How much you smoke and how long you’ve smoked can affect the chances of developing esophageal cancer.

Smoking can harm almost every organ in your body. It increases the risk of all-cause death and is responsible for health complications related to cancer, cardiovascular disease, and respiratory disease, among others.

Approximately 28.3 million adults in the United States smoke cigarettes. According to the American Cancer Society, 21,560 new cases of esophageal cancer will be diagnosed in 2023 in the United States, and 16,120 deaths will occur from this disease.

Esophageal cancer is cancer that occurs in the esophagus, the tube behind your windpipe that connects the throat to the stomach.

There are two primary forms of esophageal cancer:

  • Adenocarcinoma: The cancer begins in gland cells, commonly found in the lower third of the esophagus.
  • Squamous cell carcinoma: The cancer begins in squamous cells. It can be found anywhere but is commonly seen in the neck area and top two-thirds of the esophagus.

These cancers typically start in the innermost lining of the esophagus wall, the epithelium, and grow outward through the outer layers as the cancer progresses.

The American Cancer Society states that adenocarcinomas are the most common type of esophageal cancer seen in white people. Squamous cell carcinomas are more common in Black people.

Esophageal cancer is less common among Hispanic people, Alaska Natives, and Native Americans. It’s the least common among Pacific Islanders and Asians.

Rare forms of esophageal cancer include:

The use of tobacco in the form of cigarettes, pipes, cigars, and chewing is considered to be a major risk factor for esophageal cancer.

The more cigarettes you smoke and the longer you smoke, the higher the risk of esophageal cancer.

Smoking a pack of cigarettes or more in a day at least doubles your risk of esophageal cancer compared with a nonsmoker.

While the risk of both adenocarcinoma and squamous cell carcinoma is influenced by smoking, smoking has the greatest influence on squamous cell carcinoma development.

What percentage of esophageal cancer patients are smokers?

In the United States, 90% of esophageal squamous cell carcinoma cases can be attributed to a history of smoking, alcohol consumption, and low dietary intake of fruits and vegetables.

The majority of esophageal adenocarcinomas are linked to a condition called Barrett’s esophagus.

As many as 80% of esophageal cancer cases from Barrett’s esophagus can be traced to:

Tobacco smoke contains thousands of chemicals, many of which are known to be harmful to your health. At least 69 of the chemicals in tobacco smoke are considered cancer-causing.

Smoking causes esophageal cancer the same way it causes other cancers: Harmful chemicals in tobacco smoke damage or mutate the DNA in your cells, causing abnormal tissue growth and cellular dysfunction.

Tobacco chemicals promote cellular damage and suppress your immune system, making your body less capable of combating cancer growth.

Smoking can influence esophageal cancer indirectly as well. Smoking can increase your risk of conditions like GERD and Barrett’s esophagus, both of which can lead to esophageal cancer through processes of chronic inflammation and esophageal damage.

Smoking is not the only variable that can increase your risk of esophageal cancer.

Other risk factors include:

  • being over age 55 years
  • being male
  • alcohol consumption
  • acid reflux disease, like GERD or Barrett’s esophagus
  • a diet high in processed meats and low in fruits and vegetables
  • obesity
  • physical inactivity
  • achalasia, a condition of lower esophageal sphincter dysfunction
  • esophageal injury
  • tylosis, an inherited condition of excess cellular growth
  • Plummer-Vinson syndrome, which is the existence of tissue webs in the upper esophagus
  • human papillomavirus (HPV) infection
  • history of throat, mouth, or lung cancer

Survival rates for esophageal cancer vary by stage. The three stages used by the American Cancer Society in their 5-year survival rate projections are:

  • Localized: Cancer is in the esophagus only.
  • Regional: Cancer has spread from the esophagus to nearby tissues, lymph nodes, or both.
  • Distant: Esophageal cancer has spread to other parts of the body not near the original location.

Based on these stages, the 5-year survival rates for esophageal cancer are:

  • Localized: 47%
  • Regional: 26%
  • Distant: 6%
  • All stages combined: 21%

What 5-year survival rates mean

The American Cancer Society’s 5-year survival rates do not indicate the percentage of people who survive to the 5-year mark.

The percentages indicate how likely you are, compared with people who do not have a particular condition, to survive 5 years.

For example, a 47% 5-year survival rate means you are 47% as likely as someone without esophageal cancer to survive for the next 5 years.

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Does smoking cessation improve esophageal cancer risk or outcomes?

Esophageal cancer risk does not significantly improve if you stop smoking.

A 2017 systematic review and meta-analysis found quitting smoking did not notably change the risk of esophageal adenocarcinoma. However, the study did find that stopping smoking improved squamous cell carcinoma risk after 5 years or more.

Quitting smoking may also not improve survival rates after receiving an esophageal cancer diagnosis.

A 2019 study notes smoking status did not affect survival rates for esophageal adenocarcinoma.

Smoking is a major risk factor for esophageal cancer. It can damage your DNA, suppress your immune system, and contribute to conditions that may lead to esophageal cancer, like GERD.

Your chances of developing esophageal cancer increase the longer you smoke and the more you smoke.

Never smoking is the best way to lower your esophageal cancer risk. Smoking cessation may not significantly change your risk once you’ve started smoking, and it may not improve your survival rate after an esophageal cancer diagnosis.