Esophageal cancer is a moderately important cause of disease and death. In the United States each year, it affects about 17 thousand people and kills approximately 15 thousand.
Of the many risk factors associated with esophageal cancer, the most important include:
- Smoking: Smoking is associated with risk of esophageal cancer.
- Alcohol consumption: Studies have shown a link between alcohol and esophageal cancer.
- Gastroesophageal reflux disease (GERD), also known as acid reflux, is an important risk factor as the stomach acid reaching up the esophagus irritates the lining, which can lead to cancer.
- Obesity: Obesity, especially around the waist, is associated with esophageal cancer.
- The Western diet (high in solid oil, sugar, sweets, tea, eggs, pickles and processed meat) is associated with increased risk of esophageal cancer.
- Diet: Eating fruits and vegetables and high fiber grain products and dairy products reduces the risk of esophageal cancer.
- Hot drinks such as coffee and tea are associated with increased risk of esophageal cancer as they irritate the lining of the esophagus.
Sunlight exposure and esophageal cancer risk
Sunlight has a direct effect on reducing risk of many types of cancer. The shortwave ultraviolet portion of sunlight, ultraviolet-B (UVB), stimulates the body to produce vitamin D, which protects against cancer.
Many ecological studies (comparison of disease rates where people live to disease risk factor values) have found lower rates of esophageal cancer with respect to higher amounts of ultraviolet-B (UVB) from sunlight. Such studies were conducted in China, Japan, and the United States.
In addition, a study in Spain found lower rates of esophageal cancer in provinces where people had higher death rates from non-melanoma skin cancer.
Vitamin D and esophageal cancer
Vitamin D levels
An observational study in Italy found greatly reduced risk of esophageal cancer among men who took higher amounts of vitamin D supplements. The results were most striking for those who smoked and/or drank alcoholic beverages.
The rates of breast, colon, and rectal cancer decrease rapidly as vitamin D levels increase from very low levels [less than 10 ng/ml (25 nmol/] out to 20-30 ng/ml, then decreases at a slower rate until levels reach about 50 ng/ml (125 nmol/l). No comparable findings have been reported for other types of cancer. However, it is assumed that they behave in a similar manner.
How vitamin D works
Vitamin D has been shown to block the growth of cancer tumors. Calcitriol, an active form of vitamin D, is produced by the body from vitamin D processed by the liver. Calcitriol provides numerous benefits against cancer. This form of vitamin D encourages cells to either adapt to their organ or commit apoptosis (cell suicide). Calcitriol also limits blood supply to the tumor and reduces the spread of cancer.
High levels of vitamin D are associated with a lower risk of esophageal cancer in both observational studies on individuals and geographic studies of populations.
Based on studies of breast, colon, and rectal cancer, vitamin D levels of 40–60 ng/mL (100–150 nmol/L) may reduce the risk of cancer. Taking 1000–4000 international units (IU) (25–100 mcg)/day raises vitamin D levels to those amounts for most people.
Vitamin D and calcium
There is limited evidence that calcium is also associated with reduced risk of esophageal cancer.
People with higher vitamin D levels at time of cancer diagnosis often have a higher survival rate. This has been verified for people with breast, colorectal, lung, and prostate cancer; non-Hodgkin’s lymphoma; and melanoma. These studies suggest that increasing vitamin D levels after cancer diagnosis may improve chances of survival.
Some cancer treatment centers are now giving at least 5000 IU (125 mcg)/day vitamin D to patients with cancer. Outcome results have yet to be published.
This evidence summary was written by:
William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
The summary was reviewed by:
- Wanqing Chen <email@example.com>
Complete bibliography of research used in this summary
The research we have cited in our summary is listed below, with links to PubMed abstracts and full-text for those who wish to explore further.
- Abnet, C. C. Chen, Y. Chow, W. H. Gao, Y. T. Helzlsouer, K. J. Le Marchand, L. McCullough, M. L. Shikany, J. M. Virtamo, J. Weinstein, S. J. Xiang, Y. B. Yu, K. Zheng, W. Albanes, D. Arslan, A. A. Campbell, D. S. Campbell, P. T. Hayes, R. B. Horst, R. L. Kolonel, L. N. Nomura, A. M. Purdue, M. P. Snyder, K. Shu, X. O. Circulating 25-hydroxyvitamin D and risk of esophageal and gastric cancer: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol. 2010 Jul 1; 172 (1): 94-106.
