Harindra Jayasekara studies the risk factors for esophageal cancer at Cancer Council Victoria in Melbourne, and he admits he likes his tea and coffee extra hot. After a new British study of nearly a million adults, though, he told Medscape he would suggest letting “very hot drinks cool before drinking, particularly in susceptible populations.”
The study, led by Keren Papier at Oxford Population Health and published Sept. 8 in the International Journal of Cancer, found that people who said they preferred very hot drinks had about three times the risk of esophageal squamous cell carcinoma, or SCC, as people who took them warm. If the link is causal, the researchers estimated, drinking beverages hot instead of very hot could prevent about 14% of new SCC cases in the U.K., some 440 a year.
“This is the largest ever study to examine the relationship between hot drink consumption and oesophageal cancer,” Papier said in the university’s announcement, adding that letting drinks “cool slightly before consumption could prevent a substantial number of cancers.”
What nearly a million British adults reported
Papier’s team drew on 977,282 people in the Million Women Study and UK Biobank, followed for an average of 14.2 and 11.1 years, during which 1,045 developed SCC and 1,303 developed adenocarcinoma, the other main form of the disease. Once the number of cups was taken into account, people who liked their drinks very hot had a relative risk of 3.17 for SCC compared with the warm group, and people who liked them hot had 1.69. Drinking six or more cups a day was linked to a 71% higher SCC risk than drinking fewer, after accounting for temperature, and temperature made no clear difference for adenocarcinoma.
Joel Rubenstein, a University of Michigan specialist in esophageal disease, told Medscape that this paper and an earlier UK Biobank analysis are the first to show the temperature link in a Western population. Self-reported temperatures leave room for measurement error, he said, but “it is hard to imagine how the recall of temperature would be systematically biased to result in the observed association.”
Muy-Teck Teh, a professor of molecular oral oncology at Queen Mary University of London, was more guarded in comments to the Science Media Centre, where he said the results “should be interpreted as robust associations rather than causal proof.”
Why heat may matter for esophageal cancer
The Oxford researchers suspect that heat damages the cells lining the esophagus, “particularly in the upper section first exposed to hot drinks,” and that the resulting inflammation raises risk over the years. SCC tends to start in that upper part.
The World Health Organization’s International Agency for Research on Cancer came to a related view in 2016, when it classified drinking beverages hotter than 149°F (65°C) as “probably carcinogenic to humans.” Nobody in the British study measured their drinks with a thermometer, so their idea of “very hot” can’t be matched precisely to that line.
A rare cancer, and a short list of worries
Gilbert Welch, a general internist at Brigham and Women’s Hospital in Boston who often puts cancer risks in context, told Medscape that “esophageal cancer is rare,” and that the squamous type is becoming less common. National Cancer Institute figures cited by Medscape put the U.S. rate of esophageal SCC at 1.1 cases per 100,000 people in 2023. “Physicians need to prioritize what things to put on patients’ worry list,” Welch said.
In the U.K., Cancer Research UK, which helped fund the study, puts the lifetime risk of SCC at around 1%.
Rubenstein thought it was “prudent to avoid drinking scalding hot beverages,” but with risks this low and habits this ingrained, he said, “individuals can reasonably decide to continue drinking their warm/hot coffee or tea.” Asked what doctors should tell their patients, Jason Oke of the Centre for Evidence-Based Medicine at the University of Oxford gave Medscape a three-word answer: “Nothing unless asked.” For patients who are very worried, he said, “The fix is simple — switch to iced tea and iced lattes.”
Fiona Osgun, Cancer Research UK’s head of health information, pointed to the bigger levers in the Oxford announcement. “The most important ways to reduce the risk of this cancer type are not smoking and cutting down on alcohol,” she said.
