Abstract: The incidence rates of esophageal cancer have been decreasing since 1988 in Linxian and Cixian as the results of year-round preventive effort for several decades. But remarkable decreasing in incidence is confined to age groups above the age of 60 year old only. For the age group from 40 through 59, the decreasing is slight; and for those under the age of 40 years old, no decrease can be perceived. This may suggest that the primary risk of esophageal cancer still remains as strong in the high-risk areas, and the decreased incidence may be credited mainly to secondary preventive measures. Although early diagnosis is still the key to control esophageal cancer presently, the rate of early detection is very low due to the lacking of efficient screening programs in the high-risk areas. Recently, Cancer Foundation of China initiated a series of endoscopic screening programs across the country aimed to improve early detection and treatment in the field. The objective of this article is to provide clues to help improve screening efficiency in the field.