16.3 Risk factors

Table 16.2 Risk factors for oesophageal cancer, by direction of association and strength of evidence


Increases risk

Decreases risk

Convincing or probable

Tobacco smoking1,2,3

Non-starchy vegetables6,14


Smokeless tobacco3,4




Foods containing beta-carotene6,15


Greater body fatness/higher body mass index6

Foods containing vitamin C6,16


Gastro-oesophageal reflux disease7

Helicobacter pylori infection17,18


Low socio-economic status8

Aspirin and other non-steroidal anti-inflammatory drugs19,20


Red meat6

Gastric atrophy (adenocarcinoma)13


Processed meat6


Pickled vegetables9


High temperature drinks10

Infection with human papilloma viruses (HPV)11

Occupational exposure to hexavalent chromium12


Gastric atrophy (squamous cell carcinoma)13

1 International Agency for Research on Cancer, 2004b; 2 Boffetta et al., 2008; 3 Secretan et al., 2009; 4 chewing tobacco or snuff;

5 Islami et al., 2010; 6 World Cancer Research Fund / American Institute for Cancer Research, 2007; 7 Pera et al., 2005; 8 Faggiano et al., 1997; 9 Islami et al. 2009a; 10 Islami et al., 2009b; 11 International Agency for Research on Cancer, 2007; 12 Gatto et al., 2010;

13 Islami et al., 2011; 14 International Agency for Research on Cancer, 2003; 15 beta-carotene is found in yellow, orange and green fruits and green leafy vegetables; 16 vitamin C is found in fruit, vegetables and tubers;17 Islami and Kamangar, 2008; 18 Rokkas et al., 2007; 19 Bosetti et al., 2006; 20 Abnet et al., 2009

The two main types of oesophageal cancer are squamous cell carcinoma and adenocarcinoma. Some risk factors are shared by both types, while others are involved in one type only. Tobacco smoking causes both squamous cell carcinoma and adenocarcinoma of the oesophagus (Table 16.2). Smokers have at least a two-fold higher risk than non-smokers and risk increases with number of cigarettes smoked daily and duration of smoking. Use of smokeless tobacco products (e.g. snuff, chewing tobacco) is also associated with increased disease risk. Alcohol is also causally related to oesophageal cancer and risk increases with amount consumed.

Obesity and overweight are positively associated with adenocarcinoma. In contrast, higher levels of body fatness are either unrelated to risk of squamous cell carcinoma, or associated with a decreased risk (Smith et al., 2008). A history of gastro-oesophageal reflux disease has been associated with increased risk of adenocarcinoma, but not of squamous cell carcinoma. Gastric atrophy may be positively associated with squamous cell carcinomas and negatively associated with adenocarcinoma. Infection with the Helicobacter pylori (H pylori) bacterium has been associated with reduced risk of adenocarcinoma, while infection with human papilloma virus may play a role in squamous cell carcinoma.

Various aspects of diet have been linked with oesophageal cancer risk. Higher intakes of fruit and vegetables, particularly those containing beta-carotene (yellow, orange and green fruits and green leafy vegetables) or vitamin C, probably reduce risk. Higher intakes of red or processed meat may increase risk, but the evidence is less consistent than for fruit and vegetables. Risk may also be increased in those with higher intakes of pickled vegetables, and those who prefer to consume their hot drinks at a high temperature.

Risk of oesophageal cancer is higher in those of low socio-economic status, probably reflecting variations in exposure to tobacco and other lifestyle risk factors by social class.

Building 6800
Cork Airport Business Park
Kinsale Road, Cork T12 CDF7
Email Contact us here
Tel: +353 (0) 21 4318014
Fax: +353 (0) 21 4318016

NCRI directions

Go to top