Risks and causes of oesophageal cancer
This page is about risk factors for cancer of the food pipe (oesophageal cancer). There is information about
Oesophageal cancer risks and causes
Cancer of the food pipe (oesophagus) is more common in men than in women and in older people. There are very few cases in people under 45 years of age.
Alcohol and tobacco
Smoking tobacco and drinking a lot of alcohol are some of the main risk factors for oesophageal cancer. Your risk increases the longer you smoke.
Drinking alcohol increases the risk of squamous cell cancer of the oesophagus. If you smoke and regularly drink more than the recommended limit, your risk is much greater. The combined risk is greater than the risk of just smoking plus the risk of just drinking. But your risk gradually starts to reduce after you stop smoking or drinking.
Chewing tobacco, snuff and betel quid (also called paan or pan) also increases your risk of cancer of the oesophagus.
Other risk factors
Other risk factors for oesophageal cancer include Barrett's oesophagus and long term acid reflux, being obese, diet and rare medical conditions.
You can view and print the quick guides for all the pages in the about oesophageal cancer section.
Oesophageal cancer (cancer of the food pipe) has become more common in the past 30 years in the UK. It is the 11th most common cancer in adults, with around 8,160 cases diagnosed each year in the UK. Oesophageal cancer is about twice as common in men as in women.
As with most cancers, cancer of the oesophagus is more common in older people than in younger. There are very few cases in people under 45 years of age. Almost 9 out of 10 cases of oesophageal cancer can be linked to lifestyle and environmental factors.
Smoking tobacco and drinking a lot of alcohol are some of the main risk factors for oesophageal cancer. Cigarettes contain nitrosamines and other chemicals that increase the risk of cancer. Pipe smoking also increases the risk of oesophageal cancer. When you smoke, you always swallow some of the smoke as well as breathing it into your lungs.
Drinking alcohol increases the risk of one type of oesophageal cancer – squamous cell carcinoma (SCC). Smoking increases the risk of the two main types of oesophageal cancer – SCC and oesophageal adenocarcinoma. Your risk increases the longer you smoke.
If you smoke and regularly drink more than the recommended limit (3 units of alcohol a day for men and 2 units for women), your risk of squamous cell carcinoma is greater. The combined risk is greater than the risk of just smoking plus the risk of just drinking. But your risk gradually starts to reduce after you stop smoking or drinking.
Chewing tobacco, snuff or betel quid (also called paan or pan) also increases your risk of cancer of the oesophagus.
Obesity means being very overweight. Body mass index (BMI) is a simple way of classifying whether people are the right weight. It looks at weight compared to height. Obesity is when a person has a BMI of 30 or higher. Every 5 unit increase in BMI (for example a BMI of 25 to a BMI of 30) increases the risk of adenocarcinoma of the oesophagus by more than half.
A Cancer Research UK study estimated that being overweight and obesity causes more than 1 in 4 oesophageal cancers in men and more than 1 in 10 in women. This may be because people who are obese are more likely to suffer from acid reflux and this is a risk factor for oesophageal cancer in itself. The acid coming back up from the stomach irritates the lining of the oesophagus and over a long period of time can cause cell changes leading to Barrett's oesophagus.
A diet high in fresh fruit and vegetables may reduce the risk of oesophageal cancer. This may be because these foods contain antioxidants including vitamins A, C and E, and folate. One study has estimated that more than 4 in 10 cases of oesophageal cancer in the UK could be prevented if people ate the recommended 5 portions of fruit and vegetables a day.
Eating a lot of red or processed meat may increase your risk of oesophageal cancer. Some studies have shown that a high intake of meat which is barbecued, fried or roasted at high temperatures is linked to a higher risk of oesophageal cancer. These methods of cooking cause higher levels of chemicals called heterocyclic amines in food, and these chemicals may increase cancer risk.
Drinking very hot drinks may increase your risk of oesophageal cancer. The size of the risk increase varies in different studies. But many studies show between double and quadruple the risk in people who drink beverages hot or very hot. Hot drinks may damage the lining of the oesophagus, but this is difficult to prove.
Cancer of the oesophagus is more common in southern and eastern Africa and eastern Asia. It may be that the different diets eaten in these parts of the world increases the risk. For example traditional Asian pickled vegetables might increase the risk of oesophageal cancer. And some African diets may be low in fruit and vegetables. Some environmental factors may also be involved.
There are some other conditions that we know increase oesophageal cancer risk. These are
- Barrett's oesophagus
- Achalasia – a condition causing problems with the valve between the oesophagus and stomach
- Tylosis – a rare skin condition
- Plummer-Vinson syndrome – a condition causing difficulty swallowing
Barrett's oesophagus means that the cells lining the oesophagus have become abnormal. This can happen due to long term acid indigestion (acid reflux). The stomach acid comes back up into the oesophagus and irritates the lining. However not everyone with Barrett's oesophagus have acid reflux symptoms.
