Esophageal Cancer

This year, more than 13,000 people will be diagnosed with esophageal cancer and an estimated 12,600 will die of this disease. It will strike three to five times more men than women. Of the two types of esophageal cancer, squamous cell tumors have been historically more prevalent. However, for reasons that are not well understood, rates of adenocarcinomas of the esophagus are rising at an alarming rate.

The rise in adenocarcinoma has been extraordinarily steep among white men, surpassing the incidence of squamous cell tumors in this population.

In contrast, African American men, who have the highest overall esophageal cancer rates of any population in the United States, develop squamous cell tumors more often than adenocarcinomas. Moreover, they tend to develop the disease earlier than other groups and have poorer survival rates. Though still high, squamous cell esophageal cancer rates are falling among African American men, possibly due to lower smoking rates since the 1960s.

Barrett's esophagus is the most significant precursor for esophageal adenocarcinoma. It occurs when normal squamous epithelial cells that line the lower esophagus are replaced by columnar epithelial cells such as those normally found in the stomach. The condition is believed to be linked to the chronic reflux (backing up)of stomach acid into the esophagus, and obesity has been shown to increase the risk. Many cases of Barrett's esophagus are preventable since the condition is easy to detect with a relatively simple test. But patients may consider even chronic heartburn too trivial to mention to their doctors, and often physicians fail to ask about the problem. The most effective screening and treatment approaches for Barrett's esophagus remain in question.

Studies suggest that a few risk factors account for virtually all of the squamous cell esophageal cancers in the men studied and for 99 percent of the excess occurrence in black men:

• Major contributors to the development of squamous cell esophageal cancer are tobacco use and heavy alcohol consumption, particularly in combination.
• A recent NCI study reports that low income and infrequent consumption of fruits and vegetables also account for susceptibility to this disease.

For all esophageal cancers together, the median age at diagnosis for males is 67 years. For females, it is 73 years. Of these, 66 percent will be in the age group 65 years and older.

In 2002, NCI convened a Stomach and Esophageal Cancer Progress Review Group to assess the current state of knowledge about esophageal cancers and identify the research and resources needed to answer the many important questions about both forms of this deadly disease.

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