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:
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.
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