Cancer of the esophagus has a more varied geographical distribution and incidence than any other commonly occurring cancer. Its incidence rate is increasing in many countries, especially among males. Esophageal cancer has been found to be associated with the consumption of alcohol and tobacco, particularly when combined, and in the last decade the role of nutrition and diet in the etiology of this disease has attracted worldwide attention. Regions with a large incidence of this disease are generally located in poor parts of the world, and their inhabitants share several dietary characteristics. They subsist on a diet high in starch and almost without fresh fruit or vegetables, eat rapidly without sufficient mastication, and consume many foods (rice gruel) and drinks (tea) at very high temperatures. Hard and scratchy foods also are consumed frequently. In the high-risk region of northern Iran, where the frequency of esophageal cancer is higher among women than men, the main food during pregnancy contains strong black pepper and sharp crushed pomegranate seeds, which irritate the esophagus.