Squamous cell carcinoma
        Tobacco and Alcohol Use
        Dietary Factors
        Drinking Mate (a hot beverage common in South America)
        Aspirin and Nonsteroidal Anti-inflammatory Drug Use
Adenocarcinoma of the esophagus
        Gastroesophageal Reflux/Barrett’s Esophagus
        Aspirin and Nonsteroidal Anti-inflammatory Drug Use

Note: Separate PDQ summaries on Screening for Esophageal Cancer and Esophageal Cancer Treatment are also available.

Squamous cell cancer of the esophagus is strongly and independently associated with tobacco and alcohol abuse.[1]

Levels of Evidence

3aii: Evidence obtained from well-designed and conducted cohort or case-control studies, preferably from more than one center or research group that have a cancer incidence endpoint.

4: Ecologic and descriptive studies (e.g., international patterns studies, migration studies, time series).

The relative risk associated with tobacco use is 2.4, and the population attributable risk is 54.2% (95% confidence interval (CI), 3.0-76.2).[1] Retrospective cohort studies adjusted for tobacco use have shown a 2-fold to 7-fold increase in risk of esophageal cancer in alcoholics, compared with rates for the general population.[2] Case-control studies have also suggested a significantly increased risk of cancer of the esophagus associated with alcohol abuse.

Level of Evidence

3: Evidence obtained from well-designed and conducted cohort or case-control studies, preferably from more than one center or research group.

D iets high in vegetables and fruits are associated with a decreased risk of esophageal cancer.[1]

Level of Evidence

3: Evidence obtained from well-designed and conducted cohort or case-control studies, preferably from more than one center or research group.

High intake of vitamin C and high intake of carotenoids possibly decrease the risk of esophageal cancer.[1]

Level of Evidence

3: Evidence obtained from well-designed and conducted cohort or case-control studies, preferably from more than one center or research group.

A significant dose-response relationship has been reported in South America between the amount of mate (a hot, aromatic beverage with stimulant properties like tea or coffee) drunk each day and the risk of esophageal cancer, with an odds ratio (OR) ranging between 1.5 and 12.2.[3] The very high temperature at which this beverage is consumed appears to be important.

Level of Evidence

3: Evidence obtained from well-designed and conducted cohort or case-control studies, preferably from more than one center or research group.

E pidemiologic studies have found that aspirin or nonsteroidal anti-inflammatory drug (NSAID) use is associated with decreased risk of developing or dying from esophageal cancer (OR = 0.57, 95% CI 0.47-0.71).[4]

Levels of Evidence

3ai, 3aii: Evidence obtained from well-designed and conducted cohort or case-control studies, preferably from more than one cancer or research group, that have cancer mortality and cancer incidence endpoints.

4ai, 4aii: Ecologic and descriptive studies (e.g., international patterns studies, migration studies, time series) that have cancer mortality and cancer incidence endpoints.

A strong association exists between gastroesophageal reflux disease (GERD) and adenocarcinoma.[5] Long-standing GERD is associated with the development of Barrett’s esophagus, a condition in which an abnormal intestinal type epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus.

It is unknown whether elimination of gastroesophageal reflux by surgical or medical means will reduce the risk of esophageal adenocarcinoma.[6]

Level of Evidence

4: Ecologic and descriptive studies (e.g., international patterns studies, migration studies, time series).

Epidemiologic studies have found that aspirin or nonsteroidal anti-inflammatory drug (NSAID) use is associated with decreased risk of developing or dying from esophageal cancer (OR = 0.57, 95% CI 0.47-0.71).[4]

Levels of Evidence

3ai, 3aii: Evidence obtained from well-designed and conducted cohort or case-control studies, preferably from more than one cancer or research group, that have cancer mortality and cancer incidence endpoints.

References

1. Siemiatycki J, Krewski D, Franco E, et al.: Associations between cigarette smoking and each of 21 types of cancer: a multi-site case-control study. Int J Epidemiol 24 (3): 504-14, 1995.  [PUBMED Abstract]
   
   
2. Oesophagus. In: World Cancer Research Fund., American Institute for Cancer Research.: Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: The Institute, 1997, pp 118-129. 
   
   
3. De Stefani E, Muñoz N, Estève J, et al.: Mate drinking, alcohol, tobacco, diet, and esophageal cancer in Uruguay. Cancer Res 50 (2): 426-31, 1990.  [PUBMED Abstract]
   
   
4. Corley DA, Kerlikowske K, Verma R, et al.: Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 124 (1): 47-56, 2003.  [PUBMED Abstract]
   
   
5. Lagergren J, Bergström R, Lindgren A, et al.: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340 (11): 825-31, 1999.  [PUBMED Abstract]
   
   
6. Spechler SJ, Goyal RK: The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology 110 (2): 614-21, 1996.  [PUBMED Abstract]
   
   

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