Esophageal Cancer Risk Factors

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.

Scientists have found several factors that can affect your risk of esophageal cancer. Some are more likely to increase the risk for adenocarcinoma of the esophagus and others for squamous cell carcinoma of the esophagus.

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 not have any known risk factors.

Age

The chance of getting esophageal cancer increases with age. Fewer than 15% of cases are found in people younger than age 55.

Gender

Men are more likely than women to get esophageal cancer.

Tobacco and alcohol

The use of tobacco products, including cigarettes, cigars, pipes, and 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.

Someone who smokes a pack of cigarettes a day or more has at least twice the chance of getting adenocarcinoma of the esophagus than a nonsmoker, and the risk does not go away if tobacco use stops. The link to squamous cell esophageal cancer is even stronger, but this risk does go down for people who quit tobacco.

Drinking alcohol also increases the risk of esophageal cancer. The more alcohol someone drinks, the higher their chance of getting esophageal cancer. Alcohol increases the risk of squamous cell carcinoma more than the risk of adenocarcinoma.

Smoking combined with drinking alcohol raises the risk of the squamous cell type 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 from the stomach up 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 that seem to come from the middle of the chest. In some, though, reflux doesn’t cause any symptoms at all.

People with GERD have a slightly higher risk of getting adenocarcinoma of the esophagus. This risk seems to be higher in people who have more frequent symptoms. 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 (discussed below), which is linked to an even higher risk.

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 gland cells. These gland cells usually look like the cells that line the stomach and the small intestine, and are 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 many have no symptoms at all. People with Barrett’s esophagus are at a much higher risk than people without this condition to develop 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 pre-cancerous condition. Dysplasia is graded by how abnormal the cells look under the microscope. Low-grade dysplasia looks more like normal cells, while high-grade dysplasia is more abnormal. High-grade dysplasia is linked to the highest risk of cancer.

Obesity

People who are overweight or obese (very overweight) have a higher chance of getting adenocarcinoma of the esophagus. This is in part explained by the fact that people who are obese are more likely to have gastroesophageal reflux.

Diet

Certain substances in the diet may increase esophageal cancer risk. For example, there have been suggestions, as yet not well proven, that a diet high in processed meat 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 probably lowers 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 - much hotter than a typical cup of coffee) may increase the risk for the squamous cell type of esophageal cancer. This might be the result of long-term damage to the cells lining the esophagus from the hot liquids.

Physical Activity

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) does not relax properly. Food and liquid that are swallowed have trouble passing into the stomach and tend to collect in the lower esophagus, which 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 risk of esophageal cancer that is many times normal. On average, the cancers are found about 15 to 20 years after the achalasia began.

Tylosis

This is a rare, inherited disease that causes extra growth of the top layer of skin on the palms of the hands and soles of the feet. People with this condition also develop small growths (papillomas) in the esophagus and have a very high risk of getting squamous cell cancer of the esophagus.

People with tylosis need to be watched closely to try to find esophageal cancer early. Often this requires regular monitoring with an upper endoscopy (described in Tests for Esophagus 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 esophageal 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.

About 1 in 10 people with this syndrome eventually develop squamous cell cancer of the esophagus 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.

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 papilloma virus (HPV) infection

HPV is a group of more than 100 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma (or wart). Infection with certain types of HPV is linked to a number of cancers, including throat cancer, anal cancer, and cervical cancer.

Signs of HPV infection have been found in up to one-third of esophagus cancers from patients in parts of Asia and South Africa. But signs of HPV infection have not been found in esophagus cancers from patients in the other areas, including the US. HPV is a rare cause of esophageal cancer. 

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Chak A, Chen Y, Vengoechea J, et al. Variation in age at cancer diagnosis in familial versus nonfamilial Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev.2012;21:376–383.

Gibson MK. Epidemiology and pathobiology of esophageal cancer. Tanabe KK and Goldberg RM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 22, 2020).

Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.

Ku GY and Ilson DH. Chapter 71 – Cancer of the Esophagus. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier: 2020.

Loomis D, Guyton KZ, Grosse Y et al. Carcinogenicity of drinking coffee, mate, and very hot beverages. International Agency for Research on Cancer Monograph Working Group, Lyon, France. The Lancet Oncology. 2016; 17(7):877-8.  

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. V.4.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf on Jan 21, 2020.

PDQ® Screening and Prevention Editorial Board. PDQ Esophageal Cancer Screening. Bethesda, MD: National Cancer Institute. Updated 09/26/2019. Available at: https://www.cancer.gov/types/esophageal/hp/esophageal-screening-pdq. Accessed 01/21/2020 [PMID: 26389241].

PDQ® Screening and Prevention Editorial Board. PDQ Esophageal Cancer Screening. Bethesda, MD: National Cancer Institute. Updated 10/11/2019. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-screening-pdq. Accessed 01/21/2020. [PMID: 26389194].

Posner MC, Goodman KA, and Ilson DH. Ch 52 - Cancer of the Esophagus. In: DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams & Wilkins; 2019.

Rock CL, Thomson C, Gansler T, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians. 2020;70(4). doi:10.3322/caac.21591. Accessed at https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21591 on June 9, 2020.

Spechler SJ. Barrett's esophagus: Surveillance and management. Talley NJ, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 22, 2020).

References

Chak A, Chen Y, Vengoechea J, et al. Variation in age at cancer diagnosis in familial versus nonfamilial Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev.2012;21:376–383.

Gibson MK. Epidemiology and pathobiology of esophageal cancer. Tanabe KK and Goldberg RM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 22, 2020).

Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.

Ku GY and Ilson DH. Chapter 71 – Cancer of the Esophagus. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier: 2020.

Loomis D, Guyton KZ, Grosse Y et al. Carcinogenicity of drinking coffee, mate, and very hot beverages. International Agency for Research on Cancer Monograph Working Group, Lyon, France. The Lancet Oncology. 2016; 17(7):877-8.  

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. V.4.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf on Jan 21, 2020.

PDQ® Screening and Prevention Editorial Board. PDQ Esophageal Cancer Screening. Bethesda, MD: National Cancer Institute. Updated 09/26/2019. Available at: https://www.cancer.gov/types/esophageal/hp/esophageal-screening-pdq. Accessed 01/21/2020 [PMID: 26389241].

PDQ® Screening and Prevention Editorial Board. PDQ Esophageal Cancer Screening. Bethesda, MD: National Cancer Institute. Updated 10/11/2019. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-screening-pdq. Accessed 01/21/2020. [PMID: 26389194].

Posner MC, Goodman KA, and Ilson DH. Ch 52 - Cancer of the Esophagus. In: DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams & Wilkins; 2019.

Rock CL, Thomson C, Gansler T, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians. 2020;70(4). doi:10.3322/caac.21591. Accessed at https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21591 on June 9, 2020.

Spechler SJ. Barrett's esophagus: Surveillance and management. Talley NJ, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 22, 2020).

Last Medical Review: March 20, 2020 Last Revised: June 9, 2020

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