Oesophageal cancer risk factors

Prevention

Preventable cases of oesophageal cancer, UK

Smoking

Oesophageal cancer cases linked to exposure to tobacco smoke, UK

Too few fruit and veg

Oesophageal cancer cases linked to eating too little fruit and vegetables, UK

Excess bodyweight

Oesophageal cancer cases linked to excess bodyweight, UK

89% of oesophageal cancer cases each year in the UK are linked to major lifestyle and other risk factors.[1]

Oesophageal cancer is associated with a number of risk factors.[2-4]

Oesophageal Cancer Risk Factors

Increases risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
  • Alcoholic beverages (and acetaldehyde associated with their consumption)
  • Betel quid (with and without tobacco)
  • Smokeless tobacco
  • Tobacco smoking
  • X-radiation, gamma-radiation
  • Body fatness[a]
  • Dry cleaning
  • Mate drinking, hot[b]
  • Pickled vegetables (traditional Asian)
  • Rubber production industry
  • Tetrachloroethylene
  • Red meat
  • Processed meat
  • High-temperature drinks
 
  • Non-starchy vegetables[c]
  • Fruits[c]
  • Dietary beta-carotene[d]
  • Dietary vitamin[c,d]
  • Dietary fibre[c,d]
  • Dietary folate[c,d]
  • Dietary vitamin B6[d]
  • Dietary vitamin E3[d]

International Agency for Research on Cancer (IARC) and The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications. 

a Oesophageal adenocarcinoma (AC) only; b ‘Probable’ evidence in WCRF/AICR report; c Not salted/pickled; d Foods naturally containing or fortified with (not supplements)

References

  1. Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer 2011;105(S2):S77-S81.
  2. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Accessed July 2014.
  3. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103(24):1827-39.
  4. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
Last reviewed:

Tobacco smoking is classified by the International Agency for Research on Cancer (IARC) as a cause of oesophageal cancer.[1] An estimated 66% (63% in males and 71% in females) of oesophageal cancers in the UK are linked to tobacco smoking.[2]

Last reviewed:

Oesophageal adenocarcinoma (AC) Open a glossary item risk is 85-96% higher in ever-smokers compared with never-smokers, meta- and pooled analyses have shown.[1,2]

Oesophageal AC risk is 2.7-2.8 times higher in smokers with 45-60+ pack-years (one pack year is e.g. one 20-pack per day for one year, or 2 packs per day for half a year), compared with never-smokers, meta- and pooled analyses have shown; risk increases with number of pack-years.[2,3] Oesophageal AC risk is 2.3 times higher in people with 40+ years of cigarette smoking, compared with never-smokers, a meta-analysis showed.[1]

Oesophageal AC risk is 2.5 times higher in people who smoke 20+ cigarettes per day, compared with never-smokers, one meta-analysis showed;[1] however no association was found in a pooled analysis.[3]

Oesophageal AC risk is 29% lower in ex-smokers who quit 10+ years previously compared with continuing smokers, a pooled analysis showed; however those ex-smokers are still at 72% higher risk compared with never-smokers.[2]

Oesophageal cancer (overall) risk is not associated with waterpipe tobacco smoking, a meta-analysis showed; however study quality was poor.[4]

Last reviewed:

Oesophageal squamous cell carcinoma (SCC) Open a glossary item risk is 4.2 times higher in current smokers in Europe compared with never-smokers, a meta-analysis showed.[1]

Oesophageal SCC risk is 5.6 times higher in smokers with 60+ pack-years, compared with never-smokers, a pooled analysis showed; risk increases with number of pack-years.[2]

Oesophageal SCC risk among smokers is not associated with number of cigarettes smoked per day, a pooled analysis showed.[2]

Smoking and drinking alcohol have a synergistic effect on oesophageal SCC risk: their effect in combination is almost double the sum of their effects individually, a meta-analysis showed.[3]

Last reviewed:

Smokeless tobacco and betel quid (with and without tobacco), are classified by the International Agency for Research on Cancer (IARC) as causes of oesophageal cancer.[1]

Oesophageal squamous cell carcinoma (SCC) Open a glossary item risk is around three times higher in people who chew areca nut (often included in betel quid), compared with non-users, a meta-analysis showed.[2] Oesophageal SCC risk is around 6.8 times higher in people who chew areca nut and smoke, compared with people who do neither, a meta-analysis showed.[2]

Oesophageal cancer (overall) risk is probably not associated with smokeless tobacco use in Europe and the US, a meta-analysis showed;[3] however results are mixed.[4,5]

Last reviewed:

Body fatness is classified by World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a cause of oesophageal adenocarcinoma (AC) Open a glossary item (not squamous cell carcinoma (SCC)).[1] An estimated 22% (27% in males and 11% in females) of oesophageal cancers in the UK are linked to overweight and obesity.[2]

