Barrett's Esophagus May Be Less Risky Than Thought
Study Questions Need for Invasive Screening in Patients With Barrett's Esophagus
Oct. 12, 2011 -- People with Barrett's esophagus, a complication of heartburn and acid reflux disease, are at risk of developing a deadly kind of cancer at much lower rates than doctors previously believed, a new study shows.
The study is published in the New England Journal of Medicine.
Researchers collected information on more than 11,000 people in Denmark who were diagnosed with Barrett's esophagus to see how many would go on to develop an aggressive cancer called adenocarcinoma of the esophagus.
In Barrett's esophagus the lining of the esophagus, the muscular tube that connects the throat to the stomach, abnormally changes after repeated exposure to stomach acid.
The condition may affect as many as 1 million American adults. It is most commonly diagnosed in men who are white, overweight, and over age 50.
Previous studies have found that Barrett's esophagus increases the risk of getting cancer of the esophagus. This study found that the risk of cancer, while still elevated, is much lower than previously believed, about 0.12% per year. That equals about one case of cancer diagnosed each year for every 860 people with Barrett's. That's about an 80% lower risk than previously believed.
Those findings echo another study published earlier this year in the Journal of the National Cancer Institute. That study, of 1.7 million people in Northern Ireland, estimated the yearly risk of cancer of the esophagus in people with Barrett's to be around 0.13%, or one case of cancer each year for every 769 people diagnosed with the condition.
Researchers say the findings mean that it may not be helpful or cost-effective for doctors to give some people with Barrett's regular, invasive tests to keep looking for cancer.
"I think it's going to be a landmark study," says Heiko Pohl, MD, a gastroenterologist and associate professor of medicine at Dartmouth Medical School and Dartmouth Medical Center in Lebanon, N.H. Pohl studies the risks and benefits of cancer screening tests. He was not involved in the current research.
"This is going to help us get a better understanding of the magnitude of the problem, what Barrett's really means," he tells WebMD.
Many patients with Barrett's are offered surgery to freeze or burn off the abnormal tissue, even if they don't have any signs of cancer.
"Hopefully this study will put a little brake on the whole hype," Pohl says.
Questions About Cancer Screening
The study is likely to fuel an already highly charged debate about whether the risks of some kinds of cancer screening tests outweigh the benefits of early detection.
Earlier this week, the U.S. Preventive Services Task Force recommended against routine PSA screening for prostate cancer unless a man has suspicious symptoms. That's because studies have failed to find a lifesaving benefit for that test and positive tests often lead to treatments that can have side effects, like erectile dysfunction and incontinence.