Esophageal Cancer On the Rise
Esophageal Cancer Risk Factors
Numerous factors increase the risk for esophageal cancer:
- Age over 60
- Male sex
- Tobacco use
- Alcohol use
- Barrett's esophagus (see below)
- History of head or neck cancer
- Frequent drinking of very hot beverages
Different risk factors are important for each type of esophageal cancer:
- Squamous cell cancers: tobacco or alcohol use increase risk the most. More
than half of these cancers are linked to tobacco. Using both tobacco and
alcohol together raises the risk far more than using either alone.
- Adenocarcinomas: A condition called Barrett's esophagus contributes to this
form of esophageal cancer. Smoking doubles the risk of adenocarcinoma, but
alcohol doesn't play a role.
Barrett's Esophagus: More Serious Than Heartburn
Acid regurgitation from the stomach into the esophagus causes heartburn and
indigestion. Nearly everyone experiences this uncomfortable sensation at some
time in life. Surveys suggest that tens of millions of Americans feel reflux
symptoms at least once a week. Doctors call this "gastroesophageal reflux
disease," or GERD.
When acid reflux occurs frequently, though, the chronic irritation
(esophagitis) can cause problems:
- The cells at the bottom of the esophagus can change form in response to the
- The new abnormal cell pattern is called Barrett's esophagus.
- People with Barrett's esophagus have a 1 in 200 chance of developing
adenocarcinoma each year, far higher than the general population.
Is a rising rate of Barrett's esophagus causing the increase in the
adenocarcinoma form of esophageal cancer? No one can say, because we can't
accurately estimate how many people have Barrett's esophagus.
Barrett's esophagus is both common and elusive:
- Approximately five to eight percent of people with GERD also have Barrett's
- However, as many as 95 percent of people with Barrett's esophagus don't
know they have it.
- About one-quarter of people with Barrett's have no reflux symptoms.
- Although well-associated with adenocarcinoma, 90 percent of people with
Barrett's esophagus will never develop esophageal cancer.
A physician can only diagnose Barrett's esophagus through upper
endoscopy. While generally safe, this procedure requires sedation,
expense, and some risk.
According to the American College of Gastroenterology, "patients with
chronic GERD symptoms are those most likely to have Barrett's esophagus and
should undergo upper endoscopy."
Bains agrees: "Clearly a certain group with chronic reflux disease are at
higher risk," and should be screened with upper endoscopy.
However, the National Cancer Institute recommends against screening
asymptomatic people with endoscopy.