Oesophageal AC risk is 13% higher per 5-unit body mass index (BMI) increase, a meta-analysis of case-control and cohort studies showed;[3] meta-analyses of case-control studies only show a larger effect.[4,5]

Oesophageal AC risk is 2.5 times higher in people with the highest abdominal fatness (measured by waist circumference or waist-to-hip ratio), compared with healthy abdominal fatness level, a meta-analysis showed.[6]

Last reviewed:

Oesophageal  squamous cell carcinoma (SCC) Open a glossary item risk may be decreased with higher body mass index (BMI), meta-analyses have shown; however this may reflect confounding by smoking.[1,2]

Last reviewed:

Consumption of alcoholic beverages (and acetaldehyde associated with this) is classified by the International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a cause of oesophageal cancer.[1,2] An estimated 21% (25% in males and 11% in females) of oesophageal cancers in the UK are linked to drinking alcohol.[3]

Oesophageal adenocarcinoma (AC) Open a glossary item risk is not associated with alcohol drinking overall (versus not drinking), drink-years (one drink year is e.g. one alcoholic drink per day for one year, or 2 drinks per day for half a year) or number of alcoholic drinks consumed per day, meta-analyses have shown.[4,5]

Last reviewed:

Oesophageal squamous cell carcinoma (SCC) Open a glossary item risk is 30-38% higher in people who consume around 1-1.5 units of alcohol per day, 2.6 times higher in those who consume around 1.5-6 units of alcohol per day, and 5.5 times higher in those who consume 6+ units of alcohol per day, compared with never-drinkers, meta-analyses have shown.[1,2] The risk increase is independent of, but compounded by, smoking.[3]

Oesophageal SCC risk is 3.8 times higher in smokers with 200+ drink-years, compared with never-drinkers, a meta-analysis showed; risk increases with number of drink-years.[3]

Oesophageal cancer risk is no higher in ex-drinkers who quit 16.5 years previously compared with never-drinkers, a pooled analysis showed.[4]

Smoking and alcohol have a synergistic effect on oesophageal SCC risk.

Last reviewed:

Non-starchy vegetables, fruits, dietary beta-carotene and dietary vitamin C are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as probably protective against oesophageal cancer.[1]

Consumption of red meat is classified by WCRF/AICR as a possible cause of oesophageal cancer, based on limited evidence.[1,2]

Oesophageal squamous cell carcinoma (SCC) risk is 57% higher in people with the highest red meat intake, compared with those with the lowest, a meta-analysis showed.[3]

Last reviewed:

Consumption of processed meat is classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a possible cause of oesophageal cancer, based on limited evidence.[1

Oesophageal squamous cell carcinoma (SCC)  risk is 55% higher in people with the highest processed meat intake, compared with those with the lowest, a meta-analysis showed.[2]

Last reviewed:

Consumption of hot maté (a south American drink) is classified by the International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a probable cause of oesophageal cancer, based on limited evidence.[1]

Oesophageal squamous cell carcinoma (SCC) risk is 2.6 times higher in maté ever-drinkers versus never-drinkers, a meta-analysis showed.[2] However, a pooled analysis of case-control studies found the risk increase was only 60%.[3]

Oesophageal SCC risk is higher in those with higher maté intake, and those who drink maté at higher temperatures.[2-4]

Last reviewed:

Consumption of high-temperature drinks is classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a possible cause of oesophageal cancer, based on limited evidence.[1

Oesophageal cancer (overall) risk is higher in people who consume tea, coffee, other drinks or food at higher temperatures, a systematic review showed.[2]

Last reviewed:

Consumption of pickled vegetables (traditional Asian style) is classified by the International Agency for Research on Cancer (IARC) as a probable cause of oesophageal cancer, based on limited evidence.[1,2]

Oesophageal cancer (overall) risk is around doubled in people who consume pickled vegetables, compared with those who do not, a meta-analysis showed; most evidence is for squamous cell carcinoma (SCC).[3]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Accessed July 2014.
  2. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  3. Islami F, Boffetta P, Ren JS, Pedoeim L, Khatib D, Kamangar F. Pickled vegetables and the risk of oesophageal cancer: a meta-analysis. Br J Cancer 2009;101(9):1641-7.
Last reviewed:

Oesophageal adenocarcinoma (AC) Open a glossary item risk is more than 11 times higher in people with Barrett’s oesophagus (BO) Open a glossary item versus the general population, a cohort study showed.[1] Oesophageal AC develops in around 1 per 1,000 BO patients per year, cohort studies have shown.[1,2] on the basis of these risk levels 3-10% of people with Barrett’s oesophagus in the UK will develop oesophageal AC in their lifetime.[3] However, previous studies estimate a much higher risk of around 1 oesophageal AC case per 160-190 BO patients per year.[4,5] on the basis of these risk levels 7-13% of people with Barrett’s oesophagus in the UK will develop oesophageal AC in their lifetime.[3]

