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 18 June 2018

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News

Patients with Barrett's have a persistent excess risk of esophageal cancer

March's issue of Gut examines the incidence of cancer and mortality risks in a large Barrett's esophagus cohort in the USA

News image

Barrett's esophagus increases the risk of esophageal adenocarcinoma by 10–55 times that of the general population, but no community-based cancer-specific incidence and cause-specific mortality risk estimates exist for large cohorts in the United States.

Dr Michael Blaise Cook and colleagues from Maryland, USA identified patients with Barrett's esophagus diagnosed during 1995–2012.

Kaiser Permanente Northern California cancer registry and mortality files were used to estimate standardized incidence ratios, standardized mortality ratios and excess absolute risks.

There were 8929 patients with Barrett's esophagus providing 50,147 person-years of follow-up.

The team found that compared with the greater Kaiser Permanente Northern California population, patients with Barrett's esophagus had increased risks of any cancer, which slightly decreased after excluding esophageal cancer.

Esophageal adenocarcinoma risk was increased 24 times, which translated into an excess absolute risk of 24 cases per 10,000 person-years.

The team discovered that although esophageal adenocarcinoma risk decreased with time since Barrett's esophagus diagnosis, esophageal cancer mortality did not, indicating that the true risk is stable and persistent with time.

Relative risks of cardia and stomach cancers were increased.
Gut

Relative risks of cardia and stomach cancers were increased, but excess absolute risks were modest.

Risks of colorectal, lung and prostate cancers were unaltered.

The researchers observed that all-cause mortality was slightly increased after excluding oesophageal cancer, but time-stratified analyses indicated that this was likely attributable to diagnostic bias.

Cause-specific standardised mortality ratios were elevated for ischaemic heart disease, respiratory system diseases and digestive system diseases.

Dr Cook's team concludes, "Patients with Barrett's oesophagus had a persistent excess risk of esophageal adenocarcinoma over time, although their absolute excess risks for this cancer, any cancer and overall mortality were modest."

Gut 2018: 67 (3)
27 February 2018

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