Risk of esophageal cancer decreases with height
Taller individuals are less likely to develop esophageal cancer and it’s precursor, Barrett’s esophagus, according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.
“Individuals in the lowest quartile of height (under 5’7” for men and 5’2” for women) were roughly twice as likely as individuals in the highest quartile of height (taller than 6’ for men and 5’5” for women) to have Barrett’s esophagus or esophageal cancer,” said Aaron P. Thrift, PhD, lead study author from the Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA. “Interestingly, the relationship between height and esophageal cancer is opposite from many other cancers - including colorectal, prostate and breast - where greater height is associated with an increased risk.”
Researchers conducted a large pooled analysis using data from 14 population-based epidemiologic studies within the International Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON), including 1,000 cases of esophageal cancer and twice as many cases of Barrett’s esophagus, and twice as many controls. The researchers conducted multiple analyses, including using Mendelian randomization (which incorporates genetic information with traditional approaches) to overcome issues of confounding and bias. The results from all analyses consistently demonstrated an inverse association between height and Barrett’s esophagus or esophageal cancer. There were no differences in these estimates based on sex, age, education, smoking, GERD symptoms or body mass index. Adjusting for abdominal obesity yielded similar results.
“The identification of risk factors, such as height, will allow us to create more sophisticated and accurate methods to quantify patient risk, which will hopefully be used in the future to decide who should undergo endoscopic screening for these conditions,” added Dr. Thrift.
The researchers report no obvious explanation for the association between short height and Barrett’s esophagus or esophageal cancer. Future studies investigating the potential causal mechanisms by which risk for Barrett’s esophagus or esophageal cancer might be influenced by height are justified.
Esophageal Cancer: Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.
The following factors may raise a person’s risk of developing esophageal cancer:
Age. People between the ages of 45 and 70 have the highest risk of esophageal cancer.
Gender. Men are three to four times more likely than women to develop esophageal cancer.
Race. Black people are twice as likely as white people to develop the squamous cell type of esophageal cancer.
Tobacco. Using any form of tobacco- including cigarettes, cigars, pipes, chewing tobacco, and snuff- raises the risk of esophageal cancer, especially squamous cell carcinoma.
Alcohol. Heavy drinking over a long period of time increases the risk of squamous cell carcinoma of the esophagus, especially when combined with tobacco use.
Barrett’s esophagus. This condition can develop in some people who have chronic gastroesophageal reflux disease (GERD) or esophagitis (inflammation of the esophagus), even when a person does not have symptoms of chronic heartburn. Damage to the lining of the esophagus causes the squamous cells in the lining of the esophagus to turn into glandular tissue. People with Barrett’s esophagus are more likely to develop adenocarcinoma of the esophagus, but the risk of developing esophageal cancer is still fairly low.
Diet/nutrition. A diet that is low in fruits and vegetables and certain vitamins and minerals can increase a person’s risk of developing esophageal cancer.
Obesity. Being severely overweight and having too much body fat can increase a person’s risk of developing esophageal adenocarcinoma.
Lye. Children who have accidently swallowed lye have an increased risk of squamous cell carcinoma. Lye can be found in some cleansing products, such as drain cleaners.
Achalasia. Achalasia, a condition when the lower muscular ring of the esophagus does not relax during swallowing of food, increases the risk of squamous cell carcinoma.
Human papillomavirus (HPV). There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. Researchers are investigating HPV for esophageal cancer, but there is no clear link that squamous cell esophageal cancer is related to HPV infection.
Esophageal cancer incidence increased eight-fold in the U.S. from 1973 to 2008. Almost all cases arise from Barrett’s esophagus. Learn more about the management of Barrett’s esophagus in the American Gastroenterological Association medical position statement.
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This work was primarily funded by NIH grant R01CA136725.
About the AGA Institute
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About Clinical Gastroenterology and Hepatology
The mission of Clinical Gastroenterology and Hepatology is to provide readers with a broad spectrum of themes in clinical gastroenterology and hepatology. This monthly peer-reviewed journal includes original articles as well as scholarly reviews, with the goal that all articles published will be immediately relevant to the practice of gastroenterology and hepatology.
Thrift, A. P., Risk of Esophageal Adenocarcinoma Decreases With Height, Based on Consortium Analysis and Confirmed by Mendelian Randomization. Clinical Gastroenterology and Hepatology 2014: 12(10): 1667-1676.e1
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Rachel Steigerwald
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American Gastroenterological Association