Oesophageal AC risk among BO patients increases with BO extent (higher in long-segment than short-segment) and severity (progressively higher through non-dysplastic[4,6] low-grade dysplastic or high-grade dysplastic).Oesophageal AC risk among BO patients may be higher in males than females, and in smokers than non-smokers.[7]

Risk of oesophageal AC or BO with high-grade dysplasia, among BO patients, is 71% lower in those using proton pump inhibitors (PPIs), and 36% lower in those using cyclooxygenase (COX) inhibitors, versus non-users, meta-analyses have shown.[8,9] The risk reduction with PPI use may be greater in, or limited to, longer-term use.[8] Oesophageal AC risk among BO patients is 36% lower in non-steroidal anti-inflammatory drugs (NSAIDs) users versus non-users, and 41-47% lower in statin users, both compared with non-users, meta-analyses have shown.[10-13] The risk reduction with statins may be limited to those with high-grade dysplasia and may be confounded by NSAIDs use.[14]

References

  1. Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett's esophagus. N Engl J Med 2011;365(15):1375-83.
  2. Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011;103(13):1049-57.
  3. Gatenby P, Caygill C, Wall C, et al. Lifetime risk of esophageal adenocarcinoma in patients with Barrett's esophagus. World J Gastroenterol 2014;20(28):9611-7.
  4. Yousef F, Cardwell C, Cantwell MM, Galway K, Johnston BT, Murray L. The incidence of esophageal cancer and high-grade dysplasia in Barrett's esophagus: a systematic review and meta-analysis. Am J Epidemiol 2008;168(3):237-49.
  5. Sikkema M, de Jonge PJ, Steyerberg EW, Kuipers EJ. Risk of esophageal adenocarcinoma and mortality in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010;8(3):235-44.
  6. Desai TK, Krishnan K, Samala N, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis. Gut 2012;61(7):970-6.
  7. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut 2014;63(1):7-42.
  8. Singh S, Garg SK, Singh PP, Iyer PG, El-Serag HB. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis. Gut 2014;63(8):1229-37.
  9. Zhang S, Zhang XQ, Ding XW, et al. Cyclooxygenase inhibitors use is associated with reduced risk of esophageal adenocarcinoma in patients with Barrett's esophagus: a meta-analysis. Br J Cancer 2014;110(9):2378-88.
  10. Wang F, Lv ZS, Fu YK. Nonsteroidal anti-inflammatory drugs and esophageal inflammation - Barrett's esophagus - adenocarcinoma sequence: a meta-analysis. Dis Esophagus 2010.
  11. Singh S, Singh AG, Singh PP, et al. Statins are associated with reduced risk of esophageal cancer, particularly in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013;11(6):620-9.
  12. Beales IL, Hensley A, Loke Y. Reduced esophageal cancer incidence in statin users, particularly with cyclo-oxygenase inhibition. World J Gastrointest Pharmacol Ther 2013;4(3):69-79.
  13. Alexandre L, Clark AB, Cheong E, et al. Systematic review: potential preventive effects of statins against oesophageal adenocarcinoma. Aliment Pharmacol Ther 2012;36(4):301-11.
  14. Kantor ED, Onstad L, Blount PL, et al. Use of statin medications and risk of esophageal adenocarcinoma in persons with Barrett's esophagus. Cancer Epidemiol Biomarkers Prev 2012;21(3):456-61.
Last reviewed:

Up to 1.6% of the adult population may have BO, small cross-sectional studies suggest.[1] Because BO prevalence appears to be low, population screening is not recommended.[1] However regular endoscopic surveillance for BO patients is recommended.[1]

Oesophageal squamous cell carcinoma (SCC) risk is not associated with BO.

Last reviewed:

Barrett’s oesophagus (BO) risk is higher in males, older people, white people, and those with a history of reflux.[1,2] BO risk is also higher in ever-smokers,[3] people with higher waist circumference,[4,5] people with hiatal hernia,[6] and people with low fibre intake.[7] BO risk may be lower in people with H. Pylori infection, but evidence is mixed.[8,9]

