Risk of cancer W/O Barretts

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theacidrefluxman
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Date Joined Oct 2009
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   Posted 1/27/2013 11:23 AM (GMT -6)   
I recently read that the risk of cancer in Barrett's is like 6-7 per 1000 patient years. That is extremely low. I think it gets lower and lower as more research is done.

My Dr. has told me Barrett's is a necessary precursor to EAC. Has anyone found anything against this? I have read numerous times that "Barrett's greatly increases the risk for cancer". But shouldn't this be wrong, since there would be no risk if you didn't have Barrett's?

I am confused.

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 1/28/2013 11:13 AM (GMT -6)   
http://www.biomedcentral.com/content/pdf/1756-9966-30-23.pdf

I think I tried to look into this before. Certainly when the Barretts thread was new, I had found reports of cases of adenocarcinoma without Barretts. The above article seems to say the same, and I will try to find the time to read it more thoroughly, but it suggests there is another route to adenocarcinoma of the oesophagus which is not yet fully understood. They also reinforce the growing belief that Barretts and adenocarcinoma of the oesophagus are not strongly associated with each other.

And for new readers, please remember, the risk of Barretts progressing is very very small.

MMM
GERD (over 2 years)
Lifelong stuff: Food allergies/intolerance, eczema, asthma

theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 1/28/2013 7:36 PM (GMT -6)   
Hey MMM,

If I am not mistaken, I posted this same thread some months ago, and you were also the first to respond there. Thanks for not calling me out on starting the same thread twice. Yes, I am that neurotic.

I wish I had a definitive answer to this. Still, it seems safe to say that having Barrett's is worse than not having it, I guess. I found an article by Jesper Lagergren that was well known about how mucosal state didn't matter, and how symtpom duration and severity were what did (in relation to EAC). But when I contacted him he wrote me this:

"Barretts esophagus is a necessary step in virtually all cases of adenocarcinoma of the esophagus, but it cannot (yet) be entirely ruled out that some adenocarcinomas might develop from the glandular cells of the squmous cell of the normal esophagus. "

To me that is him essentially saying you have nothing to worry about if you don't have Barrett's.

I would give a lot to have an answer to some of these 'unanswerable' questions...I guess our knowledge is just limited.

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 1/29/2013 9:57 AM (GMT -6)   
It's unknowable currently yes, and individually it is still down to chance, luck and some genetics I guess. I do have Barretts but I'm not currently worried, especially as it didn't change at all over a 12 month period. I personally don't worry about it because I know the chances of a rogue cell in some other part of my body causing my demise is much higher. At least my Barretts will get monitored. If you have no Barretts you get less surveillance, which some would say puts you more at risk!

I now work in a department that provides support to people with cancer, so I worry far more, if I do worry, about the common cancers such as breast and bowel. Of the few that I noticed with carcinoma of the oesophagus, they were all smokers. I do understand the worry and the desire for clear answers, but right now I'd just be happy to be symptom free.

My good wishes as always,

MMM
GERD (over 2 years)
Lifelong stuff: Food allergies/intolerance, eczema, asthma

theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 3/19/2013 4:04 PM (GMT -6)   
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...

http://www.ncbi.nlm.nih.gov/pubmed/22245963

Danish Study, Jan. 2012

RESULTS:

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).
CONCLUSIONS:

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.

gigglesalc25
Regular Member


Date Joined Jan 2013
Total Posts : 79
   Posted 3/22/2013 2:12 PM (GMT -6)   
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