The Incidence of Esophageal Cancer and High-Grade Dysplasia in Barrett's Esophagus: A Systematic Review and Meta-Analysis

Abstract

Barrett's esophagus is a well-recognized precursor of esophageal adenocarcinoma. Surveillance of Barrett's esophagus patients is recommended to detect high-grade dysplasia (HGD) or early cancer. Because of wide variation in the published cancer incidence in Barrett's esophagus, the authors undertook a systematic review and meta-analysis of cancer and HGD incidence in Barrett's esophagus. Ovid Medline (Ovid Technologies, Inc., New York, New York) and EMBASE (Elsevier, Amsterdam, the Netherlands) databases were searched for papers published between 1950 and 2006 that reported the cancer/HGD risk in Barrett's esophagus. Where possible, early incident cancers/HGD were excluded, as were patients with HGD at baseline. Forty-seven studies were included in the main analysis, and the pooled estimate for cancer incidence in Barrett's esophagus was 6.1/1,000 person-years, 5.3/1,000 person-years when early incident cancers were excluded, and 4.1/1,000 person-years when both early incident cancer and HGD at baseline were excluded. Corresponding figures for combined HGD/cancer incidence were 10.0 person-years, 9.3 person-years, and 9.1/1,000 person-years. Compared with women, men progressed to cancer at twice the rate. Cancer or HGD/cancer incidences were lower when only high-quality studies were analyzed (3.9/1,000 person-years and 7.7/1,000 person-years, respectively). The pooled estimates of cancer and HGD incidence were low, suggesting that the cost-effectiveness of surveillance is questionable unless it can be targeted to those with the highest cancer risk.

Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

“…A geographic variation in BE cancer risk has been suggested by another group [46]. Very small differences in the EAC incidence were reported between different geographic regions, with only a slightly higher EAC incidence in the USA and UK compared to other European countries, which is in line with other studies [63,64]. The incidence in Australia and New Zealand was slightly lower than that in the USA and Europe including the UK [63].…”

“…Several systematic reviews and metaanalyses on the EAC risk in BE patients [60,[62][63][64][65][66] are summarized in Table 1. Among these studies, the rate of progression in BE without dysplasia at baseline to EAC is low, ranging from 0.33 % (95 % CI 0.28-0.38 %) to 0.598 % (95 % CI 0.505-0.691 %) annually [65,66].…”

Reduced Risk of Barrett’s Esophagus in Statin Users: Case–Control Study and Meta-Analysis

“…Several individual studies (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)27) and 2 systematic reviews (that produced essentially identical results despite slightly different methodologies (16,17)) have reported that statin use, and particularly statin use combined with a cyclo-oxygenase inhibitor, is associated with a reduced incidence of esophageal adenocarcinoma. This has been reported in cohort studies and case-control studies of Barrett's patients and population-based studies compared to population-based controls, although not all studies are in agreement (28).…”

“…(3,4). It is accepted that metaplastic transformation of the esophageal squamous mucosa to intestinaltype mucosa (Barrett's esophagus (BE)) is a premalignant phenotype, although the overall rate of progression is relatively low (probably about 1 in 300 patients per year, or less) (5)(6)(7) and this has allowed the development of surveillance and localised treatment strategies such as radio-frequency ablation as means of preventing the development of EAC (8). However overall mortality from EAC remains considerable with 5-year survival less than 25% (9).…”

Estrogen and gastrointestinal malignancy

“…Esophageal cancer occurs more frequently in men than women 21 and men progress to invasive carcinoma from Barrett's esophagus at twice the rate of their female counterparts 22 . While ER had been demonstrated in esophageal mucosa in 1983 23 , a second isoform of the receptor was described in 1996 24 and this warranted further characterisation and classification its presence in esophageal tissue.…”