It has recently been hypothesized that the general shift in use from suspenders to belts among men might be a factor that could promote reflux, particularly among overweight men, and thereby contribute to the alarmingly increasing incidence of esophageal and cardia adenocarcinoma. We addressed this hypothesis in a nationwide Swedish population-based case-control study, conducted in 1995-1997. Included were 189 patients with esophageal adenocarcinoma and 262 patients with cardia adenocarcinoma, who were compared with 167 patients with esophageal squamous cell carcinoma and 820 population-based control participants. Data were collected at structured face-to-face interviews with all study participants. Tumor classification was uniform and thorough. Odds ratios (OR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated in multivariable logistic regression models. Daily use of tight belts 20 years earlier did not entail an increased risk of adenocarcinoma of the esophagus (OR 1.1, 95% CI 0.7-1.8) or cardia (OR 0.8, 95% CI 0.5-1.3) compared to never use. Adjustment for reflux symptoms, body mass and other potentially relevant covariates did not influence the results. Similarly, in analyses restricted to overweight men, no associations were identified. No association with esophageal squamous cell carcinoma was found. In conclusion, this study provided no support for the hypothesis that use of tight belts is associated with an increased risk of developing esophageal or cardia adenocarcinoma.