Barrett's Esophagus May Be Less Risky Than Thought
Study Questions Need for Invasive Screening in Patients With Barrett's Esophagus
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.
But the debate over screening for cancer of the esophagus may be even more pitched because the cancer is so lethal and it's on the rise in the U.S.
"If you get the cancer, you don't survive, by and large," says Peter J. Kahrilas, MD, a gastroenterologist at Northwestern Memorial Hospital and a professor in the department of medicine at the Feinberg School of Medicine at Northwestern University in Chicago.
"The only strategy for surviving the cancer, and this is the irony of the whole thing, is early detection," says Kahrilas, who was not involved in the research but wrote an editorial on the study.
To many doctors, that means a diagnosis of Barrett's, one of the few established risk factors for cancer of the esophagus, shouldn't be ignored.
"As an esophageal surgeon who deals with esophageal cancer and who has to at times tell people, 'I'm sorry, this is now metastatic [the cancer has spread], I can't operate on you,' I have a hard time reconciling inside of myself telling someone with Barrett's, 'You have Barrett's. Don't worry about it. You don't need any further examination.' That makes me very, very nervous," says Christian G. Peyre, MD, an assistant professor of surgery at the University of Rochester Medical Center in New York. Peyre was not involved in the study.
The better question in Peyre's mind is how often people with Barrett's need to be checked.
Guidelines suggest doing a test called an endoscopy with a biopsy every two to five years in people who have Barrett's esophagus or even persistent heartburn.