The reason survival rates are not as good as other cancers is that patients are often diagnosed too late. "If the person is lucky, they are there for another reason and we pick it up early at stage 1," he said.
At stage 1, the cancer is just on the surface of cells; stage 2 the disease has entered the muscle wall; state three it has gone through the entire wall; and in stage 4, the cancer has spread.
"Most of the time, it's picked up in stage 3 or 4," he said.
Esophageal cancer, depending on its type or stage or other factors, can be treated with surgery, chemotherapy or radiation. Squamous cell cancer seems to be more receptive to radiation.
Early studies have shown that patients who get radiation treatment alone in this early form of cancer have a survival rate of 60 percent, according to Francois.
As in all cancers, three factors are involved in assessing a person's risk: genetic make-up, environmental factors like toxins (including smoking and drinking); and perhaps, new studies are showing, microbacteria in the stomach, like H-pilori.
Interestingly, stomach cancer is associated with H-pilori, according to research, but the bacteria seem somewhat "protective" for adenocarcinoma of the esophagus.
"For the average American, I wouldn't recommend screening," said Francois. "However if you have symptoms of acid reflux and they are not going away and not being treated with acid blockers, I would see a doctor to be evaluated."
Those with trouble swallowing or who have had symptoms of acid reflux for more than 10 years and are in a high-risk group like white males, should seek a one-time endoscopy to evaluate for Barrett's esophagus, said Francois.
"Then we can follow you and make sure it doesn't transition to cancer," he said.
There are no such tests for squamous cell cancer, short of a biopsy of the esophagus, for heavy smokers and drinkers like Hitchens.
Those who do drink should consider cutting back, something Hitchens -– in his own inimitable way -– said that he has done.
"There was a time when I could reckon to outperform all but the most hardened imbibers, but I now drink relatively carefully," he wrote in "Hitch-22," describing his working day.
"At about half past midday, a decent slug of Mr. Walker's amber restorative, cut with Perrier water (an ideal delivery system) and no ice. At luncheon, perhaps half a bottle of red wine: not always more but never less. Then back to the desk, and ready to repeat the treatment at the evening meal. No 'after dinner drinks' -- most especially nothing sweet and never, ever any brandy. 'Nightcaps' depend on how well the day went, but always the mixture as before. No mixing: no messing around with a gin here and a vodka there."