References

  1. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut 2014;63(1):7-42.
  2. Winberg H, Lindblad M, Lagergren J, et al. Risk factors and chemoprevention in Barrett's esophagus--an update. Scand J Gastroenterol 2012;47(4):397-406.
  3. Andrici J, Cox MR, Eslick GD. Cigarette smoking and the risk of Barrett's esophagus: a systematic review and meta-analysis. J Gastroenterol Hepatol 2013;28(8):1258-73.
  4. Kubo A, Cook MB, Shaheen NJ, et al. Sex-specific associations between body mass index, waist circumference and the risk of Barrett's oesophagus: a pooled analysis from the international BEACON consortium. Gut 2013;62(12):1684-91.
  5. Singh S, Sharma AN, Murad MH, et al. Body mass index in relation to oesophageal and oesophagogastric junction adenocarcinomas: a pooled analysis from the International BEACON Consortium. Clin Gastroenterol Hepatol 2013;11(11):1399-1412.e7.
  6. Andrici J, Tio M, Cox MR et al. Hiatal hernia and the risk of Barrett's esophagus. J Gastroenterol Hepatol 2013;28(3):415-31
  7. Sun L, Zhang Z, Xu J, et al. Dietary Fiber Intake Reduces Risk for Barrett's Esophagus and Esophageal Cancer. Crit Rev Food Sci Nutr. 2015 13:0.
  8. Fischbach LA, Nordenstedt H, Kramer JR, et al. The association between Barrett's esophagus and Helicobacter pylori infection: a meta-analysis. Helicobacter 2012;17(3):163-75.
  9. Wang C, Yuan Y, Hunt RH. Helicobacter pylori infection and Barrett's esophagus: a systematic review and meta-analysis. Am J Gastroenterol 2009;104(2):492-500.
Last reviewed:

Oesophageal adenocarcinoma (AC) Open a glossary item risk is 4.9 times higher in people who have gastro-oesophageal reflux disease (GORD, or GERD in American English spelling) symptoms at least weekly, versus people who have GORD symptoms less frequently or never, a meta-analysis showed.[1] Oesophageal AC risk is 7.4 times higher in people who have GORD symptoms daily, versus people who have GORD symptoms less frequently or never, a meta-analysis showed.[1]

Oesophageal AC risk is 2.8 times higher in people who have had GORD symptoms for under 10 years, and 6.2 times higher in those who have had GORD symptoms for 20 years or more, both versus people who have never had GORD symptoms, a pooled analysis showed.[2]

Barrett’s oesophagus (BO) develops in 5-13% of people with GORD.[3] Long-segment BO risk is 3-4.9 times higher in people with GORD symptoms, versus people without GORD symptoms, a meta-analysis showed.[4] Short-segment BO risk is probably not associated with GORD, but results are mixed.[4]

Around 15% of people in Europe have GORD, a systematic review showed.[5]

Last reviewed:

Oesophageal squamous cell carcinoma (SCC) risk is 94% higher in people with gastric atrophy Open a glossary item versus those without, a meta-analysis showed. Oesophageal adenocarcinoma (AC) risk is not associated with gastric atrophy.[1]

Last reviewed:

Oesophageal cancer (overall) risk is 28% higher in diabetic men compared with non-diabetic men, a meta-analysis showed.[1] Oesophageal cancer risk in women is not associated with diabetes, a meta-analysis showed.[1] The association with diabetes may be stronger for oesophageal adenocarcinoma (AC).[1]

Oesophageal cancer (overall) risk in diabetics is probably not associated with diabetes treatment type, a case-control study showed.[2]

References

  1. Huang W, Ren H, Ben Q, Cai Q, Zhu W, Li Z. Risk of esophageal cancer in diabetes mellitus: a meta-analysis of observational studies. Cancer Causes Control 2012;23(2):263-72.
  2. Becker C, Meier CR, Jick SS, et al. Case-control analysis on metformin and cancer of the esophagus. Cancer Causes Control 2013;24(10):1763-70.
Last reviewed:

Oesophageal adenocarcinoma (AC) risk may be higher in people hospitalised with asthma, cohort studies suggest.[1] Risk is 55% higher in theophylline (an asthma medication) users compared with non-users, a meta-analysis showed.[2] Asthma is associated with gastro-oesophageal reflux disease (GORD),[3] this may be because theophylline relaxes the oesophageal sphincter so can cause or exacerbate reflux.[2]

References

  1. Ji J, Shu X, Li X, Sundquist K, Sundquist J, Hemminki K. Cancer risk in hospitalised asthma patients. Br J Cancer 2009;100(5):829-33.
  2. Alexandre L, Broughton T, Loke Y, Beales IL. Meta-analysis: risk of esophageal adenocarcinoma with medications which relax the lower esophageal sphincter. Dis Esophagus 2012;25(6):535-44.
  3. Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut 2007;56(12):1654-64.
Last reviewed:

Oesophageal cancer risk is higher in people with achalasia,[1] coeliac disease Open a glossary item[2], or Plummer-Vinson syndrome.[3]

Last reviewed:

Oesophageal cancer (overall) risk is 74% higher in bisphosphonate users compared with non-users, one meta-analysis showed;[1] however previous meta-analyses showed no association.[2,3] The risk increase may be higher in/limited to long-term use, and Etidronate (not Aledronate).[1]

Last reviewed:

Oesophageal adenocarcinoma (AC) risk is 66% higher in anticholinergics users compared with non-users, a meta-analysis showed.[1] Anticholinergics relax the oesophageal sphincter so can cause or exacerbate reflux.

