Facing the Facts about Esophageal Cancer

Heartburn is common. Esophageal cancer isn't. According to the American Cancer Society, less than 1 percent (0.4 percent to 0.5 percent) of the people with Barrett's esophagus progress to esophageal cancer in a given year. The lifetime risk is related to how many years you live with the condition, but most experts say that a Barrett's patient's risk of getting cancer in his or her lifetime is less than 5 percent.

There are actually two types of esophageal cancer. One is a complication of long-term acid reflux (adenocarcinoma), and the other probably isn't related to reflux, but is related to excess use of tobacco and alcohol (squamous cancer).Adenocarcinoma is more common in the United States.Squamous cancer is more common in other parts of the world (for example, the incidence in northern China, India, and southern Africa). As Table 1 demonstrates, the number of cases of both kinds of esophageal cancer and, sadly, the number of deaths, have been rising steadily in the United States over the past 30 years.

Table 1 Esophageal Cancer in the United States

Year	New Cases	Deaths
1973	5,500	6,488
1980	8,020	7,985
1990	10,380	9,719
2000	11,770	12,232
2004	14,250 (estimate)	13,300 (estimate)

Source: American Cancer Society

Identifying people at risk

According to the American Cancer Society and the National Cancer Institute (NIC), in the United States, the people with the highest risk of esophageal cancer are

• Men: The National Cancer Institute says both types of esophageal cancer are three to five times more common among men than among women.

• African Americans: Squamous cell esophageal cancer is three times more common among American black men than among American white men. NCI says African American women are also at higher risk than Hispanic and non-Hispanic white women.

• Middle-aged and senior citizens: Both types of esophageal cancer are most common among people ages 45 to 70.

• Smokers and drinkers: Both alcohol and tobacco smoke irritate the esophagus, but neither one alone is as potent a risk factor as the two together. Why? Scientists theorize that alcohol acts as a solvent for carcinogens in burning tobacco, carrying them into the esophageal lining. This may be more of an issue in squamous cell esophageal cancer, but it's likely true in both types.

• People who eat their food very hot: Foods and beverages consumed very hot irritate the esophagus; theoretically they may raise the risk of repeated injury leading to cell changes leading (mainly) to squamous cell cancer.

Predicting outcomes

Esophageal cancer isn't a walk in the park. Forty years ago, only 1 to 4 percent of Americans diagnosed with this disease lived for at least five years. Today, while the five-year survival rate has risen to 9 to 13 percent, and many patients live much longer, this cancer is still highly lethal.

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