- Amsel, J. Waterbor, J. W. Oler, J. Rosenwaike, I. Marshall, K. Relationship of site-specific cancer mortality rates to altitude. Carcinogenesis. 1982; 3 (5): 461-5.
- Blumthaler, M. Ambach, W. Rehwald, W. Solar UV-A and UV-B radiation fluxes at two Alpine stations at different altitudes. Theoretical and Applied Climatology. 1992; 46 (1): 39-44.
- Boscoe, F. P. Schymura, M. J. Solar ultraviolet-B exposure and cancer incidence and mortality in the United States, 1993-2002. BMC Cancer. 2006; 6264.
- Chen, W. Clements, M. Rahman, B. Zhang, S. Qiao, Y. Armstrong, B. K. Relationship between cancer mortality/incidence and ambient ultraviolet B irradiance in China. Cancer Causes Control. 2010 Jun 16;
- Chen, W. Dawsey, S. M. Qiao, Y. L. Mark, S. D. Dong, Z. W. Taylor, P. R. Zhao, P. Abnet, C. C. Prospective study of serum 25(OH)-vitamin D concentration and risk of oesophageal and gastric cancers. Br J Cancer. 2007 Jul 2; 97 (1): 123-8.
- Devesa, S. S. Grauman, D. J. Blot, W. J. Pennello, G. A. Hoover, R. N. Fraumeni, J. F. Jr. Atlas of Cancer Mortality in the United States, 1950-1994. NIH Publication No. 99-4564. 1999 April 17, 2010;
- Gammon, M. D. Schoenberg, J. B. Ahsan, H. Risch, H. A. Vaughan, T. L. Chow, W. H. Rotterdam, H. West, A. B. Dubrow, R. Stanford, J. L. Mayne, S. T. Farrow, D. C. Niwa, S. Blot, W. J. Fraumeni, J. F., Jr. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst. 1997 Sep 3; 89 (17): 1277-84.
- Garland, C. F. Gorham, E. D. Mohr, S. B. Garland, F. C. Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009 Jul; 19 (7): 468-83.
- Giovannucci, E. Liu, Y. Rimm, E. B. Hollis, B. W. Fuchs, C. S. Stampfer, M. J. Willett, W. C. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst. 2006 Apr 5; 98 (7): 451-9.
- Goodwin PJ, Ennis M, Pritchard KI, Koo J, Hood N. Prognostic effects of 25-hydroxyvitamin D levels in early breast cancer. J Clin Oncol. 200 Aug; 27 (10): 3757-63.
- Grant, W. B. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002 Mar 15; 94 (6): 1867-75.
- Grant, W. B. The likely role of vitamin D from solar ultraviolet-B irradiance in increasing cancer survival. Anticancer Res. 2006 Jul-Aug; 26 (4A): 2605-14.
- Grant, W. B. A meta-analysis of second cancers after a diagnosis of nonmelanoma skin cancer: additional evidence that solar ultraviolet-B irradiance reduces the risk of internal cancers. J Steroid Biochem Mol Biol. 2007 Mar; 103 (3-5): 668-74.
- Grant, W. B. An ecologic study of cancer mortality rates in Spain with respect to indices of solar UVB irradiance and smoking. Int J Cancer. 2007 Mar 1; 120 (5): 1123-8.
- Grant, W. B. An ecological study of cancer mortality rates including indices for dietary iron and zinc. Anticancer Res. 2008 May-Jun; 28 (3B): 1955-63.
- Grant, W. B. A critical review of Vitamin D and Cancer: A report of the IARC Working Group. Dermatoendocrinol. 2009 Jan; 1 (1): 25-33.
- Grant, W. B. How strong is the evidence that solar ultraviolet B and vitamin D reduce the risk of cancer?: An examination using Hill’s criteria for causality. Dermatoendocrinol. 2009 Jan; 1 (1): 17-24.
- Grant, W. B. Air pollution in relation to U.S. cancer mortality rates: an ecological study; likely role of carbonaceous aerosols and polycyclic aromatic hydrocarbons. Anticancer Res. 2009 Sep; 29 (9): 3537-45.
