More people with Barrett's esophagus at high risk of developing esophageal cancer than previously thought

April 17, 2000

Significantly more people who suffer from Barrett's esophagus, a precancerous condition often associated with frequent heartburn, may be at high risk of developing esophageal cancer than previously thought, according to researchers at the Fred Hutchinson Cancer Research Center in Seattle. These findings, by Rebecca Rudolph, M.D., M.P.H., and colleagues, appear today in the Annals of Internal Medicine.

An estimated 20 million Americans experience chronic heartburn that goes well beyond the occasional misery of having one too many chili dogs. About 2 million of these people have Barrett's esophagus, a premalignant condition of the esophagus, the tube that carries food from the mouth to the stomach. While the condition is most prevalent in middle-aged white men, the incidence of Barrett's esophagus is rising in women and African Americans. A physician may suspect that the condition is present if part of the inner lining of the esophagus is red rather than the usual light pink. This is determined through a procedure called endoscopy, in which a tubelike instrument is used to view the esophageal lining. However, a definite diagnosis cannot be made unless small samples of the red lining are biopsied, or removed and examined under a microscope, and found to have cellular changes typical of this disorder.

People with "long-segment" Barrett's esophagus, in which the red lining is 3 cm or more in length, are about 40 times more likely than those in the general population to develop esophageal cancer. As a result, they typically undergo regular endoscopic screening and biopsies to ensure their condition has not progressed to cancer.

Substantially more common, however, is "short-segment" Barrett's, in which the patch of affected tissue is no more than 3 cm long. Until recently, esophageal-cancer risk in people with shorter segments was largely unknown because such patients often were excluded from studies because their condition was more difficult to diagnose through endoscopy, and because researchers initially were uncertain whether short-segment Barrett's indeed was a cancer risk factor at all.

Rudolph and colleagues at the Hutchinson Center and the University of Washington have found that, contrary to popular belief, the risk of esophageal cancer in patients with short-segment Barrett's is not substantially lower than in patients with longer patches of affected tissue. "The general feeling among gastroenterologists has been that people with short- segment Barrett's are probably at a much lower risk of developing esophageal cancer, and so it is possible that these people aren't being monitored as aggressively as they should," says Rudolph, the lead author of the study. The study, the largest single-center trial of its kind, involved 309 Barrett's patients, primarily from the Puget Sound area, who were followed and closely monitored for four years.

Barrett's-related esophageal cancer strikes about 10,000 people a year, and for unknown reasons, the incidence is rising faster than that of any other cancer in the United States. Barrett's-related cancers tripled between 1976 and 1990, and more than doubled in the past decade. If not diagnosed early, the outlook is grim; more than 90 percent of patients with invasive esophageal adenocarcinoma die within five years of diagnosis. Currently, the recommended screening frequency for Barrett's esophagus ranges from once every three to six months to once every two to three years, depending on segment length and the degree of dysplasia, or cellular abnormality, detected under the microscope upon biopsy.

"Until more data is available, the frequency of endoscopic surveillance should be determined without regard to the patient's segment length," says Rudolph, a clinical specialist in the Center's Public Health Sciences Division. "For now, people with short-segment Barrett's should be treated exactly the same as people with long-segment Barrett's."
-end-
Senior authorship of the study was shared by Brian Reid, M.D., Ph.D., a member of the Center's Clinical, Human Biology and Public Health Sciences divisions and a professor of gastroenterology at UW; and Thomas Vaughan, M.D., M.P.H., a member of the Center's Public Health Sciences Division and a professor of epidemiology at the UW School of Public Health and Community Medicine. This research was supported by grants from the National Institutes of Health. Editor's note: A copy of the paper "Effect of Segment Length on Risk for Neoplastic Progression in Patients with Barrett Esophagus" is available on the journal's Web site, http://www.acponline.org, or by calling 215-351-2656.

The Fred Hutchinson Cancer Research Center is an independent, nonprofit research institution dedicated to the development and advancement of biomedical technology to eliminate cancer and other potentially fatal diseases. Recognized internationally for its pioneering work in bone-marrow transplantation, the Center's four scientific divisions collaborate to form a unique environment for conducting basic and applied science. The Hutchinson Center is the only National Cancer Institute-designated comprehensive cancer center in the Pacific Northwest. For more information, visit the Center's Web site at http://www.fhcrc.org.

Fred Hutchinson Cancer Research Center

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.