Oesophageal  squamous cell carcinoma (SCC)  risk is not associated with anticholinergics use.[1]

Last reviewed:

X-radiation and Gamma radiation are classified by the International Agency for Research on Cancer (IARC) as causes of oesophageal cancer.[1] An estimated 3% (2% in males and 4% in females) of oesophageal cancers in the UK are linked to ionising radiation, mainly radiotherapy for previous cancer.[2]

Oesophageal cancer (overall) associated with radiotherapy for previous cancer occurs in survivors of breast (though evidence is mixed[3]), lung, oropharyngeal and laryngeal cancers.[4]

Oesophageal cancer accounts for an estimated 46% of radiotherapy-attributable second cancers in breast cancer survivors in the UK.[4]

Last reviewed:

Oesophageal cancer (overall) risk is higher in survivors of Hodgkin lymphoma (5.2 times higher), larynx cancer (3.2 times higher), oral cavity and pharynx cancer (2.2 times higher), female breast cancer (2.1 times higher), lung cancer (80% higher), non-Hodgkin lymphoma (98% higher), testicular cancer (95% higher), or cervical cancer (37% higher), 10 or more years after their primary cancer, a pooled analysis showed.[1]

Oesophageal cancer secondary to another cancer is typically squamous cell carcinoma (SCC), though the SCC proportion varies by site of the primary cancer.[1]

This may reflect the effect of treatment for the primary cancer, or shared lifestyle, environmental or genetic risk factors.

Last reviewed:

Working in dry-cleaning (entailing exposure to tetrachloroethylene [PCE] and trichloroethylene [TCE]), or the rubber production industry, are classified by the International Agency for Research on Cancer (IARC) as probable causes of oesophageal cancer, based on limited evidence.[1,2] An estimated 3% (3% in males and 1% in females) of oesophageal cancers in the UK are linked to occupational exposures to soots or tetrachloroethylene.[3,4]

Oesophageal adenocarcinoma (AC) risk is not associated with occupational TCE exposure, a pooled analysis showed.[5]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Accessed July 2014.
  2. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  3. Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer 2011;105(S2):S77-S81.
  4. Bevan R, Young C, Holmes P, et al. Occupational cancer in Britain. Gastrointestinal cancers: liver, oesophagus, pancreas and stomach. Br J Cancer 2012;107 Suppl 1:S33-40.
  5. Hansen J, Sallmén M, Seldén AI, et al. Risk of cancer among workers exposed to trichloroethylene: analysis of three Nordic cohort studies. J Natl Cancer Inst 2013;105(12):869-77.
Last reviewed:

Oesophageal adenocarcinoma (AC) risk is 3.5 times higher in people with a parent diagnosed with oesophageal cancer (overall), a cohort study showed.[1] The risk may be higher in people with an affected mother, and in people with a parent with squamous cell carcinoma (SCC).[1]

Oesophageal SCC risk is not associated with oesophageal cancer in a parent.[1]

Around 7% of people with Barrett’s oesophagus (BO) have a first-degree relative (parent, sibling, or child) with BO or oesophageal AC, a cohort study showed.[2]

Oesophageal cancer risk is higher in people whose spouse has/had upper aerodigestive tract cancer, perhaps indicating a role for shared behavioural risk factors such as smoking in familial clustering of oesophageal cancer.[3]

References

  1. Ji J, Hemminki K. Familial risk for esophageal cancer: an updated epidemiologic study from Sweden. Clin Gastroenterol Hepatol 2006;4(7):840-5.
  2. Verbeek RE, Spittuler LF, Peute A, et al. Familial Clustering of Barrett's Esophagus and Esophageal Adenocarcinoma in a European Cohort. Clin Gastroenterol Hepatol 2014.
  3. Weires M, Bermejo JL, Sundquist J, et al. Clustering of concordant and discordant cancer types in Swedish couples is rare. Eur J Cancer 2011;47(1):98-106.
Last reviewed:

Oesophageal adenocarcinoma (AC) risk is 25-32% lower in hormone replacement therapy (HRT) Open a glossary item ever-users compared with never-users, meta-analyses have shown.[1,2]

Oesophageal cancer (overall) risk is not associated with HRT use, a pooled analysis of case-control studies showed.[3]

Last reviewed:

Oesophageal cancer (overall) risk is 58% lower in mothers who breastfed for at least 12 months, compared with mothers who did not breastfeed at all, a pooled analysis showed.[1]

