Nearly half of the esophageal cancer cases worldwide occur in China, and Henan Province (especially along the Taihang Mountains such as Linzhou, Anyang, and other areas) has long been one of the highest incidence regions domestically. This is not solely caused by climate or "iron teeth and copper gums," but the result of multiple factors accumulating over time.

The key high-risk factors include:
1. **Long-term consumption of very hot foods and drinks** (one of the most direct and widely confirmed factors)
In Henan's culinary culture, dishes like braised noodles, spicy hot soup, mutton soup, and hot porridge must be eaten "while hot." Once cooled, the taste deteriorates or even becomes "mushy." Many people can swallow foods at 65–80℃+ directly. The International Agency for Research on Cancer (IARC) under the World Health Organization has already classified hot drinks/hot foods at ≥65℃ as Group 2A carcinogens. Repeated scalding of the esophageal mucosa → chronic inflammation → abnormal cell proliferation → significantly increased risk of cancer. Laboratory and population studies confirm that the esophageal mucosa can tolerate temperatures up to about 50–60℃; long-term exposure above this temperature is essentially chronic "self-scalding."
2. **Exposure to nitrosamine compounds** (once known as the "chemical culprit")
Research in Lin County, Henan, a high-incidence area in the last century, found that high levels of nitrites in local pickled cabbage jars, fermented vegetables, moldy grains, and well water/overnight water could easily lead to the synthesis of potent carcinogens called nitrosamines in the stomach. Over the past decades, comprehensive interventions such as water improvement, toilet upgrades, mold prevention, and reduced pickling have significantly lowered the incidence (Linzhou's rate dropped from nearly 500/100,000 to about 50–60/100,000).
3. **Mold toxin + nutritional deficiencies** (a historical legacy)
Previously, grains (mainly corn) were prone to mold, producing aflatoxins and ochratoxins, which synergistically cause cancer with nitrosamines. Additionally, a monotonous diet lacking fresh vegetables and fruits led to severe deficiencies in vitamin A/B2/C, selenium, molybdenum, zinc, and other nutrients, which are known protective factors. Without these, carcinogens are more likely to take effect.
4. **Smoking + heavy alcohol consumption** (amplifiers)
Henan's liquor consumption has been among the highest nationwide, with 52° (percent alcohol) spirits being common. Tobacco and alcohol are independent high-risk factors for esophageal cancer, and their combined effect doubles the risk. Drinking alcohol along with hot soup and hot noodles further exacerbates the damage.
"Henan people eat very hot food," "hot enough to make you gasp and still burn the skin," and "strong tolerance" are indeed adaptations developed through long-term high-temperature eating habits. However, this is precisely the vicious cycle of repeated injury and repair of the esophageal mucosa—tolerance increases, but so does the risk of malignant transformation. It’s not "iron teeth and copper gums" protecting them; rather, it’s causing them to unknowingly "scald" themselves into a high-risk pathway.
In summary:
**High incidence of esophageal cancer in Henan ≠ "climate/habits/poverty" itself, but the result of a "culture of very hot foods + historical nitrosamine/mold/toxins/nutrition deficiencies + smoking and drinking" combined assault over decades.**
The good news is: Linzhou has proven that by changing hot food habits, reducing pickling, improving water quality, preventing mold, supplementing nutrition, and controlling smoking and alcohol, the incidence rate can be significantly reduced.
The bad news is: as long as the idea of "eating while hot is more delicious" persists, the "Henan nail" of esophageal cancer may continue for some time.
Don’t wait until swallowing difficulties occur to regret it. For those over 40, especially in high-incidence areas, regular gastroscopy screening is recommended.
Eating hot food for a moment of pleasure, but esophageal cancer treatment is a crematorium—this is no joke.
(Data references: National Cancer Center, Linzhou on-site research, WHO/IARC reports, etc.)