People who have symptoms of acid reflux every week or more have around 5 times the risk of adenocarcinoma of the oesophagus compared to people who have symptoms less often or who do not have reflux. People with Barrett's oesophagus may be around 11 times more likely than the general population to develop adenocarcinoma of the oesophagus.
Remember that the overall risk to any person of getting oesophageal cancer is quite small. The risk for adenocarcinoma with Barrett's oesophagus may be around 11 times higher, but this is still a small risk. It is thought that 1 out of every 860 people with Barrett's oesophagus will go on to develop oesophageal adenocarcinoma each year.
Achalasia is a condition where the valve between your stomach and oesophagus (cardiac sphincter) does not relax properly. This valve prevents food and liquid backing up into the oesophagus. So with achalasia, the lower part of the oesophagus becomes stretched and food gets stuck there. Men with achalasia have an 8 to 16 times higher risk of both main types of oesophageal cancer compared to the general population. Women with achalasia have a 20 times higher risk of adenocarcinoma of the oesophagus. But no increase in the risk of squamous cell oesophageal cancer.
Tylosis is an extremely rare inherited skin condition. The skin grows much too thick on the palms of the hands and soles of the feet. People who develop symptoms between age 5 and 15 (Tylosis A) are at a greatly increased risk of squamous cell oesophageal cancer.
This is a rare condition. People with Plummer Vinson syndrome have anaemia (low red blood cells) due to a lack of iron. They also develop small, thin growths of tissue which block part of their food pipe, making swallowing difficult. Plummer Vinson syndrome has been linked to an increased risk of squamous cell oesophageal cancer.
There is very little research into how occupation is related to the risk of oesophageal cancer. And it is often difficult to separate the effects of occupational exposures from other lifestyle factors. But a few studies show that workers exposed for long periods of time to tetrachloroethylene (a chemical used in dry cleaning and metal degreasing), soot or working in rubber production have an increased risk of oesophageal cancer.
Helicobacter pylori (H Pylori) is a bacteria that causes stomach ulcers and can cause stomach cancer. Researchers have found that certain strains of H Pylori may protect against adenocarcinoma of the oesophagus. This may be because H pylori seems to reduce the risk of Barrett’s oesophagus.
People who have had radiotherapy for previous cancers (including cancers of the breast, lung, oropharynx, larynx and Hodgkin's lymphoma) have an increased risk of oesophageal cancer. The risk of developing oesophageal cancer in the general population is quite small so this increase in risk is still small. Radiotherapy after a mastectomy for breast cancer seems to increase the risk more than radiotherapy after lumpectomy. The risk to you from your primary cancer if you don't have radiotherapy is much higher than the risk of developing oesophageal cancer if you do have radiotherapy.
Bisphosphonates are drugs used to strengthen bones, often in people with bone thinning (osteoporosis), myeloma or cancer which has spread to the bones. Some studies have shown an increase in risk of oesophageal cancer in patients who take oral bisphosphonates. But other studies have not found this link. And so research into this is ongoing.
A type of study called a meta analysis combines the results of several individual studies looking into a particular topic. This is more reliable than than the results of a single study. Meta analyses have looked at the links between oesophageal cancer risk and several types of drugs. Some of these are described below.
Women who have ever taken hormone replacement therapy (HRT) for the menopause seem to have a lower risk of oesophageal cancer compared with women who have never taken HRT. But there is some evidence that women taking oestrogen only HRT are more likely to have acid reflux, which has been linked to an increased risk of oesophageal cancer.
People who take drugs to lower cholesterol in the blood (statins) also seem to have a lower risk of oesophageal cancer compared with people who do not take statins.
People who take aspirin or other non steroidal anti inflammatory drugs (such as Ibuprofen) seem to have a lower risk of oesophageal cancer. These drugs might also reduce the risk of oesophageal cancer in people with Barrett's oesophagus.
Remember that these drugs can be dangerous because they can irritate the stomach lining and cause bleeding. You should not start to take aspirin or other anti inflammatory drugs without checking with your doctor first.
Some studies have shown a higher risk of oesophageal cancer in people who have poor oral hygiene or symptoms of oral disease, such as tooth loss or decay. But these findings are based on small numbers and so the evidence is not clear yet. Tooth loss can sometimes be due to poor diet or long term infection of the gums, and these factors may possibly increase the risk of oesophageal cancer too. Tooth loss may also cause problems with chewing, so larger pieces of food are swallowed which may irritate the oesophagus.
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