Last reviewed:

Oesophageal cancer (overall) risk is 69% higher in people with AIDS Open a glossary item, compared with uninfected people or the general population, a pooled analysis showed.[1]

The risk increase is greater for oesophageal adenocarcinoma (AC) (91% higher risk) than for oesophageal squamous cell carcinoma (SCC) (47% higher risk), pooled analyses have shown.[1]

Oesophageal cancer risk overall is not associated with HIV infection in the absence of AIDS, or HIV and AIDS combined, meta- and pooled analyses have shown.[1,2]

References

  1. Persson EC, Shiels MS, Dawsey SM, Bhatia K, Anderson LA, Engels EA.Increased risk of stomach and esophageal malignancies in people with AIDS. Gastroenterology 2012;143(4):943-950.e2.
  2. Shiels MS, Cole SR, Kirk GD, Poole C. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 2009;52(5):611-22.
Last reviewed:

Oesophageal squamous cell carcinoma (SCC) risk is 2.4-3.6 times higher in people with HPV-16 infection, compared with uninfected people, meta-analyses have shown.[1,2]

Oesophageal SCC risk is not associated with HPV-18 infection.[1]

Last reviewed:

Oesophageal cancer (overall) risk may be higher in recipients of solid organ transplant or stem cell transplant, compared with the general population;[1-3] however the size of the risk increase varies widely, and some studies show no association.[4]

Last reviewed:

Non-starchy vegetables, fruits, dietary beta-carotene and dietary vitamin C are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as probably protective against oesophageal cancer.[1] An estimated 46% of oesophageal cancers in the UK are linked to eating fewer than five portions of fruit and vegetables per day.[2]

Dietary fibre, dietary folate, dietary vitamin B6 and dietary vitamin E3 are classified by WCRF/AICR as possibly protective against oesophageal cancer, based on limited evidence.[1]

Oesophageal cancer risk is lower in people with the highest intake of the following foods, versus those with the lowest intake, meta- and pooled analyses or systematic reviews have shown:

  • Vegetables (oesophageal adenocarcinoma (AC)) – 24% lower risk.[3]
  • Vegetables (oesophageal squamous cell carcinoma (SCC)) – 44% lower risk.[4]
  • Fruit (oesophageal AC) – 27% lower risk.[3]
  • Fruit (oesophageal SCC) – 47% lower risk.[4]
  • Citrus fruit (oesophageal SCC) – 37% lower risk. [5]
  • Dietary folate (oesophageal AC) – 43% lower risk.[6]
  • Dietary/blood folate (oesophageal SCC) – 37% lower risk.[6]
  • Dietary fibre (oesophageal AC) – 50% lower risk.[7]
  • Dietary fibre (oesophageal SCC) – 47% lower risk.[7]
  • Dietary carotenoids – 19-42% lower risk (some evidence of variation by oesophageal cancer type and population).[8]

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  2. Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer 2011;105(S2):S77-S81.
  3. Li B, Jiang G, Zhang G, et al. Intake of vegetables and fruit and risk of esophageal adenocarcinoma: a meta-analysis of observational studies. Eur J Nutr 2014.
  4. Liu J, Wang J, Leng Y, et al. Intake of fruit and vegetables and risk of esophageal squamous cell carcinoma: a meta-analysis of observational studies. Int J Cancer 2013;133(2):473-85.
  5. Wang A, Zhu C, Fu L, et al. Citrus Fruit Intake Substantially Reduces the Risk of Esophageal Cancer: A Meta-Analysis of Epidemiologic Studies. Medicine (Baltimore). 2015;94(39):e1390.
  6. Tio M, Andrici J, Cox MR, et al. Folate intake and the risk of upper gastrointestinal cancers: a systematic review and meta-analysis. J Gastroenterol Hepatol 2014;29(2):250-8.
  7. Sun L, Zhang Z, Xu J, et al. Dietary Fiber Intake Reduces Risk for Barrett's Esophagus and Esophageal Cancer. Crit Rev Food Sci Nutr. 2015,13:0.
  8. Ge XX, Xing MY, Yu LF, et al. Carotenoid intake and esophageal cancer risk: a meta-analysis. Asian Pac J Cancer Prev 2013;14(3):1911-8.
Last reviewed:

Oesophageal cancer risk is lower in people who use the following medications or have the following medical conditions, compared with people who do not, meta- and pooled analyses, systematic reviews or large cohort studies have shown:

