Does Beverage Temperature Really Increase Cancer Risk?

Hot Beverages and Esophageal Cancer: What Doctors and Patients Should Really Know

The Big Picture
Esophageal cancer is among the more aggressive malignancies, often diagnosed late and associated with poor outcomes. Globally, it comes in two main forms: squamous cell carcinoma (ESCC) and adenocarcinoma (EAC). Each type has different risk factors, geographical patterns, and patient profiles.

In recent years, one risk factor has drawn increasing attention: drinking very hot beverages. While tea, coffee, and herbal infusions have been consumed for centuries, their temperature — not necessarily their contents — has become a focus in cancer prevention research.

Known Risk Factors for Esophageal Cancer
Esophageal Squamous Cell Carcinoma (ESCC)

• More common in Asia, Africa, and parts of South America.
  
  
• Strongly linked to tobacco, heavy alcohol use, low socioeconomic status, poor oral hygiene, and, as recent evidence shows, very hot drinks.
  

Esophageal Adenocarcinoma (EAC)

• Increasingly common in Western countries.
  
  
• Driven by gastroesophageal reflux disease (GERD), obesity, and Barrett’s esophagus.
  
  
• Evidence for a link with hot beverages is weak.
  

What Earlier Studies Showed
Older epidemiological studies, especially from regions with high ESCC incidence, consistently showed that the temperature of drinks mattered more than the volume consumed. People who drank tea, coffee, or maté at very high temperatures were at significantly higher risk of esophageal cancer compared with those who drank them warm.

Maté, in particular, consumed scalding hot in South America, stood out as a strong example: both the amount and the heat independently raised risk.

The Role of Temperature
The key message from decades of research is that the heat itself — not necessarily the chemical contents of tea or coffee — damages the lining of the esophagus.

• Repeated thermal injury can cause micro-traumas in the squamous lining.
  
  
• These tiny injuries heal with cell proliferation, which increases opportunities for DNA errors and mutations.
  
  
• Over years, this creates fertile ground for malignant transformation, especially when combined with other carcinogens like tobacco smoke and alcohol.
  

Large-Scale Evidence from Western Populations
The more recent large-scale cohort studies have given us sharper insights. In Western populations where adenocarcinoma dominates, very hot drinks do not appear strongly linked to EAC.

But for ESCC, the findings are striking:

• People drinking more than four cups of “hot” beverages daily had higher risk.
  
  
• Those drinking eight or more cups of “very hot” beverages daily had up to five- or six-fold higher risk of ESCC compared with people who drank warm or no hot drinks.
  

The relationship is dose-dependent: both temperature and number of cups per day matter.

Why Squamous Cell Carcinoma?
The squamous lining of the upper and mid-esophagus is thin and vulnerable to direct thermal injury. Adenocarcinoma, on the other hand, tends to arise lower in the esophagus due to chronic reflux and acid exposure. The pathogenesis is different, which may explain why hot drinks are far more relevant for ESCC than EAC.

Expert Commentary
Cancer centers and specialists highlight an important point: hot drinks alone do not cause esophageal cancer. Instead, they act as one piece of a complex puzzle.

• A smoker who also drinks very hot tea may multiply their risk.
  
  
• Someone who drinks scalding coffee and also consumes heavy alcohol is at even higher risk.
  
  
• In contrast, a person who drinks two or three cups of hot coffee daily but does not smoke, drinks alcohol minimally, and maintains good health has a much lower overall risk.
  

The take-home message: very hot beverages amplify existing risks rather than act as a single, isolated cause.

Biological Plausibility
Why does heat matter? Several mechanisms have been proposed:

1. Thermal Injury – Direct burns cause repeated cycles of injury and repair, increasing mutation risk.
   
   
2. Synergy with Carcinogens – Hot beverages may make the esophagus more permeable to tobacco- and alcohol-related carcinogens.
   
   
3. Inflammation – Chronic irritation and inflammation trigger changes in cell signaling that favor tumor growth.
   
   
4. Cumulative Damage – The more frequently hot drinks are consumed, the less time the tissue has to recover, increasing risk over decades.
   

How Hot Is “Too Hot”?
Researchers suggest that beverages consumed above 65°C (149°F) should be considered “very hot.” At this temperature, thermal injury is more likely.

In many Western households, coffee or tea is often consumed cooler than this — either by adding milk or letting it sit for a few minutes. But in some cultures, especially where drinks are consumed straight from boiling pots or kettles, temperatures easily exceed this threshold.

Case Examples for Clinical Context
Case 1: The High-Risk Patient
A 55-year-old man in Central Asia drinks ten cups of steaming hot tea daily, smokes, and drinks alcohol heavily. His combined risks make him highly vulnerable to ESCC. For him, reducing beverage temperature is a meaningful intervention.

Case 2: The Moderate Drinker
A 45-year-old woman in Europe drinks two cups of coffee daily, hot but not scalding, and does not smoke. Her overall risk from hot drinks is negligible compared with other factors.

Case 3: The Reflux Patient
A 50-year-old obese man with chronic GERD and Barrett’s esophagus drinks three cups of tea daily. For him, hot drinks likely play little role in his EAC risk; managing reflux and weight is far more important.

Public Health Implications
Global Differences

• In countries with high ESCC incidence, especially where cultural practices involve drinking boiling-hot tea or maté, public health campaigns could emphasize allowing drinks to cool before consumption.
  
  
• In Western countries, obesity and reflux remain the bigger drivers of EAC, but hot drink temperature should still be part of prevention messaging.
  

Simple Recommendations

• Let drinks cool a few minutes before sipping.
  
  
• Add milk or cooler liquid when possible.
  
  
• Avoid gulping large quantities of steaming hot liquid.
  
  
• Focus on reducing stronger risks such as tobacco, alcohol, and obesity.
  

What We Still Don’t Know

• The exact temperature threshold for risk is still debated.
  
  
• Most studies rely on self-reported “hot” versus “very hot,” which is subjective.
  
  
• Whether cooling practices (like adding milk) significantly reduce risk has not been conclusively studied.
  
  
• The interaction between hot drinks and emerging dietary or genetic risk factors remains under-explored.
  

Key Messages for Doctors

• Always consider cultural drinking habits when assessing patient risk for esophageal cancer.
  
  
• Hot drink consumption should be part of the history, especially in patients from high-risk regions.
  
  
• Counseling should be balanced: hot drinks matter, but smoking, alcohol, obesity, and reflux remain the bigger culprits.
  
  
• Prevention is multifactorial — small behavioral changes like cooling drinks may help, but broader lifestyle modifications have greater impact.