AIM: In order to detect risk factors for esophageal cancer, a national research program was carried out during the Eighth Five-Year Plan (from 1991 to 1995). METHODS: Cixian County and Chichen County in Hebei Province were selected as the index and the control for the study fields with higher or lower incidence of esophagus cancer in China, respectively. In these areas, we investigated the pollution of three nitrogenous compounds in well water for drinking and the use of nitrogen fertilizer in farming. RESULTS: In well water, nitrate nitrogen, nitrite nitrogen and ammonia nitrogen were 8.77 mg/L, 0.014 mg/L and 0.009 mg/L in Cixian County in 1993, respectively. They were significantly higher than their levels (3.84 mg/L, 0.004 mg/L and 0.004 mg/L) in Chichen County (P < 0.01, t = 6.281, t = 3.784, t = 3.775). There was a trend that the nitrogenous compounds in well water increased from 1993 to 1996. The amount of nitrogen fertilizer used in farming was 787. 6 kg per hectare land in Cixian County in 1991, significantly higher than 186 kg per hectare in Chichen County (t = 9.603, P < 0.001). CONCLUSION: These investigations indicate that the pollution of nitrogenous compounds in well water for drinking is closely related to the use of nitrogen fertilizer in farming, and there is a significantly positive correlation between the level of three nitrogenous compounds in well water and the mortality of esophageal cancer (correlation coefficient =0.5992). We suggest that improvement of well system for drinking water quality should be an effective measure for esophageal cancer prevention and control in rural areas.