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Esophageal Cancer Prevention (PDQ®): Prevention - Health Professional Information [NCI] - Summary of Evidence

Note: Separate PDQ summaries on Esophageal Cancer Screening, Esophageal Cancer Treatment, and Levels of Evidence for Cancer Screening and Prevention Studies are also available.

Squamous Cell Carcinoma

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Avoidance of tobacco and alcohol

Based on solid evidence, avoidance of tobacco and alcohol would decrease the risk of squamous cell cancer.[1]

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 twofold to sevenfold 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.

Description of the Evidence

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Fair.
  • Consistency: Multiple studies.
  • Magnitude of Effects on Health Outcomes: Large positive benefit.
  • External Validity: Fair.

Dietary factors

Based on fair evidence, diets high in cruciferous (cabbage, broccoli, cauliflower) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer.[3,4]

Description of the Evidence

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Fair.
  • Consistency: Multiple studies.
  • Direction and Magnitude of Effect: Small positive.
  • External Validity: Fair.

Aspirin and nonsteroidal anti-inflammatory drug use

Based on fair evidence, 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 (odds ratio [OR] = 0.57; 95% CI, 0.47–0.71).[5]

Description of the Evidence

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Fair.
  • Consistency: Good.
  • Magnitude of Effects on Health Outcomes: Large positive.
  • External Validity: Fair.

Based on solid evidence, harms of NSAID use include upper gastrointestinal bleeding and serious cardiovascular events such as myocardial infarction, heart failure, hemorrhagic stroke, and renal impairment.

Description of the Evidence

  • Study Design: Evidence obtained from randomized controlled trials.
  • Internal Validity: Good.
  • Consistency: Good.
  • Magnitude of Effects on Health Outcomes: Increased risk, small magnitude.
  • External Validity: Good.
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