June 21, 2011
Barrett’s Esophagus and Cancer Risk
(Ivanhoe Newswire) -- Patients with Barrett's esophagus may have a lower risk of esophageal cancer than previously thought, according to this study.
Barrett's esophagus is a precancerous condition, and patients who have it are often advised to have regular endoscopies to watch for signs of esophageal adenocarcinoma, the most common kind of esophageal cancer. However, how often Barrett's esophagus progresses to cancer has not been clear.
In this study, Shivaram Bhat, B.Ch., MRCP, of Queens University Belfast and colleagues followed 8,522 patients in the Northern Ireland Barrett's Esophagus Registry, one of the largest registries in the world of people with the condition. After an average follow-up time of 7 years, 79 patients were diagnosed with esophageal cancer, 16 with cancer of the gastric cardia (the part of the stomach closest to the esophagus), and 36 with precancerous changes known as high-grade dysplasia. In the entire group, the incidence of these three conditions combined was 0.22% per year. Previous studies have reported an incidence of cancer among people with Barrett's esophagus between 0.58 percent and 3 percent per year.
Men were significantly more likely to progress to malignancy than women, and people age 60-69 had a higher risk than those under 50 or those age 80 and over. The highest rates of progression were among patients with low-grade dysplasia (1.40 percent) or specialized intestinal metaplasia (0.38 percent) at their initial endoscopy and biopsy.
The authors conclude that the risk of Barrett's esophagus progressing to esophageal cancer is less than previously reported and that this finding has implications for clinical practice.
"Current recommendations for surveillance are based on higher estimates of cancer risk among patients with [Barrett's esophagus] than were seen in this study and therefore, they may not be justified," they were quoted as saying.
SOURCE: Journal of the National Cancer Institute, published online June 16, 2011