At present, it is difficult for the medical community to explain exactly what triggers esophageal cancer.
But in general, the occurrence of esophageal cancer may be related to genetics, poor lifestyle habits, and long-term exposure to adverse factors. The study of attributable risk of malignancy in China showed that 46% of the cases of esophageal cancer incidence and death could be attributed to smoking, alcohol consumption, and low intake of vegetables and fruits.
Genetic factors
Esophageal cancer is not directly inherited, but if your family has had any tumors (including esophageal cancer), your risk of developing esophageal cancer may be higher.
Studies have found that in areas of China with a high incidence of esophageal cancer (such as Lin County, Henan Province), 25% to 50% of people with esophageal cancer have had a relative in their family who has had cancer. Moreover, the incidence and mortality rate of esophageal cancer remained at a high level after residents of the high incidence areas moved to other cities.
Effect of age, gender
Men and older adults (60 years and older) are more likely to develop esophageal cancer. Epidemiological studies show that the gender ratio of esophageal cancer is about 3 to 4:1, and the high incidence age is 50 to 70 years.
Love to eat foods that are too hot and rough
People who often eat food or drinks above 65°C, food that is too hard or not chewed finely, and those who have the habit of chewing betel nut and tobacco will have chronic damage to the esophageal mucosa. Keeping such dietary habits for a long time, the repeated mucosal damage-repair-re-damage-repair process may lead to precancerous lesions of esophageal cancer.
In 2016, the World Health Organization (WHO) listed hot drinks above 65°C as a risk factor for esophageal cancer.
Low intake of fresh vegetables and fruits
Too few fresh vegetables and fruits lead to deficiencies in the intake of vitamins A, B2, and C, which are risk factors for esophageal cancer. In contrast, intake of vegetables and fruits can significantly reduce the risk of esophageal squamous carcinoma.
In addition, epidemiological surveys have shown that obesity, which is associated with eating too little fresh vegetables and fruits, is also associated with the development of esophageal cancer. And obesity-associated esophageal cancer is mainly adenocarcinoma.
Smoking, alcohol abuse
Smoking is a risk factor associated with Barrett’s esophagus, esophageal adenocarcinoma, and esophageal squamous carcinoma. Smokers are 5 times more likely to develop squamous carcinoma than nonsmokers. Also, men are at higher risk than women for smoking-induced esophageal squamous carcinoma.
Alcohol has been identified as a risk factor for esophageal squamous carcinoma. The average weekly alcohol intake of more than 170 grams is associated with a significantly increased risk of squamous carcinoma. It is important to note that drinking high levels of liquor, as well as smoking and alcohol abuse at the same time, is associated with a higher chance of developing esophageal cancer.
Nitrate or nitrite intake
Studies have found that nitrate and nitrite levels in drinking water in areas with a high incidence of esophageal cancer in northern China (mainly in the Taihang Mountains, located at the junction of Henan, Hebei, and Shanxi) are significantly higher than in areas with a low incidence of esophageal cancer, and may be an important causative factor for esophageal cancer.
Toxins from fungi or molds
Results from a study of esophageal cancer in Lin County demonstrated that local residents’ favorite sauerkraut contained high levels of mold, and that the amount of sauerkraut consumed was positively associated with the incidence of esophageal cancer.
Oral bacteria
There is a certain amount of natural bacteria in the mouth, and poor oral hygiene may lead to high bacterial growth and flora disorders that may induce serious infections. Research at NYU Langone Health Cancer Treatment Center has found that perennial lack of oral hygiene is associated with an increased incidence of esophageal cancer. Among these, the periodontal pathogen, tannerella forsythia, was associated with a higher risk of esophageal adenocarcinoma (21% increase); another causative agent, porphyromonas gingivalis ( porphyromonas gingivalis) is associated with a higher risk of esophageal squamous carcinoma.
But the researchers specifically emphasized that this finding only proves that the presence of such oral bacteria may have some relationship with esophageal cancer, but not that these bacteria can directly cause esophageal cancer.
It is worth clarifying that although all of the above factors may be associated with the development of esophageal cancer, it does not follow that the presence of these conditions necessarily leads to cancer. In the same environment, only a minority of people develop esophageal cancer and most do not, so there are individual differences in each person’s response to the cancer-causing and cancer-promoting factors in the environment.