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Posted at 7:00 AM ET, 12/14/2010

GERD and esophageal cancer

By Jennifer LaRue Huget
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People who suffer from GERD -- gastroesophageal reflux disease -- have enough to worry about, from the threat that the next meal may trigger a painful flare-up to uncertainty about whether insurance will cover their meds. So it's nice for many of us to be able to move one worry -- and a pretty big one, at that -- toward the bottom of the list.

New research out of the University of Michigan shows that, contrary to what's been believed, GERD is not strongly linked to the development of esophageal cancer, at least not for many of the millions of Americans who suffer from the ailment.

A study published last week in the American Journal of Gastroenterology estimates that, among white non-Hispanic Americans, women with GERD symptoms very rarely go on to develop cancer of the esophagus. Same goes for men under age 50, who are at far greater risk of getting colon cancer than esophageal cancer.

Men over age 60, though, are at much greater risk, but the risk of colorectal cancer still is much higher.

GERD involves the rise of stomach acid and juices into the esophagus; it occurs when the lower esophageal sphincter is too weak to seal the stomach off from the esophagus. The prolonged exposure to stomach acid irritates the lining of the esophagus, causing symptoms that range from heartburn and a bitter taste in the mouth to a dull chest pain that can mimic the feeling associated with heart attack. While most people have occasional heartburn, those who experience it twice a week or more frequently are said to have GERD. The condition usually can be managed with lifestyle and diet changes and medication.

In some cases, GERD causes changes to the esophagus lining that can be precancerous. An upper endoscopy can detect such changes. But the new study suggests that white men age 60 and older who experience GERD symptoms weekly "might warrant screening [for esophageal cancer] if that practice is particularly accurate, safe, effective, and inexpensive."

Correction: The original version of this blog entry featured an inaccurate headline stating that the link between GERD and esophageal cancer is not strong. That headline is amended here.
Also, the blog neglected to explain that the study it reported on involved the need to screen for esophageal cancer among certain populations of people with GERD. The study did not investigate the biological connection between GERD and esophageal cancer.

I'll be revisiting this issue in The Checkup on Monday, Dec. 20.

By Jennifer LaRue Huget  | December 14, 2010; 7:00 AM ET
Categories:  Cancer, Chronic Conditions, Obesity, Pregnancy, Women's Health  
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Comments

The link between GERD and Esophageal Cancer is strong and no research has found otherwise. You have done a grave disservice to your readers with a headline that completely misstates the results of a study concerning the fastest increasing cancer diagnosis in the U.S. Esophageal Cancer has increased in this country at a rate of more than 400 percent in the past 20 years – and it is often tantamount to a death sentence.

The study you cite in your report estimated the risk of Esophageal Cancer in different populations to determine the efficacy of screening for this cancer with upper endoscopy. It did not study the biological link between Esophageal Cancer and GERD. Telling your readers they no longer need to worry about the risk of Esophageal Cancer if they suffer with GERD is worse than telling them they needn’t wear sunscreen when going outdoors. Esophageal Cancer kills nearly twice as many Americans as melanoma, yet few heartburn sufferers even realize they are at risk. Your faulty interpretation of the Michigan study makes the situation even worse by telling those who may be aware of the risk they can disregard it.

Esophageal Cancer is one of the deadliest of cancers. Fewer than one in five who are diagnosed will survive. Part of the reason for that low chance of survival is that it usually isn’t detected until advanced stages where treatment is rarely successful. But when detected in early stages or in precancerous Barrett’s Esophagus, new procedures have been able to actually cure patients at a rate of about 98 percent. That’s why telling GERD sufferers not to be concerned about their risk for Esophageal Cancer is irresponsible. Early detection saves lives. The risks are real and complacency is dangerous.

In the U.S., more than 16,000 Americans are diagnosed each year and more than 14,000 will die from Esophageal Cancer. It is true that women are affected at much lower rates than men and white men are affected at a higher rate than those of other races. But 2,850 American women are expected to die of Esophageal Cancer this year, compared with 11,650 men. If only they had known that they were at risk.

The Michigan study attempts to identify groups at greatest risk for esophageal cancer so they can be targeted for screening with upper endoscopy. Unfortunately, study methodology prevented the authors from taking into account the length of time a patient suffered with GERD prior to screening. So someone who has had significant acid reflux since high school or college may definitely be a candidate for Esophageal Cancer screening at the age of 40.

The Michigan study really points out the need for more research support to develop better, more cost effective early detection methods so that lives can be saved - not a disregard for the deadly consequences those who are at risk may face.

Bruce D. Greenwald, M.D.
President

Mindy Mintz Mordecai
Executive Director

Esophageal Cancer Action Network
www.ecan.org

Posted by: mindymm | December 16, 2010 3:21 AM | Report abuse

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