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

Abstract

Objectives Recent advances in the management of Barrett's esophagus may kindle enthusiasm for screening for esophageal adenocarcinoma (EAC). Symptoms of gastroesophageal reflux disease (GERD) are recognized as relative risks for EAC. However, the absolute incidence of EAC in specific populations with GERD is unknown. We aimed to estimate the symptom-, age-, and sex-specific incidences of EAC, and place these incidences in the perspective of other cancers for which screening is endorsed. Methods A Markov computer model utilizing published and publicly available data was created to estimate the age- and sex-specific incidences of EAC in American white non-Hispanics with GERD symptoms. Results The incidence of EAC in men younger than 50 years with GERD symptoms is very low (for instance, at the age of 35 years, incidence = 1.0/100,000), and their incidence of colorectal cancer is relatively much higher (for instance, at the age of 35 years, incidence of colorectal cancer is 6.7-fold greater). The incidence of EAC in older men with weekly GERD symptoms is substantial (for instance, at the age of 70 years, incidence = 60.8/100,000 person-years), but their incidence of colorectal cancer is at least threefold greater. The incidence of EAC in women with GERD is extremely low, and similar to that of breast cancer in men (for instance, 3.9/100,000 person-years at the age of 60 years). Conclusions Screening for EAC should not be performed in men younger than 50 years or in women because of very low incidences of cancer, regardless of the frequency of GERD symptoms. In white men with weekly GERD over the age of 60 years, the incidence of EAC is substantial, and might warrant screening if that practice is particularly accurate, safe, effective, and inexpensive.

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

“…In a study using the SEER (Th e Surveillance, Epidemiology, and End Results) database, women composed only 12% of all EACs. In this study, the risk of EAC in women with GERD symptoms was approximately equivalent to the risk of breast cancer in men (3.9 per 100,0000 at age 60 years) ( 34 ).…”

“…Routine staging of patients with nodular BE with EUS or other imaging modalities before EMR has no demonstrated benefi t. Given the possibility of over-and understaging, fi ndings of these modalities should not preclude the performance of EMR to stage-early neoplasia (Strong recommendation, moderate level of evidence). 34. In patients with known T1b disease, EUS may have a role in assessing and sampling regional lymph nodes, given the increased prevalence of lymph node involvement in these patients compared with less advanced disease (strong recommendation, moderate level of evidence).…”

“…Hence, a BE screening strategy based solely on GERD symptoms is likely to be unsuccessful. Women (even those with daily or weekly refl ux symptoms) have a low incidence of EAC comparable to that of men without refl ux symptoms ( 34 ). Th is may relate to the lower risk of progression to EAC in women with BE compared with men with BE ( 60,87 ) and should likely infl uence the threshold of BE screening in women.…”

Diagnosis and management of gastro-oesophageal reflux disease

“…Los Angeles (LA) grades C and D [9]. Barrett's oesophagus increases in prevalence after age 50, especially in Caucasian males [10].The patients with erosive oesophagitis are more likely to be men. Women are more likely to have non erosive reflux disease (NERD).…”

“…Barrett's oesophagus is more frequent in men compared to women [11]. The male to female, gender ratio for oesophageal adenocarcinoma is estimated to be 8:1 [10].…”