Barrett’s esophagus may be linked to lower risk for malignancy than previously reported

Bhat S. J Natl Cancer Inst. 2011;doi:10.1093/jnci/djr203.

The risk for esophageal cancer among patients with Barrett’s esophagus may not be as high as previously thought, according to researchers in Northern Ireland.

Using data from the Northern Ireland Barrett's esophagus Register, which includes all adults in Northern Ireland diagnosed with Barrett’s esophagus between 1993 and 2005, researchers identified 8,522 patients with the lesion with or without specialized intestinal metaplasia.

Average follow-up was 7 years, at which time 79 patients were diagnosed with esophageal cancer, 16 with cancer of the gastric cardia and 36 with high-grade dysplasia. Combined, the incidence was 0.22% per year; previous studies have reported an incidence between 0.58% and 3% per year.

When assessing the incidence of cancer and high-grade dysplasia in various subgroups, the researchers found that the risk was statistically higher in patients with specialized intestinal metaplasia vs. those without (0.38% per year vs. 0.07% per year; HR=3.54; 95% CI, 2.09-6.00). Additionally, men were at higher risk than women (0.28% per year vs. 0.13% per year; HR=2.11; 95% CI, 1.41-3.16), and patients with low-grade dysplasia were at higher risk than those without dysplasia (1.4% vs. 0.17%; HR=5.67, 95% CI, 3.77-8.53).

“Current recommendations for surveillance are based on higher estimates of cancer risk among patients with [Barrett’s esophagus] than were seen in this study, and therefore, they may not be justified,” the researchers wrote. “We eagerly await further research into tissue biomarkers, optical recognition of dysplasia, and nonsurgical therapies for dysplasia and neoplasia. Such research may enable targeted surveillance of those [Barrett’s esophagus] patients who are at greatest risk of neoplastic progression, with the ultimate aim of reducing morbidity and mortality from esophageal adenocarcinoma.”

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