Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Risk of cancer is low in patients with Barrett's esophagus
Clinical Question
What is the annual incidence of esophageal cancer among patients with Barrett's esophagus?
Bottom line
In patients with Barrett's esophagus (BE), only about 1 in 420 receives a diagnosis of esophageal cancer per year. 2b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Population-based
Synopsis
Previous studies have reported a range of annual incidences of cancer in patients with BE from 0.2% to 0.5%, depending on the location of the study and whether both prevalent and incidence cancers were counted. This is the largest US cohort study; Kaiser Permanente enrolled 8929 patients with BE between 1995 and 2012. The mean age at study entry was 61 years, 66% were men, and mean follow-up was 5.6 years. Cancer incidence and mortality were compared with the entire Kaiser Permanente population, stratified by age and sex. The standardized incidence ratio (SIR) for esophageal cancer (16) and gastric cancer (4.4) was significantly increased in patients with BE. These SIRs were larger in women than in men, although the absolute number of cancers was greater in men. In absolute terms, there was an excess of 44 digestive cancers, slightly more than half of which were esophageal, per 10,000 patient-years of follow-up. The SIRs were greatest in the first 3 years, because of detection of prevalent cancers, and declined to approximately half after 3 years. The incidence of esophageal cancer alone was 24 per 10,000 person-years, or approximately 0.24% per year, which is consistent with the large, well-done Danish registry trial that found a rate of 0.12% after prevalent cancers were excluded (http://www.essentialevidenceplus.com/content/poem/131201).
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Very helpful information
Good poem
Could this change how often they need surveillance gastroscopy?
we need more studies that support clinical scientific evidence rather than " word of mouth evidence " which many times start in medical school !
I’d like to know if this impacts the surveillance that’s recommended for Barrett’s œsophagus
THis is reassuring, and being the second large cohort study affirms low risk, and peaking at 3 years. Wonder the added risk of Smoking on cohort?
Barrett's Esophagus and esophageal/gastric cancer
This is somewhat reassuring ... but I'm not sure how this changes practice in terms of management of patients with known BE. I will be a bit less anxious about these patients if they miss screening, but nevertheless, I don't feel confident with not screening ... I will be relying on my friendly neighbourhood gastroenterologists for advice.
Your title: "Risk of cancer is low in patients with Barrett's esophagus." (Misleading)
In your discussion:The standardized incidence ratio (SIR) for esophageal cancer (16) and gastric cancer (4.4) was significantly increased in patients with BE. These SIRs were larger in women than in men, although the absolute number of cancers was greater in men. In absolute terms, there was an excess of 44 digestive cancers, slightly more than half of which were esophageal, per 10,000 patient-years of follow-up.
I am confused, your title and the discussion seem to be contradictory ????
The original authors' conclusion: "Patients with BE had a persistent excess risk of oesophageal adenocarcinoma over time, although their absolute excess risks for this cancer, any cancer and overall mortality were modest.