The incidence of a deadly form of esophagus cancer that is associated with gastro esophageal reflux disease (GERD) is rising at an alarming rate, experts say.
Approximately 90% of people who develop adenocarcinoma of the esophagus die within five years and, currently, there are few effective prevention, screening or treatment methods available.
Most Rapidly Increasing Cancer
"Of all the cancers that are increasing, this one is the most rapidly increasing. It way outpaces melanoma and prostate cancer," says Dr. Rhonda F. Souza, coauthor of the report and associate professor of medicine at the Dallas VA Medical Center and the Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center at Dallas.
The incidence of esophageal adenocarcinomas has soared 600% since the 1970s. By contrast, the incidence of gastric cancers has been on the wane in most Western countries for the last 50 years.
Despite the startling increase, the actual number of adenocarcinomas of the esophagus is not huge-7,000 to 8,000 new cases per year in the United States. "Even though it's increased, it's still not as prevalent as colon cancer," Souza says.
Major Risk Factors
Unlike colon cancer, however, there are no effective screening techniques for esophageal adenocarcinomas. The major risk factors for this type of cancer are GERD and Barrett's esophagus, a condition in which part of the esophagus lining is replaced by tissue that is similar to what is normally found in the intestine.
Each year, approximately one-half of 1% of the people who have Barrett's (one person in 200) will go on to develop adenocarcinoma of the esophagus.
"People who get this cancer are those who have GERD and, in the US, probably 6O million people have reflux and approximately 20% of those have reflux on a weekly basis. Those are the ones who'd be most at risk to get this cancer," Souza says. "If you have chronic reflux, you need to pay attention, and if you have reflux and you have trouble swallowing, weight loss or bleeding, you should see a doctor. Those are early-warning signs."
Obesity may also play a role in the disease. "No one is really sure," Souza says. "In the West, body mass index is increasing, and it's thought that by becoming obese, people are more predisposed to getting heartburn [GERD]."
"Probably the single most important thing we can do is lose weight, because increased abdominal weight tends to hold back the normal flow of food, and that's one thing that can create GERD," says Dr. B Jay Brooks, Jr., chairman of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge, Louisiana.
There is some evidence that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) may help prevent esophagus cancer from developing in patients who have Barrett's esophagus. Souza and her coauthor, however, are not convinced that the benefits of taking these drugs outweigh the risks.
For those at high risk-a white male age 65 to 74 years old who has longstanding heartburn, for example-Souza recommends seeing a physician and getting an endoscopy even in the absence of any alarm symptoms and, hopefully, before a tumor has developed.
"Endoscopically, we can see precursor lesions," Souza points out. If any abnormalities are found, patients can then enroll in a more formal surveillance program. "Your chances are better because it's at an earlier stage," she adds.
"If people have reflux symptoms, they really do need to see their doctors because, many times, an upper endoscopy can detect things very quickly. Then you can treat it aggressively to try to prevent the progression. It's not 100%, but it's the best that we have at this point," says Brooks.
