risk of esophageal cancer subsequent to barrett's esophagus diagnosis

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mock turtle
Regular Member


Date Joined Mar 2011
Total Posts : 467
   Posted 7/7/2011 10:50 PM (GMT -6)   
if i am reading this study right

the risk of getting esophageal cancer after diagnosis of barretts metaplasia

is less than 1 percent each year...maybe half that

risks if the diagnosis is dysplasia are incrementally higher

(please somebody correct me if i am interpreting the numbers wrong)

this doesnt mean you shouldnt be concerned

this doesnt mean you shouldnt be watchful and take corrective action

but , a diagnosis of baretts is not a probable death sentence,... not by a long shot

http://aje.oxfordjournals.org/content/168/3/237

"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."

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 7/8/2011 7:48 AM (GMT -6)   
Hi Mock T,

I think we discussed this a while back and the risk then was around 3% - not that high. But the newer study has brought the risk down lower, which is very good news. Thanks for highlighting it on the forum!

MMM
New stuff: GERD. Interstitial Cystitis
Lifelong stuff: Food allergies, eczema, asthma

Chuck T
Regular Member


Date Joined May 2011
Total Posts : 143
   Posted 7/8/2011 9:35 AM (GMT -6)   
Here is an interesting article i just found about Barretts. It came from Harvard and was first published a couple of weeks ago. Seems like researchers are starting to get their hands around the disease a little bit better. My doctor recently told me that since I didnt have Barretts on my first scope, that my odds of getting it were relatively low. This research seems to support that theory.

http://www.focushms.com/features/new-insights-into-origin-of-deadly-cancer/

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 7/8/2011 10:48 AM (GMT -6)   
Hmmm..... I had no Barretts visible on my first scope in 2007. However in 2011 biopsies did show a small area of Barretts. I don't know whether it was there all along - I had terrible reflux during pregnancies, so any damage could just as well be from then (kids now 6 and 8). My consultant said that if they take biopsies low down near the LES they often find Barretts; so I don't know how many people are walking around with it, with silent reflux, or past reflux, that don't know they have it. I almost wish I didn't know, seeing as it's unlikely to get monitored! But the newer research is reassuring.
New stuff: GERD. Interstitial Cystitis
Lifelong stuff: Food allergies, eczema, asthma

mock turtle
Regular Member


Date Joined Mar 2011
Total Posts : 467
   Posted 7/8/2011 11:05 AM (GMT -6)   
barretts esophagus is the bodies response to the stress and damage of reflux

the esophagus starts to build cells that look like the ones found in the stomach an duodenum which are accustomed to acid exposure

it may be that barretts is protective...all be it, indicative of an individual whos esophagus is frequently assaulted

and without the barretts response the cancer rate for that level of exposure might even be higher!

kind of like a sun tan

think of it...probably more people with year after year sun tans get skin cancer

but the people who remain pale all year really are comprised of two groups

one group never gets sun an never gets skin cancer caused by the suns UV

the other part of the pale skin group (people with blond and red hair and light skin) never tan, when exposed to the sun, but they have an elevated risk of skin cancer

so i wonder if there are people out there who have high levels of exposure to reflux but never get barretts but are still at elevated risk for esophageal cancer

im just guessing...wondering

theacidrefluxman
Veteran Member


Date Joined Oct 2009
Total Posts : 739
   Posted 7/8/2011 6:15 PM (GMT -6)   
@ Chuck T. Very interesting, and thank you for the article! But I am a bit confused...how does the article support the theory that you won't get Barrets if you don't have it more or less by the time of your first scope? From what I read it is saying that all normal humans have the cells waiting there, including us, so more reflux = more barrets. What did you read into that article that I missed? Thanks.

Chuck T
Regular Member


Date Joined May 2011
Total Posts : 143
   Posted 7/8/2011 6:55 PM (GMT -6)   
Wasnt saying that you wont get Barretts, just repeating what my doc said. In the article, they mention that they were surprised at how fast the Barretts occurred in rats, and that the model of esophogeal cells getting damaged and becoming Barretts is being replaced by the idea that it is related to primitive cells at the esophageal junction. They also imply that there is a genetic aspect to it. My take away from the article is that there is a certain amount of damage that may activate the Barretts kind of like a threshold, and if you have reflux and have been scoped, then maybe your body isnt at that threshold. And maybe, if you reflux doesnt get worse, you wont ever get there. But I really have no idea. Just trying to make sense of what my doc said. Who knows.

mock turtle
Regular Member


Date Joined Mar 2011
Total Posts : 467
   Posted 7/9/2011 1:15 AM (GMT -6)   
chuck t
i agree that there is probably some threshold level of acid exposure that prompts barretts
and
that there is a genetic pre-disposition

and btw if somebody gave me the choice...i would rather be found to not have barretts
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