Heartburn Isn't a Cancer Sentence

Cancer risk from Barrett's esophagus not as high as previously thought

(RxWiki News) Over time, heartburn can wear down the lining of your esophagus. This can put you at risk for cancer. But is the risk really that high?

While it is known that Barrett's esophagus (damage to lining of the esophagus from stomach acid) increases a patient's risk of cancer, researchers found that risk is lower than previously thought. This could mean that the costs of screening and treatment may cancel out some of their benefits to patients.

"Barrett's esophagus doesn't always lead to cancer."

Barrett's esophagus is caused by acid reflux disease, the main cause of heartburn. People develop Barrett's esophagus when stomach acids damage the lining of the esophagus, basically making the tissue similar to that of the intestines or stomach. This tissue then becomes more likely to be cancerous.

Doctors use different screening and treatment methods to make sure patients with this problem do not develop cancer. However, Shivaram Bhat, M.B.B.Ch., M.R.C.P., from Queens University Belfast in Northern Ireland, and colleagues found that it may not be worth the cost to test every Barrett's esophagus patient for cancer.

The researchers found only 0.22 percent of patients with Barrett's esophagus developed cancer or pre-cancerous tissue every year. However, when they used a much more specific definition of Barrett's esophagus, that number rose to 0.38 percent per year.

Nonetheless, both rates of cancer are lower than those found in past studies.

The researchers also found that the risk of cancer from Barrett's esophagus was higher in men than in women.

In a separate article about this study, David A. Corley, M.D., Ph.D., from the Division of Research at Kaiser Permanente, explains a few key points drawn from these findings.

First, patients without intestinal metaplasia (when the esophagus tissue becomes like stomach tissue) are at a very low risk of esophageal cancer, which means they probably not benefit from testing or treatments.

Second, testing and treatment may be cost-effective for patients who do have intestinal metaplasia, as doctors may be able to help those patients avoid cancer. However, Corley adds, it would only be cost-effective if the tests and treatments actually work, which is not yet proven by research.

Third, the cancer risk from Barrett's esophagus is higher among men than women. This may mean that testing men for cancer risk may be more cost-effective than frequent testing in women.

Because the risk of cancer from Barrett's esophagus is lower than previously thought, Bhat and colleagues conclude that the currently recommended testing strategies may not be cost-effective.

For their study, the researchers followed 8,522 patients with Barrett's esophagus. The patients were part of the Northern Ireland Barrett's esophagus Register, one of the largest Barrett's esophagus databases.

Following the patients for a mean of 7 years, the researchers saw 79 patients diagnosed with esophageal cancer, 16 with cancer of the gastric cardia (part of the stomach), and 36 with high-grade pre-cancerous tissue.

The study received support from the Ulster Cancer Foundation and the Health and Social Care Research and Development Office in Norther Ireland, and was published in the Journal of the National Cancer Institute.

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Review Date: 
June 17, 2011