- Grant, W. B. Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level; implications for meta-analyses and setting vitamin D guidelines. Dermato-endocrinology. 2011; 3 (3):
- Grant, W. B. An ecological study of cancer incidence and mortality rates in France with respect to latitude, an index for vitamin D production. Deramato-Endocrinology. 2010 April/May/June; 2 (2):
- Grant, W. B. Observational vs. ecological studies regarding the ultraviolet-B-vitamin D-cancer hypothesis. Am J Epidemiol. 2010 in press;
- Grant, W. B. Garland, C. F. The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates. Anticancer Res. 2006 Jul-Aug; 26 (4A): 2687-99.
- Helzlsouer, K. J. Overview of the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol. 2010 Jul 1; 172 (1): 4-9.
- Hypponen, E. Power, C. Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr. 2007 Mar; 85 (3): 860-8.
- Hofmann, J. N. Yu, K. Horst, R. L. Hayes, R. B. Purdue, M. P. Long-term variation in serum 25-hydroxyvitamin D concentration among participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cancer Epidemiol Biomarkers Prev. 2010 Apr; 19 (4): 927-31.
- Holmes RS, Vaughan TL. Epidemiology and pathogenesis of esophageal cancer. Semin Radiat Oncol. 2007 Jan; 17 (1): 2-9.
- Ingraham, B. A. Bragdon, B. Nohe, A. Molecular basis of the potential of vitamin D to prevent cancer. Curr Med Res Opin. 2008 Jan; 24 (1): 139-49.
- Jorde, R. Sneve, M. Hutchinson, M. Emaus, N. Figenschau, Y. Grimnes, G. Tracking of serum 25-hydroxyvitamin D levels during 14 years in a population-based study and during 12 months in an intervention study. Am J Epidemiol. 2010 Apr 15; 171 (8): 903-8.
- Krishnan, A. V. Trump, D. L. Johnson, C. S. Feldman, D. The role of vitamin D in cancer prevention and treatment. Endocrinol Metab Clin North Am. 2010 Jun; 39 (2): 401-18, table of contents.
- Lappe, J. M. Travers-Gustafson, D. Davies, K. M. Recker, R. R. Heaney, R. P. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun; 85 (6): 1586-91.
- Launoy, G. Milan, C. Day, N. E. Pienkowski, M. P. Gignoux, M. Faivre, J. Diet and squamous-cell cancer of the oesophagus: a French multicentre case-control study. Int J Cancer. 1998 Mar 30; 76 (1): 7-12.
- Leffell, D. J. Brash, D. E. Sunlight and skin cancer. Sci Am. 1996 Jul; 275 (1): 52-3, 56-9.
- Lipworth, L. Rossi, M. McLaughlin, J. K. Negri, E. Talamini, R. Levi, F. Franceschi, S. La Vecchia, C. Dietary vitamin D and cancers of the oral cavity and esophagus. Ann Oncol. 2009 Jun 1;
- Mizoue, T. Ecological study of solar radiation and cancer mortality in Japan. Health Phys. 2004 Nov; 87 (5): 532-8.
- Ng, K. Wolpin, B. M. Meyerhardt, J. A. Wu, K. Chan, A. T. Hollis, B. W. Giovannucci, E. L. Stampfer, M. J. Willett, W. C. Fuchs, C. S. Prospective study of predictors of vitamin D status and survival in patients with colorectal cancer. Br J Cancer. 2009 Sep 15; 101 (6): 916-23.
- Peterlik, M. Grant, W. B. Cross, H. S. Calcium, vitamin D and cancer. Anticancer Res. 2009 Sep; 29 (9): 3687-98.
- Tuohimaa, P. Pukkala, E. Scelo, G. Olsen, J. H. Brewster, D. H. Hemminki, K. Tracey, E. Weiderpass, E. Kliewer, E. V. Pompe-Kirn, V. McBride, M. L. Martos, C. Chia, K. S. Tonita, J. M. Jonasson, J. G. Boffetta, P. Brennan, P. Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: vitamin D as a possible explanation. Eur J Cancer. 2007 Jul; 43 (11): 1701-12.
- Wolfgarten, E. Rosendahl, U. Nowroth, T. Leers, J. Metzger, R. Holscher, A. H. Bollschweiler, E. Coincidence of nutritional habits and esophageal cancer in Germany. Onkologie. 2001 Dec; 24 (6): 546-51.
- Zheng, S. Vuitton, L. Sheyhidin, I. Vuitton, D. A. Zhang, Y. Lu, X. Northwestern China: a place to learn more on oesophageal cancer. Part one: behavioural and environmental risk factors. Eur J Gastroenterol Hepatol. 2010 Aug; 22 (8): 917-25.