COMMENTARY

Risk for Progression to Cancer in Barrett's Esophagus

David A. Johnson, MD

Disclosures

November 04, 2011

In This Article

Author's Note: Barrett's esophagus (BE) is a precancerous condition that progresses to high-grade dysplasia (HGD) at an estimated rate of 0.5%-0.9% per year. Current national society guidelines suggest performing endoscopic surveillance and biopsy of metaplastic esophageal tissue mucosa at 3-year intervals in patients with nondysplastic BE and shorter surveillance intervals or ablative therapy for patients with evidence of dysplasia. However, the cost-effectiveness of surveillance is dependent on the risk for progression of nondysplastic BE to dysplasia or cancer, a risk that remains unclear. A number of recent articles have raised questions about the current "standard of care" for the need for diagnosis and surveillance of patients with BE.

Risk of Malignant Progression in Barrett's Esophagus Patients: Results From a Large Population-Based Study

Bhat S, Coleman HG, Yousef F, et al
J Natl Cancer Inst. 2011;103:1049-1057

Study Summary

Bhat and colleagues conducted a retrospective review of data from a BE registry of 8522 patients (58% men) in Northern Ireland. Investigators assessed the rate of progression of BE to high-grade dysplasia (HGD) or cancers of the esophagus or gastric cardia. The mean follow-up was 7 years (range: 1-22 years). Overall, HGD or cancer occurred in 0.22% of patients per year. Among the 46% of patients with specialized columnar metaplasia (SCM) at baseline, the risk for HGD or cancers was higher than for those without SCM at baseline (0.38% per year vs 0.07% per year). Men had a higher risk than women (0.28% per year vs 0.13% per year). The rate of progression to cancer did not vary among patients who had BE for 1-6 years, 6-11 years, or >11 years.

Viewpoint

This is one of the largest studies to date to evaluate the risk for progression of BE to cancer. In contrast to those in the United States, European guidelines do not require biopsy evidence of SCM for the diagnosis of BE. Therefore, it would be inappropriate to apply the overall risk for progression to cancer observed in this study cohort (with and without SCM) to the US population. However, given the extremely low cancer rates in the patients without SCM, the value and cost-effectiveness of surveillance raises questions about current standards.

Abstract

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