Esophageal Cancer: Prevention

To prevent esophageal cancer (esophageal cancer), attention must be paid to reducing individual risk factors. Behavioral risk factors

  • Diet
    • Too little fish consumption; inverse correlation between fish consumption and risk of disease.
    • Nitrosamine exposure Smoked and cured foods and foods high in nitrates and nitrites Nitrate is a potentially toxic compound: Nitrate is reduced to nitrite in the body by bacteria (saliva/stomach). Nitrite is a reactive oxidant that reacts preferentially with the blood pigment hemoglobin, converting it to methemoglobin. Furthermore, nitrites (also contained in cured sausage and meat products and ripened cheese) form nitrosamines with secondary amines (contained in meat and sausage products, cheese and fish), which have genotoxic and mutagenic effects. The daily intake of nitrate is usually about 70% from the consumption of vegetables (lettuce and lettuce, green, white and Chinese cabbage, kohlrabi, spinach, radish, radish, beet), 20% from drinking water (nitrogen fertilizer) and 10% from meat and meat products and fish.
    • Micronutrient deficiency (vital substances) – see prevention with micronutrients; deficiencies of molybdenum, vitamin A and / or zinc are also believed to have an impact on the development.
  • Consumption of stimulants
    • Alcohol (esp. concentrated alcohol); increases risk of squamous cell carcinoma of the esophagus
    • Tobacco (smoking); increases risk for squamous cell carcinoma and adenocarcinoma of the esophagus and esophagogastric junction
  • Drug use
    • Smoking opiates
    • Betel nut (chewing betel nut)/betel nut alkaloids; increases risk for squamous cell carcinoma of the esophagus
  • Hot drinks (> 65 °C)
    • Drinking hot tea and smoking or consuming alcohol at the same time increases the risk of esophageal cancer by 5-fold in Chinese menNote: In 2016, the International Agency for Research on Cancer (IARC) classified very hot drinks (above 65 °C) as “probably carcinogenic.”
  • Psycho-social situation
  • Obesity (overweight) – especially the truncal obesity; increases the risk of adenocarcinoma of the esophagus and esophagogastric junction.
  • Android body fat distribution, that is, abdominal/visceral, truncal, central body fat (apple type) – high waist circumference or waist-to-hip ratio (THQ; waist-to-hip ratio (WHR)) is present; increases the risk of adenocarcinomas of the esophagusWhen waist circumference is measured according to the International Diabetes Federation (IDF, 2005) guideline, the following standard values apply:
    • Men <94 cm
    • Women < 80 cm

    The German Obesity Society published somewhat more moderate figures for waist circumference in 2006: < 102 cm for men and < 88 cm for women.

Environmental pollution – intoxications (poisonings).

  • Ingestion of aflatoxins, nitrosamines or betel nut.
  • Acid and alkali burns (→ scar stenoses).
  • Condition after neoplasia (malignant neoplasms) of the head and neck region.

Caution. Every patient with long-standing gastroesophageal reflux disease should receive an esophagogastroduodenoscopy (ÖGD; endoscopy of the esophagus, stomach and a short portion of the small intestine) at least once!

Prevention factors (protective factors)

  • High intake of fruits and vegetables may contribute to risk reduction of esophageal cancer.
  • High versus low leisure-time physical activity is associated with a lower risk of esophageal cancer (-42%; HR 0.58, 95% CI 0.37-0.89).
  • Surgical or drug antireflux therapy for gastroesophageal reflux reduces the risk of esophageal adenocarcinoma.
  • Acetylsalicylic acid (ASA) – daily use; risk reduction of 50%.