I don't understand...
A few studies from 1999 and 2002 argue that symptom severity and not mucosal state are what matters, and that the risk was the same for people with the same amount of symptoms despite whether or not they had Barrett's.
But then I read this study, which seems to make a hell of a case that without erosive esophagitis you shouldn't get cancer...
Danish Study, Jan. 2012
In the study cohort, 26,194 of the patients (77%) had erosive reflux disease and 37 subsequently developed esophageal adenocarcinoma after a mean follow-up time of 7.4 years. Their absolute risk after 10 years was 0.24% (95% confidence interval [CI], 0.15%-0.32%). The incidence of cancer among patients with erosive reflux disease was significantly greater than that expected for the general population (standardized incidence ratio, 2.2; 95% CI, 1.6-3.0). In contrast, of the 7655 patients with nonerosive reflux disease, only 1 was diagnosed with esophageal adenocarcinoma after 4.5 years of follow-up evaluation (standardized incidence ratio, 0.3; 95% CI, 0.01-1.5).
Erosive reflux disease, but not nonerosive disease, increased the risk of esophageal adenocarcinoma, based on analysis of population-based Danish medical registries. Inflammation therefore might be an important factor in the progression from reflux to esophageal adenocarcinoma.
This is the study from 2002:
In 118 (62%) of the 189 esophageal adenocarcinoma cases, Barrett's esophagus was detected. The strength of the association with symptoms of reflux was identical for patients with esophageal adenocarcinomas who had Barrett's esophagus and those who did not. Barrett's esophagus appears not to be a necessary step in the evolution of esophageal adenocarcinoma. The excess risk of adenocarcinoma among patients with Barrett's esophagus has been estimated to be 30-60 times that of the general population in large studies. Because the risk among subjects in our study with the most severe and long-standing symptoms of reflux was of the same magnitude, and because the association was equally strong among esophageal adenocarcinoma with Barrett's esophagus and those without it, we hypothesize that gastroesophageal reflux, may be the crucial factor. Therefore, it may be necessary to reappraise the critical role of Barrett's esophagus in the carcinogenic pathway.