrome)
• Bloom syndrome
• Fanconi anemia
• Familial Barrett’s esophagus

To learn more about these syndromes, see Causes, Risk Factors, and Prevention of Esophageal Cancer.

History of certain other cancers

People who have had certain other cancers, such as lung cancer, mouth cancer, and throat cancer have a high risk of getting squamous cell carcinoma of the esophagus as well. This may be because these cancers can also be caused by smoking.

Human papillomavirus (HPV) infection

HPV is a group of more than 200 related viruses. They are called papillomaviruses because some of them cause a type of growth called a papilloma (or wart). Infection with certain types of HPV is linked to some types of cancer, including throat cancer, anal cancer, and cervical cancer.

Signs of HPV infection have been found in up to 1 in 3 esophageal cancers from people in parts of Asia and South Africa. But HPV infection has not been shown to be a risk factor for esophageal cancer in other parts of the world, including the US.