  • Aspirin (oesophageal adenocarcinoma (AC)) – 25% lower risk in twice-weekly users versus non-users (risk reduction plateaus at use 4.5 times per week).[1]
  • Aspirin (oesophageal AC) – 47% lower risk in users of 3 years versus non-users (risk reduction plateaus at 6 years use).[1]
  • Aspirin (oesophageal squamous cell carcinoma (SCC)) – 39% lower in regular users versus never-users.[2]
  • Non-aspirin non-steroidal anti-inflammatory drugs (NA-NSAIDs) (oesophageal AC) – 32-35% lower risk in ever-users versus non-users.[3,4]
  • NA-NSAIDs (oesophageal SCC) – risk around halved in ever-users versus non-users.[5]
  • Statins (oesophageal cancer overall) – 14-28% lower in users versus non-users.[6-8]
  • Nitrates (oesophageal SCC) – risk lower in users versus non-users.[9]
  • Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (oesophageal cancer overall) – risk lower in users versus non-users.[10]
  • Parkinson’s disease – 15% lower risk in people with the condition versus those without (probably linked with lower smoking rates in people with Parkinson’s disease).[11]

References

  1. Xiaohua Y, Zhenjiang Y, Weidong L, Pengcheng X, Sidong C. The non-linear threshold association between aspirin use and esophageal adenocarcinoma: results of a dose-response meta-analysis. Pharmacoepidemiol Drug Saf 2014;23(3):278-84.
  2. Bosetti C, Rosato V, Gallus S, Cuzick J, La Vecchia C. Aspirin and cancer risk: a quantitative review to 2011. Ann Oncol 2012;23(6):1403-15.
  3. Liao LM, Vaughan TL, Corley DA, et al. Nonsteroidal anti-inflammatory drug use reduces risk of adenocarcinomas of the esophagus and esophagogastric junction in a pooled analysis. Gastroenterology 2012;142(3):442-452.
  4. Abnet CC, Freedman ND, Kamangar F, Leitzmann MF, Hollenbeck AR, Schatzkin A. Non-steroidal anti-inflammatory drugs and risk of gastric and oesophageal adenocarcinomas: results from a cohort study and a meta-analysis. Gastroenterology Br J Cancer 2009;100(3):551-7.
  5. Sun L, Yu S. Meta-analysis: non-steroidal anti-inflammatory drug use and the risk of esophageal squamous cell carcinoma. Dis Esophagus 2011;24(8):544-9.
  6. Singh S, Singh AG, Singh PP, et al. Statins are associated with reduced risk of esophageal cancer, particularly in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013;11(6):620-9.
  7. Beales IL, Hensley A, Loke Y. Reduced esophageal cancer incidence in statin users, particularly with cyclo-oxygenase inhibition. World J Gastrointest Pharmacol Ther 2013;4(3):69-79.
  8. Alexandre L, Clark AB, Cheong E, et al. Systematic review: potential preventive effects of statins against oesophageal adenocarcinoma. Aliment Pharmacol Ther 2012;36(4):301-11.
  9. Alexandre L, Broughton T, Loke Y, Beales IL. Meta-analysis: risk of esophageal adenocarcinoma with medications which relax the lower esophageal sphincter. Dis Esophagus 2012;25(6):535-44.
  10. Yoon C, Yang HS, Jeon I, Chang Y, Park SM. Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers and cancer risk: a meta-analysis of observational studies. CMAJ 2011;183(14):E1073-84.
  11. Ong EL, Goldacre R, Goldacre M. Differential risks of cancer types in people with Parkinson's disease: a national record-linkage study. Eur J Cancer 2014;50(14):2456-62.
Last reviewed:

Oesophageal adenocarcinoma (AC) risk is 21-32% lower in the most physically active people compared with the least, meta-analyses have shown.[1,2] Oesophageal squamous cell carcinoma (SCC) risk is 34% lower in the most physically active people compared with the least, one meta-analysis showed;[1] however another meta-analysis showed no association.[2]

Last reviewed:

Oesophageal adenocarcinoma (AC) risk is 41-43% lower in people with H. Pylori infection, compared with uninfected people, meta-analyses have shown.[1,2] This may be linked with lower gastric acid levels in H. pylori infection.[2]

Oesophageal squamous cell carcinoma (SCC) risk is overall not associated with H. Pylori infection, meta-analyses have shown, though this varies by H. Pylori type and population.[1,2]

Last reviewed:

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) make no judgement on the association between oesophageal cancer risk and intake of cereals (grains) and their products; starchy roots, tubers, and plantains; pulses (legumes); soya and soya products; herbs, spices, and condiments; poultry; fish; eggs; milk and dairy products; total fat; saturated fatty acids; monounsaturated fatty acids; polyunsaturated fatty acids; sugary foods and drinks; salt; salting; fermenting; pickling; smoked and cured foods; nitrates and nitrites; frying; grilling (broiling) and barbecuing (charbroiling); protein; vitamin A; retinol; thiamin; riboflavin; calcium; iron; zinc; pro-vitamin A carotenoids; beta-cryptoxanthin; Seventh-day Adventist diets; adult attained height; or energy intake, due to limited evidence.[1]

