In those populations, the highest chili intake was associated with substantially lower gastrointestinal cancer risk. Only one reported Helicobacter pylori status, despite that infection being a major gastrointestinal cancer risk factor. That study measured mortality, not esophageal cancer incidence, and it is observational as well. Esophageal cancer remains a lethal disease usually found late, according to National Cancer Institute surveillance data, and the established drivers are tobacco, heavy alcohol, reflux, and obesity. None of the chili studies recorded how hot the food or drink was, leaving a plausible confounder unmeasured.