Who Gets EC, and What Causes It?

by Cathy Byland Weeks

This is a hard question. Who gets EC? Why do they get it?

Well, the key word is "tends." Certain people tend to get EC, while others don't.

For example, African Americans tend to get the disease more often than European Americans, and men get it a lot more often than women do. For every woman that I hear of with this cancer, I hear of at least 3 or 4 men that have it. But why? I'm not certain, but I think men have trouble with heartburn more often than women. What is it about men that predisposes them to this? What is it about women that protects them? In an attempt to answer this rhetorical question, I recently had a conversation with a female Esophageal Cancer patient, and it went something like this:

Q: What sets you apart? Most Esophageal Cancer patients are men. You fit the profile for EC in that you had had long-term acid reflux but there are people out there who have reflux, and never get cancer. Someone once accused EC of being a sexist disease (gee, aren't you glad you broke through *that* glass ceiling! ;-) and it seems at times that it is.

A: I've asked myself many times--Why Me? I smoked about a pack a day when I was in college, but haven't had a whole cigarette in probably 25 years, and haven't had a puff in at least 15 years. I try to stay away from secondhand smoke and really have little trouble avoiding it. As for alcohol consumption--very little, maybe 2-3 weak drinks a month, and no beer. So other than the chronic reflux there just doesn't seem to be an explaination for it all--just the luck of the draw I guess!!!

Generally speaking, people who have had chronic heartburn or "acid-reflux," over a long period of time tend to be much more at risk of getting EC. Long-term irritation of the esophagus causes a condition called "Barrett's Esophagus," a condition in which the cells of the Esophagus change to resemble stomach-lining cells, rather than Esophageal cells. Barrett's Esophagus is considered a pre-cancerous condition.

Smokers and drinkers also tend be higher risk, but people who both smoke AND drink are at a MUCH, MUCH higher risk. Somehow the interaction of smoke and the alcohol within the body seems prime the esophagus for cancer.

However, why do some people get it and not others? My father's family has no history of cancer whatsoever. Dad used to drink, but quit entirely back in 1974. Not a drop of alcohol in over 20 years. He used to be a pack-a-day smoker, but he quit smoking the day I was born, back in 1969. The studies of EC don't say too much about smokers and drinkers who have been "on-the-wagon" for long periods of time. If Dad had never smoked or drank, would he have gotten cancer? Who knows.

Dad ate a healthy, well-balanced diet, exercized regularly, and took care of himself. He was slightly over-weight, but his weight never fluctuated much. Dad rarely even caught colds. However he had acid-reflux, but was unaware of it. Bingo.

But what about the people (and there are plenty of them) who get EC, and don't fall into a single high-risk category? Why do they get this disease? Genetic tendency maybe. Environmental factors possibly. High stress levels or traumatic life events are considered by many to be among the causes of cancer. But plenty of people live high-stress lives and never get the disease.

So why do people get cancer? I guess the female EC patient I spoke to said it best:

It's "just luck of the draw!!"