Oesophageal cancer risk is not associated with the following factors, meta- and pooled analyses or systematic reviews have shown:

  • Zinc intake (though some evidence of risk decrease limited to Asian populations).[2]
  • Dietary fibre (oesophageal squamous cell carcinoma (SCC)).[3]
  • Green tea (though some evidence of risk decrease limited to Asian populations, case-control studies, females).[4,5]
  • Black tea.[4]
  • Coffee.[4,6] (though some evidence of risk decrease[7])
  • Fish (though some evidence of SCC risk decrease limited to hospital-based case-control studies).[8]
  • Red and processed meat (oesophageal AC) (though some evidence of risk increase limited to case-control studies).[9] Note red and processed meat intake is associated with oesophageal SCC risk.
  • Parity (oesophageal cancer overall).[10]
  • Age at menarche (oesophageal cancer overall).[10]
  • Age at menopause (oesophageal cancer overall).[10]
  • Oral contraceptives (AC alone,[11] and oesophageal cancer overall).[10]
  • Gallstones.[12]
  • Dietary acrylamide (though risk increase for obese people).[13]
  • Vitamin D supplements.[14]
  • Allium vegetables.[15]

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  2. Li P, Xu J, Shi Y, et al. Association between zinc intake and risk of digestive tract cancers: a systematic review and meta-analysis. Clin Nutr 2014;33(3):415-20.
  3. Coleman HG, Murray LJ, Hicks B, et al. Dietary fiber and the risk of precancerous lesions and cancer of the esophagus: a systematic review and meta-analysis. Nutr Rev 2013;71(7):474-82.
  4. Zheng JS, Yang J, Fu YQ, Huang T, Huang YJ, Li D. Effects of green tea, black tea, and coffee consumption on the risk of esophageal cancer: a systematic review and meta-analysis of observational studies. Nutr Cancer 2013;65(1):1-16.
  5. Zheng P, Zheng HM, Deng XM, Zhang YD. Green tea consumption and risk of esophageal cancer: a meta-analysis of epidemiologic studies. BMC Gastroenterol 2012;12:165.
  6. Yu X, Bao Z, Zou J, Dong J. Coffee consumption and risk of cancers: a meta-analysis of cohort studies. BMC Cancer 2011;11:96.
  7. Han YJ, Li J, Huang W, Fang Y, Xiao LN, Liao ZE. Fish consumption and risk of esophageal cancer and its subtypes: a systematic review and meta-analysis of observational studies. Eur J Clin Nutr 2013;67(2):147-54.
  8. Huang W, Han Y, Xu J, Zhu W, Li Z. Red and processed meat intake and risk of esophageal adenocarcinoma: a meta-analysis of observational studies. Cancer Causes Control 2013;24(1):193-201.
  9. Cronin-Fenton DP, Murray LJ, Whiteman DC, et al. Reproductive and sex hormonal factors and oesophageal and gastric junction adenocarcinoma: a pooled analysis. Eur J Cancer 2010;46(11):2067-76.
  10. Lagergren K, Lagergren J, Brusselaers N. Hormone replacement therapy and oral contraceptives and risk of oesophageal adenocarcinoma: A systematic review and meta-analysis. Int J Cancer 2014.
  11. Tavani A, Rosato V, Di Palma F, et al. Red and processed meat intake and risk of esophageal adenocarcinoma: a meta-analysis of observational studies. Ann Oncol 2012;23(8):2173-8.
  12. Pelucchi C, La Vecchia C, Bosetti C, Boyle P, Boffetta P. Exposure to acrylamide and human cancer--a review and meta-analysis of epidemiologic studies. Ann Oncol 2011;22(7):1487-99.
  13. Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev 2014;6:CD007469.
  14. Guercio V, Turati F, La Vecchia C, et al. Allium vegetables and upper aerodigestive tract cancers: a meta-analysis of observational studies. Mol Nutr Food Res. 2016;60(1):212-22.
Last reviewed:

Cancer Statistics Explained

See information and explanations on terminology used for statistics and reporting of cancer, and the methods used to calculate some of our statistics.

Citation

You are welcome to reuse this Cancer Research UK statistics content for your own work.

Credit us as authors by referencing Cancer Research UK as the primary source. Suggested styles are:

Web content: Cancer Research UK, full URL of the page, Accessed [month] [year]. 

Publications: Cancer Research UK ([year of publication]), Name of publication, Cancer Research UK. 

Rate this page:

Currently rated: 4 out of 5 based on 3 votes
Thank you!
We've recently made some changes to the site, tell us what you think

Share this page