Esophageal Cancer Crisis in Golestan Province, Iran; Focus on Risk Factors: Back to Future

Esophageal cancer (EC) is categorized histologically to two common groups; adenocarcinomas and squamous cell carcinomas, with high incidence and mortality worldwide. Esophageal squamous cell carcinoma (ESCC) is the most prevalent (more than 90%) form of all EC cases in Golestan province. Golestan province, as the high-risk province for ESCC, is located in the eastern part of the Caspian littoral area of Iran, although in the last decades, the occurrence rates have decreased in this area. Tobacco smoking, opium consumption, low oral hygiene, drinking hot liquids, insufficient intake of fresh fruits and vegetables, and poor socioeconomic status increase the risk of ESCC in Golestan, although exposure to infections and toxic chemical compounds are also reported. Here, we summarize the previous epidemiological studies from 1970 to 2019 that have investigated the risk factors involved in ESCC in this high-risk area. More prospective cohort studies are required to assess the risk factors, categorize high-risk peoples, and evaluate early detection and involved mechanisms.