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This cohort study is evaluating the environmental and genetic risk factors for esophageal squamous cell carcinoma (ESCC) in Golestan Province, Iran. The study is led by the Digestive Diseases Research Institute of Tehran University of Medical Sciences in collaboration with NCI Division of Cancer Epidemiology and Genetics, and the International Agency for Research on Cancer (IARC) in Lyon. From 2004 – 2008, the study recruited approximately 50,000 adults. The study population is a sample of the Golestan population, aged 40-75 years. Baseline assessments included a lifestyle questionnaire, a semi-quantitative food frequency questionnaire, and collection of blood, hair, nails and urine. Measurements included height, weight, waist and hip circumference, body size at different ages, and physical activity. Annual follow-up is ongoing.