For primary prevention, smoking cessation and avoidance of heavy alcohol intake may significantly reduce the risk for squamous cell carcinoma. A healthful diet with fresh fruits and vegetables but no highly salted, preserved, or smoked food should lead to a reduction in the risk for both of the major forms esophageal cancer. For secondary prevention, routine screenings by endoscopes may confer benefits to individuals with Barrette's esophagus. Treatment with endoscopic ablation combined with proton pump inhibitors may retard Barrett's esophagus to normal squamous mucosa.
Research has been under way to determine the chemopreventive effects of 13-cis-retinoic acid, nonsteroidal antiinflammatory drugs (e.g., aspirin and sulindac), selenium, and ornithine decarboxylase inhibitor, a-difluoromethylornithine, in patents with Barrett's esophagus. These agents also hold promise for preventing squamous cell carcinoma. Other chemo-preventive agents that may be useful for reducing both types of esophageal cancer include ascorbic acid, polyphenols (e.g., ellagic acid and epigallocate-chin-3-gallate), and sulfhydryl compounds. These agents have been shown in animal models to inhibit nitrosamine formation and enhance the activities of detoxifying enzymes such as glutathione-S-transferase and glutathione peroxidase, but evidence from humans is sparse.
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