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A risk factor is something that increases your chance of getting a disease or condition.

It is possible to develop esophageal cancer with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing esophageal cancer. If you have a number of risk factors, ask your healthcare provider what you can do to reduce your risk.

Risk factors for esophageal cancer include the following:

Alcohol intake greatly increases your risk of esophageal cancer, depending upon the strength of the drink (beer less, whiskey more). Combined with smoking, the risks are multiplied.

Moderate smoking, by itself, does not greatly increase the risk of esophageal cancer, but it does promote many other diseases including several other cancers. Heavy smoking, particularly of black tobacco, a term of interest primarily to pipe smokers, at least doubles your risk of esophageal cancer.

The combined effect of heavy alcohol consumption and black-tobacco smoke has been shown to multiply the risk of esophageal cancer by a 100 fold. Moderate alcohol intake combined with moderate tobacco use (of any kind) increase the risk 10-20 fold, whereas moderate use of either of these substances by itself does not affect risk statistics.

Eating or drinking substances that can be directly damaging to the esophagus can increase the risk of esophageal cancer. Such irritants include the following:

  • Nitrosamines, which naturally occur in foods in many areas of the world where rates of esophageal cancer are high, such as Northern China
  • Drain cleaners or lye (the liquid obtained by leaching wood ashes), which may predate the development of cancer by as much as 40 years
  • Very hot beverages
  • Toxins in pickled vegetables

Exposure to other esophageal irritants can also increase your risk. These include radiation and smoked opiates, such as an opium pipe.

Certain medical conditions can increase your risk of esophageal cancer.

Gastroesophageal reflux disease (GERD)—This occurs when gastric acid, food, and liquid from the stomach chronically flow up into the esophagus. GERD causes a 40-fold increase in the risk of adenocarcinoma.

Barrett’s esophagus—Barrett’s esophagus occurs when the squamous cells in the lower esophagus are exposed to acid from the stomach due to acid reflux. The acid causes the cells to change from squamous cells, which are flat, to cells shaped like columns. These column-shaped cells are the hallmark of Barrett’s esophagus and can eventually become an adenocarcinoma.

Achalasia—This is a relatively rare disorder of the smooth muscle of the esophagus that makes it difficult for food and liquid to pass through the esophagus and into the stomach. Achalasia causes a 15-fold increase in cancer risk, most likely due to the irritation from food retained in the esophagus.

Nutrient deficiencies—Being deficient in folic acid, vitamins A and C, and riboflavin, molybdenum, and selenium increases the risk of esophageal cancer.

Obesity—Obesity is associated with a higher risk of adenocarcinoma.

Human papilloma virus (HPV) infection—HPV can cause normal cells to become abnormal. HPV infection has been linked to increased risk of several cancers. There is increasing evidence that HPV infection may play a role in esophageal cancer risk as well.


Esophageal cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated June 2, 2013. Accessed August 2, 2013.

Esophageal cancer. National Cancer Institute website. Available at: http://www.nci.nih.gov/cancerinfo/wyntk/esophagus. Accessed August 2, 2013.

Esophagus cancer. American Cancer Society website. Available at http://www.cancer.org/acs/groups/cid/documents/webcontent/003098-pdf.pdf. Accessed August 2, 2013.

1/13/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Wysowski DK. Reports of esophageal cancer with oral bisphosphonate use. N Engl J Med. 2009;360:89-90.

8/23/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Cardwell CR, Abnet CC, Cantwell MM, Murray LJ. Exposure to oral bisphosphonates and risk of esophageal cancer. JAMA. 2010;304(6):657-663.

Last reviewed August 2013 by Mohei Abouzied, MD; Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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