COMMENTARY

Risk for Progression to Cancer in Barrett's Esophagus

David A. Johnson, MD

Disclosures

November 04, 2011

In This Article

Esophageal Adenocarcinoma Incidence in Individuals With Gastroesophageal Reflux: Synthesis and Estimates From Population Studies

Rubenstein JH, Scheiman JM, Sadeghi S, Whiteman D, Inadomi JM
Am J Gastroenterol. 2011;106:254-260

Study Summary

The third article of interest on the topic of re-evaluating the standard of care for BE/EAC screening is from Rubenstein and associates. These researchers questioned whether the standard practice of screening for EAC in patients with chronic gastroesophageal reflux disease (GERD) has value relative to other preventive screening programs. They created a Markov computer model using readily available national surveillance data to estimate the age- and gender-specific incidences of EAC among non-Hispanic white individuals with GERD in the United States. To place the results in context, they cited incidences of breast cancer and colorectal cancer (CRC), for which screening recommendations are well-established.

Overall, at any age, the incidence of EAC was lower in women than in men. For a woman aged 60 years, with weekly GERD symptoms, the incidence of EAC was 3.9/100,000 person-years (similar to the incidence of breast cancer in men) compared with 34.6/100,000 for a man with weekly GERD symptoms. The incidence of EAC in men < 50 years of age with weekly GERD symptoms was relatively low compared with those > 60 years of age. For example, the incidence of EAC was 1.0/100,000 person-years at 35 years of age (6.7 times lower than the incidence of CRC) vs 60.8/100,000 at 70 years of age (3 times lower than the incidence of CRC).

Viewpoint

Although the incidence of EAC has risen sharply, the disease is still relatively rare and occurs primarily in men for unknown reasons. An editorialist[2] commented that neither consensus guidelines nor physician practice takes this gender disparity into account in making screening recommendations for EAC, presumably in part to prevent any appearance of sexism. These data suggest that women with GERD have the same risk for EAC as men have for breast cancer -- a point that may be a useful perspective for clinicians to apply to their practice and help them understand the relative "values" of their current screening practices.

Abstract

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