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Posted at 7:00 AM ET, 12/20/2010

GERD and esophageal cancer: 5 things you should know

By Jennifer LaRue Huget
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After I reported on a study about gastroesophageal reflux disease (GERD) and esophageal cancer last week, I heard from the folks at the Esophageal Cancer Action Network (ECAN), a nonprofit organization that works to raise awareness of esophageal cancer and advocates for better research into the deadly disease's causes and potential treatments.

Mindy Mordecai, ECAN's executive director, and Bruce Greenwald, a gastroenterologist at the University of Maryland School of Medicine and ECAN's president, took me to task for downplaying the fact that GERD (and persistent heartburn) is a major risk factor for esophageal cancer and for seeming to suggest that people with GERD needn't worry about developing that cancer. That wasn't what I meant to suggest at all. But I can appreciate their concern that a person reading my blog might come away not understanding that GERD is nothing to be dismissed lightly.

With help from Mordecai, I put together this list of five things you need to know about GERD and esophageal cancer. Here they are:

  • Though esophageal cancer is rare, its incidence is rising (according to ECAN, its incidence has risen by 400 percent in the past 20 years), for reasons that are poorly understood.
  • While most people with GERD will not develop esophageal cancer, GERD remains a major risk factor for that cancer. 
  • Common symptoms of GERD include hoarseness, cough, throat clearing, regurgitation, sore throat and wheezing. Controlling GERD symptoms with medications doesn't necessarily protect against esophageal cancer. And not everyone who has GERD experiences recognizable symptoms. 
  • According to the American Cancer Society, five-year survival rates for those diagnosed with esophageal cancer are quite low, ranging from 17 percent to 37 percent, depending on how localized the cancer is. The ACS notes that "Cancer of the esophagus usually is diagnosed at a late stage and therefore has a poor outlook for survival."
  • There is debate in the medical community as to who should be screened for esophageal cancer. Talk with your doctor about your own risk and whether screening is appropriate.

Here's more information about esophageal cancer. And here's more information about GERD.

By Jennifer LaRue Huget  | December 20, 2010; 7:00 AM ET
Categories:  Cancer, Prevention, digestive tract health  | Tags:  Cancer  
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Comments

I appreciate the interest in our study published earlier this month in the American Journal of Gastroenterology (http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2010470a.html). I agree with Dr. Greenwald and Ms. Mordecai that symptoms of GERD are among the strongest known relative risk factors for esophageal adenocarcinoma, raising the risk about 5-fold, but I would disagree with any implication that most people with GERD need to worry about developing the cancer.

I believe your readers could be confused about the differences between relative and absolute risks. If the chance of a lottery ticket being a winner is 1 in a million, then if a woman buys 5 tickets, she is 5 times more likely to win the lottery than someone who buys just 1, which seems like a large relative chance. However, she still only has a 5 in a million chance of winning the lottery, which is a very small absolute chance. The point is that even if someone has GERD, his or her chance of developing the cancer is still quite low.

Esophageal cancer is a serious disease, often with a poor prognosis. There are two main types of esophageal cancer – squamous and adenocarcinoma. Only the adenocarcinoma is associated with GERD, and only about 1/2 of patients with adenocarcinoma experience GERD prior to developing the cancer. And adenocarcinoma of the esophagus is still a rare cancer. About 4,000 Americans with GERD develop esophageal adenocarcinoma annually, compared to 150,000 new cases of colon cancer and 200,000 new cases of breast cancer. As many as 1 in 4 adults experience GERD, so the vast majority of people with GERD will never develop esophageal cancer. Our study estimated that:

- women with GERD have a risk of esophageal cancer that is similar to the risk of men developing breast cancer.

- a 40 year old man with GERD symptoms has a risk of esophageal adenocarcinoma that is one-fifth his risk of colon cancer, and yet physicians do not recommend colon cancer screening for average risk 40-year olds.

- in men with GERD over the age of 60, their risk of developing esophageal cancer is substantial, and might warrant endoscopic screening if it is effective at reducing mortality from the cancer. However, there is no high quality evidence that screening for this type of cancer is effective.

It is important to note that this study is about screening in people with uncomplicated GERD symptoms. If someone has trouble swallowing or unintentional weight loss, they should contact their physician because those symptoms could be due to a cancer that is already present.

We agree entirely with Dr. Greenwald and Ms. Mordecai that our study “points out the need for more research support to develop better, more cost effective early detection methods so that lives can be saved.”

Joel H. Rubenstein, MD, MSc
Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan &
University of Michigan Medical School Division of Gastroenterology

Posted by: joelrubenstein | December 21, 2010 5:10 PM | Report abuse

I appreciate Dr Rubenstein's clarification of the relative versus absolute risk. I certainly understand the reluctance in the medical community to aggressively screen those patients with uncomplicated GERD.

As a patient, I was repeatedly reassured that the acid reflux I experienced was uncomfortable but manageable. Just continue to take my Prilosec, avoid spicy foods, avoid caffeine, etc, etc, and things would be fine. Esophageal cancer was never mentioned. I did not worry when I had to start chewing my food more. I did not seek medical attention until I felt things sticking on the way to my stomach. Even then, the gastroenterologist who saw me advised I may have a polyp or erosion, not to worry. Imagine my surprise when two days later I learned that I had adenocarcinoma. Unfortunately, I was one of those who "won the lottery".

My frustration is the lack of awareness that this disease even exists. I was diagnosed at the age of 44years, a non-drinker, non-smoker, with no family history of cancer. I was not familiar with esophageal cancer. How I wish I had known the warning signs.

I hope ECAN is able to educate the public and the medical community of the connection that exists between gastroesophageal reflux disease and adenocarcinoma. While it may be like "winning the lottery" now, let's make this lottery impossible to win.

I am continuing treatments two years later in hopes I will get to see my four year old daughter go to school...

Lottery winner:
Gastroesophageal adenocarcinoma Grade 4a

Posted by: kodvm | December 21, 2010 11:46 PM | Report abuse

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