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Esophageal Cancer On the Rise

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Esophageal Cancer Risk Factors

Numerous factors increase the risk for esophageal cancer:

  • Age over 60
  • Male sex
  • Tobacco use
  • Alcohol use
  • Barrett's esophagus (see below)
  • History of head or neck cancer
  • Frequent drinking of very hot beverages
  • Obesity

Different risk factors are important for each type of esophageal cancer:

  • Squamous cell cancers: tobacco or alcohol use increase risk the most. More than half of these cancers are linked to tobacco. Using both tobacco and alcohol together raises the risk far more than using either alone.
  • Adenocarcinomas: A condition called Barrett's esophagus contributes to this form of esophageal cancer. Smoking doubles the risk of adenocarcinoma, but alcohol doesn't play a role.

Barrett's Esophagus: More Serious Than Heartburn

Acid regurgitation from the stomach into the esophagus causes heartburn and indigestion. Nearly everyone experiences this uncomfortable sensation at some time in life. Surveys suggest that tens of millions of Americans feel reflux symptoms at least once a week. Doctors call this "gastroesophageal reflux disease," or GERD.

When acid reflux occurs frequently, though, the chronic irritation (esophagitis) can cause problems:

  • The cells at the bottom of the esophagus can change form in response to the acid irritation.
  • The new abnormal cell pattern is called Barrett's esophagus.
  • People with Barrett's esophagus have a 1 in 200 chance of developing adenocarcinoma each year, far higher than the general population.

Is a rising rate of Barrett's esophagus causing the increase in the adenocarcinoma form of esophageal cancer? No one can say, because we can't accurately estimate how many people have Barrett's esophagus.

Barrett's esophagus is both common and elusive:

  • Approximately five to eight percent of people with GERD also have Barrett's esophagus.
  • However, as many as 95 percent of people with Barrett's esophagus don't know they have it.
  • About one-quarter of people with Barrett's have no reflux symptoms.
  • Although well-associated with adenocarcinoma, 90 percent of people with Barrett's esophagus will never develop esophageal cancer.

A physician can only diagnose Barrett's esophagus through upper endoscopy. While generally safe, this procedure requires sedation, expense, and some risk.

According to the American College of Gastroenterology, "patients with chronic GERD symptoms are those most likely to have Barrett's esophagus and should undergo upper endoscopy."

Bains agrees: "Clearly a certain group with chronic reflux disease are at higher risk," and should be screened with upper endoscopy.

However, the National Cancer Institute recommends against screening asymptomatic people with endoscopy.

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