Critical review of the evidence for a causal association between exposure to asbestos and esophageal cancer

Crit Rev Toxicol. 2019 Aug;49(7):597-613. doi: 10.1080/10408444.2019.1692190.


Esophageal cancers comprise about 1% of all cancers diagnosed in the US but are more prevalent in other regions of the world. Several regulatory agencies have classified asbestos as a known human carcinogen, and it is linked to multiple diseases and malignancies, including lung cancer and mesothelioma. In a 2006 review of the epidemiological literature, the Institute of Medicine (IOM) did not find sufficient evidence to demonstrate a causal relationship between asbestos exposure and esophageal cancer. To reevaluate this conclusion, we performed a critical review of the animal toxicological, epidemiological, and mechanism of action literature on esophageal cancer and asbestos, incorporating studies published since 2006. Although there is some evidence in the epidemiological literature for an increased risk of esophageal cancer in asbestos-exposed occupational cohorts, these studies generally did not control for critical esophageal cancer risk factors (e.g. smoking, alcohol consumption). Furthermore, data from animal toxicological studies do not indicate that asbestos exposure increases esophageal cancer risk. Based on our evaluation of the literature, and reaffirming the IOM's findings, we conclude that there is insufficient evidence to demonstrate a causal link between asbestos exposure and esophageal cancer.

Keywords: Asbestos; causal analysis; epidemiology; esophageal cancer; mechanism of action; toxicology.

Publication types

  • Review

MeSH terms

  • Animals
  • Asbestos*
  • Environmental Exposure / statistics & numerical data*
  • Esophageal Neoplasms / epidemiology*
  • Hazardous Substances*
  • Humans


  • Hazardous Substances
  • Asbestos