Factors such as obesity, tobacco consumption, and older age can increase the risk of developing esophageal cancer. Some risk factors are within a person’s control, while others are not.

Esophageal cancer starts in the esophagus, a muscular tube that moves food from the mouth down to the stomach. The two main types of esophageal cancer are adenocarcinoma and squamous cell carcinoma.

Cancers develop when the DNA in cells changes. Doctors are unsure what causes gene mutations in people with esophageal cancer, but people can inherit some gene mutations. Other factors can also increase a person’s risk of esophageal cancer.

This article outlines the risk factors for esophageal cancer. It also explains the difference between modifiable and unmodifiable risk factors.

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A “risk factor” is anything that increases a person’s chance of developing a health condition. There are two types of risk factors:

  • Modifiable risk factors: Some risk factors are modifiable because, theoretically, people can adapt their behavior to change them. For example, obesity is a modifiable risk factor because people can lose weight by changing their eating habits and exercising regularly.
  • Nonmodifiable risk factors: Nonmodifiable risk factors are beyond a person’s control, and experts do not know how to change them. For example, age is a nonmodifiable risk factor for esophageal cancer, as people cannot control it.

The following sections outline modifiable and nonmodifiable risk factors for esophageal cancer.

Learn more about esophageal cancer.

The risk of developing esophageal cancer increases with age. The condition is more common in people aged 65 years and above. A systematic review of studies from 2021 reports that the most common age for esophageal cancer diagnosis is 70–79 years. Among patients diagnosed with the condition, 33% are over 75 years at diagnosis, and 8% are over 85 years.

Males are more likely to develop esophageal cancer than females. According to the American Cancer Society, about 1 in 125 males in the United States will develop esophageal cancer in their lifetime, while about 1 in 417 females will develop it.

Higher tobacco and alcohol use among males may increase their risk and explain the disparity.

Tobacco and alcohol consumption can increase the risk of esophageal cancer. The risk is higher for people who use both alcohol and tobacco.

According to the American Society for Clinical Oncology, light alcohol drinkers are about 1.3 times more likely than nondrinkers to develop cancer. Those who drink heavily are nearly 5 times more likely.

The American Cancer Society (ACS) notes that people who smoke a pack of cigarettes or more per day are at least twice as likely to get esophageal cancer as nonsmokers.

GERD occurs when the acid-containing contents of the stomach repeatedly flow back into the esophagus, a symptom called acid reflux. Chronic GERD can increase the risk of developing esophageal adenocarcinoma, a common form of esophageal cancer.

However, GERD is a common condition, and most people with it will not develop esophageal cancer.

Learn more about GERD.

GERD is linked to an increased risk of developing Barrett‘s esophagus. Barrett’s esophagus occurs when squamous cells — the flat, thin cells that line the esophagus — get damaged and change into another type of cell. This may happen due to constant acid reflux.

Compared with people without the condition, those with Barrett’s esophagus are more likely to develop esophageal adenocarcinoma.

Learn more about Barrett’s esophagus.

People with overweight or obesity have an increased risk of developing esophageal cancer. According to a 2020 study, this may partly be because people with obesity are more likely to have other risk factors, such as GERD.

Research indicates that certain foods, such as processed meat or meat cured with nitrate, can form carcinogens that increase the risk of developing different types of cancer.

Frequently drinking very hot drinks may damage the lining of the esophagus and increase the risk of esophageal squamous cell carcinoma (ESCC).

For some people, a sedentary lifestyle can cause weight gain, which is a risk factor for esophageal cancer. Also, evidence indicates that being more physically active can reduce the risk of developing esophageal adenocarcinoma.

This rare disorder causes impaired relaxation of the lower part of the esophagus, making it difficult to swallow food. People with achalasia may develop esophageal cancer about 15–20 years after symptoms begin.

Learn more about esophageal achalasia.

Tylosis is an extremely rare inherited condition that causes the skin on the hands and feet to thicken, often due to a gene mutation. Tylosis also causes small groCE wths to form in the esophagus and is associated with a significant risk of developing ESCC.

Accidentally drinking lye, a chemical ingredient in many household cleaners, can burn the esophagus. As the injury heals, the scar tissue may cause a narrowing of the esophagus, increasing the risk of developing ESCC years after the injury.

Plummer-Vinson syndrome is a rare condition that causes iron deficiency anemia, webs in the upper part of the esophagus, and difficulty swallowing.

The web in the esophagus is a thin piece of tissue extending from the inner part of the esophagus, causing narrowing. This condition can increase the risk of developing esophageal cancer.

Evidence indicates an association between HPV and cancers such as anal, throat, and cervical cancers. It may also play a role in esophageal cancer, but more research is necessary to confirm this.

Learn more about HPV.

People with a history of other cancers, such as mouth, throat, or lung cancer, have a higher risk of developing ESCC. This may be because these cancers share common risk factors, such as smoking.

People can reduce their risk of esophageal cancer by:

  • adopting a healthy eating pattern
  • achieving and maintaining a moderate weight
  • being physically active
  • quitting or reducing tobacco and alcohol consumption
  • getting treatment for medical conditions, such as GERD and Barrett’s esophagus

Esophageal cancer is more common in older adults and males. Physical inactivity, a family history of cancer, and underlying medical conditions such as GERD are also risk factors for esophageal cancer.

Making healthy lifestyle choices can help reduce the risk of developing the condition.