Original Contribution | Published:

Esophagus

Esophageal Adenocarcinoma Incidence in Individuals With Gastroesophageal Reflux: Synthesis and Estimates From Population Studies

The American Journal of Gastroenterology volume 106, pages 254260 (2011) | Download Citation

Abstract

OBJECTIVES:

Recent advances in the management of Barrett's esophagus may kindle enthusiasm for screening for esophageal adenocarcinoma (EAC). Symptoms of gastroesophageal reflux disease (GERD) are recognized as relative risks for EAC. However, the absolute incidence of EAC in specific populations with GERD is unknown. We aimed to estimate the symptom-, age-, and sex-specific incidences of EAC, and place these incidences in the perspective of other cancers for which screening is endorsed.

METHODS:

A Markov computer model utilizing published and publicly available data was created to estimate the age- and sex-specific incidences of EAC in American white non-Hispanics with GERD symptoms.

RESULTS:

The incidence of EAC in men younger than 50 years with GERD symptoms is very low (for instance, at the age of 35 years, incidence=1.0/100,000), and their incidence of colorectal cancer is relatively much higher (for instance, at the age of 35 years, incidence of colorectal cancer is 6.7-fold greater). The incidence of EAC in older men with weekly GERD symptoms is substantial (for instance, at the age of 70 years, incidence=60.8/100,000 person-years), but their incidence of colorectal cancer is at least threefold greater. The incidence of EAC in women with GERD is extremely low, and similar to that of breast cancer in men (for instance, 3.9/100,000 person-years at the age of 60 years).

CONCLUSIONS:

Screening for EAC should not be performed in men younger than 50 years or in women because of very low incidences of cancer, regardless of the frequency of GERD symptoms. In white men with weekly GERD over the age of 60 years, the incidence of EAC is substantial, and might warrant screening if that practice is particularly accurate, safe, effective, and inexpensive.

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Author information

Affiliations

  1. Veterans Affairs Center of Excellence for Clinical Management Research, Ann Arbor, Michigan, USA

    • Joel H Rubenstein
  2. Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA

    • Joel H Rubenstein
    •  & James M Scheiman
  3. Cancer and Population Health, Queensland Institute of Medical Research, Brisbane, Australia

    • Shahram Sadeghi
    •  & David Whiteman
  4. Division of Gastroenterology, University of Washington, Seattle, Washington, USA

    • John M Inadomi

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Competing interests

Guarantor of the article: Joel H. Rubenstein, MD, MSc.

Specific author contributions: Study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, statistical analysis, and approval of final submitted draft: Joel H. Rubenstein; study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and approval of final submitted draft: James M. Scheiman; acquisition of data, critical revision of the manuscript for important intellectual content, and approval of final submitted draft: Shahram Sadeghi; study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and approval of final submitted draft: David Whiteman; study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and approval of final submitted draft: John M. Inadomi.

Financial support: J.H.R. is the Damon Runyon—Gordon Family Clinical Investigator. D.C.W. is supported by a Research Fellowship from the National Health and Medical Research Council (NHMRC) of Australia. This work is supported by the National Institutes of Health (J.H.R.: K23DK079291 and J.M.I.: K24 DK080941). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Potential competing interests: James M. Scheiman has served as a consultant for AstraZeneca, Novartis, Pfizer, Bayer, Takeda, Pozen, and NiCox, and has received speaker's honoraria from Takeda and AstraZeneca. John M. Inadomi has served as a consultant to Takeda, AstraZeneca, and Ethicon Endo Surgery, and has received grant support from BARRX. Joel H. Rubenstein, Shahram Sadeghi, and David Whiteman have no relationships to disclose.

Corresponding author

Correspondence to Joel H Rubenstein.

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DOI

https://doi.org/10.1038/ajg.2010.470

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