Risk Factors for Oesophageal Cancer

Executive Summary

Risk factors influence the chance of developing cancer among individuals, but individuals with no risk factors also develop cancer. The risk factors associated with oesophageal cancer include age, race, gender, tobacco, obesity, Barrett’s oesophagus, alcohol consumption, swallowing lye, inappropriate diet and nutrition, Human papillomavirus (HPV) infection, and Achalasia. People between 45 and 70 have the highest risk of oesophageal cancer. Black people are twice as likely as white people to have the squamous cell type of oesophageal cancer. Being very overweight and having too much body fat can increase a person’s risk of developing oesophageal adenocarcinoma.

Risk Factors Associated with Oesophageal Cancer.

A risk factor can be anything that influences the development of any cancer. But having a risk factor, or many does not give certainty of having particular cancer. Some people with no risk factors can also develop cancer. 

The following factors may raise a person’s risk of developing oesophageal cancer ^​1​:

• Age: People between 45 and 70 have the highest risk of oesophagal cancer.
• Race: Black people are twice as likely as white people to have the squamous cell type of oesophagal cancer.
• Gender: Men are 3 to 4 times more likely than women to develop oesophagal cancer ^​2​.
• Tobacco: Using any form of tobacco, such as cigarettes, cigars, pipes, chewing tobacco, and snuff, raises the risk of oesophagal cancer, especially squamous cell carcinoma.
• Obesity: Being very overweight and having too much body fat can increase a person’s risk of developing oesophagal adenocarcinoma.
• Barrett’s oesophagus: This condition can develop in some people with chronic gastroesophageal reflux disease (GERD) or esophagitis inflammation of the oesophagus, even when a person does not have symptoms of chronic heartburn. Damage to the oesophagus lining causes the squamous cells in the oesophagus lining to turn into glandular tissue. People with Barrett’s oesophagus have more chances of developing adenocarcinoma of the oesophagus, but the risk of developing oesophageal cancer is still relatively low ^​3​.
• Alcohol: Heavy drinking over a long period increases the risk of squamous cell carcinoma of the oesophagus, especially when combined with tobacco use ^​4​.
• Lye: Children who have accidentally swallowed lye have a higher risk of squamous cell carcinoma. Lye can be found in a few cleaning products, like drain cleaners.
• Diet/nutrition: A diet low in fruits and vegetables and specific vitamins and minerals can increase a person’s risk of developing oesophageal cancer.
• Human papillomavirus (HPV): Researchers are investigating HPV as a risk factor for oesophageal cancer, but there is no clear connection that squamous cell oesophageal cancer is related to HPV ^​5​. Sexual activity with someone having HPV is the most common way of transmitting HPV. There are different types of HPV strains. Research links some HPV strains more strongly with some types of cancers. HPV vaccines can help prevent people from developing specific cancers. HPV is a group of more than 100 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 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 people in parts of Asia and South Africa. But signs of HPV infection have not been found in esophagus cancers from people in the other areas, including the US. HPV is a rare cause of esophageal cancer.
• Achalasia: Achalasia is a condition when the lower muscular ring of the oesophagus does not relax during the swallowing of food. Achalasia increases the chances of squamous cell carcinoma.
• 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.

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