# 🌍 Esophageal Cancer Science Popularization
## 1 Global Burden and Epidemiological Characteristics
Esophageal cancer is a malignant tumor with significant geographical variations and is a serious health challenge worldwide.
– **Incidence and Mortality Overview**: According to data from the 2025 Global Burden of Disease (GBD) study, there were approximately 576,000 new cases of esophageal cancer globally in 2021, with an age-standardized incidence rate of 6.65 cases per 100,000 people. At the same time, approximately 539,000 people died from esophageal cancer globally, with an age-standardized mortality rate of 6.25 cases per 100,000 people. Compared to 1990, both incidence and mortality rates have decreased (by 24.87% and 30.67%, respectively), but due to population growth and aging, **the absolute number of cases and deaths is expected to continue to rise**.
– **Heavy Regional Burden**: The burden of esophageal cancer is not evenly distributed. East Asia (especially China) accounts for nearly two-thirds of global esophageal cancer cases and deaths. Furthermore, the Central African and Sub-Saharan African region has the highest age-standardized incidence and mortality rates globally. Data shows that more than half of new esophageal cancer cases and deaths worldwide occur in China, making it the country with the heaviest burden of esophageal cancer globally.
– **Significant gender differences:** Globally, esophageal cancer affects men far more than women, with significantly higher incidence and mortality rates in all age groups.
## 2 Major Pathological Types and Global Distribution
Esophageal cancer primarily presents in two pathological types, with distinct biological characteristics and geographical distributions.
– **Esophageal squamous cell carcinoma:**
– **Globally dominant type:** This is the most common type of esophageal cancer globally, especially in the so-called “esophageal cancer belt” (including China, Iran, and Central Asia).
– **Relationship with China:** In China, squamous cell carcinoma accounts for over 90% of esophageal cancer cases.
– **Esophageal Adenocarcinoma**:
– **Rising in Western Countries**: Although the incidence of esophageal squamous cell carcinoma has declined in some regions, **the incidence of esophageal adenocarcinoma has risen sharply in Western countries (such as the United States) since the late 20th century**, although the rate of increase may have slowed in recent years.
– **Association with Gastroesophageal Reflux Disease and Obesity**: The rising trend of adenocarcinoma is closely related to factors such as gastroesophageal reflux disease, Barrett’s esophagus, and obesity.
The table below clearly illustrates the core differences between the two major pathological types:
| Characteristics | Esophageal squamous cell carcinoma (ESCC) | Esophageal adenocarcinoma (EAC) |
| :— | :— | :— |
| **Global Prevalence** | Main types, especially in Asia and the “esophageal cancer belt” | More common in Western countries |
| **Prevalent Regions** | Parts of East Asia, Central Asia, and Africa | Developed countries such as North America and Europe |
| **Major Risk Factors** | Smoking, alcohol consumption, hot food, malnutrition | Gastroesophageal reflux disease, Barrett’s esophagus, obesity |
| **Trends** | Incidence declining in most parts of the world | Previously rose sharply in Western countries, recent growth rate may be slowing |
## 3 Major Risk Factors and Primary Prevention
The occurrence of esophageal cancer is closely related to a variety of lifestyle and environmental factors, meaning that many cases can be prevented by changing habits.
– **Dietary-Related Risks**:
– **Hot food and drinks**: This is a widely recognized important risk factor. The World Health Organization has classified **beverages heated above 65°C** as Group 2A carcinogens. Long-term consumption of extremely hot beverages (such as scalding hot tea and soup) can repeatedly burn the esophageal mucosa, causing a cycle of damage and repair, thus increasing the risk of cancer. It is recommended to keep food and beverages at a temperature **below 50°C** before consumption.
– **Pickled foods**: Pickled vegetables, cured meats, salted fish, and other pickled foods contain **nitrites**, which can be converted into the potent carcinogen **nitrosamines** in the body. Studies have shown that frequent consumption of pickled foods significantly increases the risk of death from esophageal cancer.
– **Moldy foods**: Moldy peanuts, corn, and other foods may contain **aflatoxin**, a highly toxic and potent carcinogen that cannot be broken down by ordinary cooking temperatures.
– **Poor eating habits**: **Eating too quickly (increasing the risk of physical damage to the esophagus) and **an unbalanced diet** (insufficient intake of fresh fruits and vegetables) are also risk factors.
– **Other Lifestyle and Disease Risks:**
– **Smoking and Alcohol Consumption:** Both are definite risk factors for esophageal cancer, especially esophageal squamous cell carcinoma.
– **Obesity and Gastroesophageal Reflux:** Obesity is a significant contributing factor to esophageal adenocarcinoma, often accompanied by gastroesophageal reflux disease (GERD). Long-term reflux can lead to Barrett’s esophagus, a precancerous lesion of adenocarcinoma.
## 4 Global Treatment Advances and Future Prospects
The treatment of esophageal cancer is rapidly evolving, with significant breakthroughs particularly in precision medicine and immunotherapy.
– **Treatment Market and Models:** The global market for esophageal cancer treatment is steadily growing, reflecting substantial clinical demand and active research and development. Currently, chemotherapy still plays a crucial role in treatment regimens, but immunotherapy, targeted therapy, and combination therapies are increasingly becoming the focus of research and application.
– **Breakthroughs in Innovative Therapies:**
– **Immune Checkpoint Inhibitors:** Drugs such as nivolumab have shown potential to outperform traditional chemotherapy in the treatment of esophageal cancer.
– **Antibody-Drug Conjugates (ADCs):** In recent years, ADC drugs have achieved breakthroughs in multiple cancer types. **In November 2025, the Chinese pharmaceutical company Baili Tianheng announced that its first-in-class EGFR×HER3 bispecific antibody ADC drug, iza-bren, met both the progression-free survival and overall survival primary endpoints in a Phase III clinical trial for advanced esophageal squamous cell carcinoma.** This became the world’s first Phase III study of an ADC drug to achieve double positive results in this field, bringing new hope to patients undergoing later-line treatment.
– **Precision Medicine and Global Collaboration:** The future direction is personalization and precision. For example, the collaboration between Boston Gene and Kyoto University in Japan aims to use an **artificial intelligence platform to analyze tumor molecular profiles** to identify biomarkers that can predict treatment efficacy, thereby matching patients with the most effective treatment options.
## 5 Summary and Core Prevention Recommendations
In summary, esophageal cancer is a significant global health problem with a heavy and unevenly distributed burden. Understanding its risk factors and latest advancements allows for better prevention and control.
**Prevention is far better than cure when it comes to esophageal cancer.** Core recommendations are as follows:
– **Break the habit of eating “hot” foods:** Patiently wait for food and drinks to cool to lukewarm before consuming them.
– **Optimize your diet:** Eat plenty of fresh fruits and vegetables, and **strictly limit your intake of pickled foods.**
– **Discard moldy food:** Discard any food suspected of being moldy; don’t let small things lead to big problems.
– **Develop good eating habits:** Chew slowly and thoroughly, and avoid overeating.
– **Maintain a healthy weight:** Weight control helps prevent gastroesophageal reflux and adenocarcinoma.
For people in high-risk areas or those with unhealthy lifestyle habits, regular checkups and early screening are crucial. Although the global age-standardized incidence rate has declined, the absolute number of cases may continue to rise in the future due to population growth and aging. Therefore, continuously promoting **primary prevention (changing unhealthy lifestyles)**, **secondary prevention (early screening and diagnosis)**, and **the research and development of innovative therapies** are multiple key pathways to reduce the global burden of esophageal cancer.