ESOPHAGIC CANCER: An alarming increase

The prevalence of Barrett’s esophagus (BO) is estimated to be around 1% but the disease can be asymptomatic in up to 90% of patients. It is therefore a silent killer with minimal symptoms until an advanced stage. Barrett’s esophagus – the main precursor lesion to esophageal adenocarcinoma, which begins in the gland cells in the lining of the esophagus – is primarily caused by chronic acid reflux. Other risk factors include older age, male gender, obesity, smoking, and alcohol consumption.

10-15% of people with GERD develop OB, with the same symptoms of GERD (heartburn, acid regurgitation, nausea, difficulty swallowing, loss of appetite, weight loss, peptic ulcers in the esophagus and esophageal stricture), but more severe. Patients with OB then have a risk of developing esophageal cancer and this risk is estimated at 30 to 125 times higher than in the general population.

The incidence of esophageal cancer in France is estimated at approximately 5,000 cases per year. In 80% of cases, it affects men over the age of 55, and in 90% of cases, it is linked to the consumption of tobacco and/or alcohol.

Multiple risk factors and no endoscopy in most patients

The study who analyzed data from more than 5 million electronic patient records, reveals that among adults aged 45 to 64, this incidence nearly doubled between 2012 and 2019. encourage them to screen more middle-aged, higher-risk patients,” notes lead author Dr. Bashar J. Qumseya, associate professor of medicine and chief of endoscopy at the University of Florida, Gainesville. “Whenever we see an increase in the prevalence of a type of cancer, we have to ask ourselves if this is due to better screening or if it is a real increase in the prevalence of the disease. Our study demonstrates that this is an increase in the prevalence of the disease”. Thus, the analysis reveals that during the follow-up period,

• the rate of endoscopy (or oesophagogastroduodenoscopy – EGD) has not changed;
• the highest incidence is always found in the over 65s;
• however, the cancer rate almost doubled in the 45-64 age group, from 49/100,000 to 94/100,000;
• the prevalence of Barrett’s esophagus in this same age group increased by regarding 50%, from 304 to 466 per 100,000 patients.

What implication? Middle-aged patients with multiple risk factors would benefit from earlier and/or more frequent screening: “While many patients have colonoscopies starting at age 45, those with multiple risk factors might have endoscopy done at the same time.”

“From other analyzes we have conducted on this dataset, we know that even patients with 4 or more risk factors for esophageal cancer do not undergo endoscopy. It is therefore clear that we can do better”.