Good News! The Risk of Esophageal Cancer is Lower than Expected

People who suffer from acid reflux, or gastroesophageal reflux disease (GERD), are at an increased risk of acquiring Barrett’s esophagus, which can then go on to esophageal cancer, or adenocarcinoma.  How likely one condition will lead to the next is the subject of a report from Ann Arbor researchers that’s published online in the American Journal of Gastroenterology.  Acid reflux is very common, GERD less so, Barrett’s is rare, and esophageal cancer very rare.  But the risk of progress can vary according to gender, age, and severity of symptoms.

Published and publicly-available data were used to estimate the likelihood of developing esophageal cancer in people with GERD. The principal conclusions of the analysis were:

1.     Women with GERD are likely to have a low rate of cancer, similar to that for breast cancer in men, i.e. 3.9/100,000 person-years at the age of 60.

2.    The incidence of esophageal cancer in men under 50 with GERD is very low e.g. at the age of 35, it’s 1.0/100,000 person-years; the incidence of colorectal cancer at this age is 6 to 7 times higher. 

3.    The incidence of esophageal cancer in men over 60 with weekly GERD symptoms is ‘substantial’, but still only 1/3 that of colorectal cancer; e.g. at age 60, it’s 3.9/100,000 person-years.

The implications of this analysis relate to the need for screening, using esophagoscopy, with or without biopsy. The principal author says screening is normally unnecessary for men under 50 or in women, regardless of the frequency of GERD symptoms.  However, in men with GERD symptoms weekly or more often, who are over 60, screening may be warranted.  Even then, in such a patient colon cancer screening may be more important than esophageal screening.  Of course, if alarm symptoms are present, such as difficulty swallowing, unexpected weight loss, or vomiting, all bets are off, and an endoscopy should be done.