Esophageal Cancer Awareness Month: The Role of Reflux, Tobacco, and Alcohol

What this observance is

Every April, Esophageal Cancer Awareness Month brings attention to cancer of the esophagus — the tube that carries food from the throat to the stomach. The Esophageal Cancer Action Network (ECAN) established the observance in 2009, and periwinkle is its awareness color. The goal is to help people recognize a cancer that is not widely discussed and to understand risk factors, several of which can be addressed.

What this cancer is

According to the National Cancer Institute, the two most common types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. NCI explains that these two forms tend to develop in different parts of the esophagus and are driven by different genetic changes — and, importantly, they have different risk factors.

NCI links squamous cell carcinoma of the esophagus most strongly to smoking and heavy alcohol use. It links adenocarcinoma of the esophagus strongly to gastroesophageal reflux disease (GERD) — especially when GERD is long-lasting with severe daily symptoms. NCI explains that repeated reflux can irritate the lower esophagus and, over time, lead to a condition called Barrett esophagus, in which the affected cells may later become adenocarcinoma. Obesity combined with GERD may further raise the risk.

Screening and prevention (per NCI)

NCI states that there is no standard or routine screening test for esophageal cancer. It describes several tests — such as esophagoscopy and biopsy — that are being used or studied, and notes that taking biopsy samples from the lower esophagus may detect early Barrett esophagus in people who have risk factors for it. But NCI is careful to say these are not established routine screening programs, and it notes that screening carries risks, including false results.

On prevention, NCI is more encouraging. It notes that avoiding tobacco and alcohol lowers the risk of squamous cell carcinoma of the esophagus. Because tobacco and alcohol are modifiable, they are practical places to act — quitting smoking is one concrete step NCI supports. If you have long-standing reflux, that is worth discussing with your clinician. And to think through which screenings apply to you overall, our free screening check-up tool is a gentle starting point.

How to take part

• If you use tobacco or drink heavily, ask about reducing those risks.
• If you have frequent, severe, or long-lasting reflux, mention it to your healthcare team.
• Learn the difference between the two main types and their different risk factors.
• Share accurate information about this often under-recognized cancer.

Questions to ask a healthcare team

• Do my reflux symptoms warrant further evaluation or monitoring?
• What is Barrett esophagus, and am I at risk for it?
• Given my history, what steps could lower my risk of esophageal cancer?
• What help is available if I want to stop using tobacco or cut back on alcohol?