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Cancer Genetics

Barrett Esophagus and Cancer Risk

10/24/2000

Question:

Is there a high risk of Barrett esophagus turning into cancer? I have read a lot of articles on it and some say there is only a very small risk and other`s say the risk is great. It`s hard to know what to believe.

Answer:

One reason that you often see such a wide range of esophageal cancer risks associated with Barrett esophagus is that the cancer risk differs depending on the severity of the Barrett esophagus. Barrett esophagus is diagnosed when the normal squamous epithelium of the esophagus is replaced by columnar epithelium (the type of cells that normally line the stomach)probably due to chronic exposure to stomach acids through gastroesophageal reflux disease.

It is now understood that there is a pathway through which the Barrett esophagus cells go before becoming cancerous. First, the Barrett columnar epithelium changes into a "low-grade dysplasia" with some of the cells looking abnormal under the microscope; then the cells may change to "high-grade dysplasia" with even more looking abnormal; then they can become cancerous.

There are data from 5 different centers that followed individuals with Barrett esophagus (BE) to see if they developed cancer.

* Of 150 patients with BE and no dysplasia, 5 (or 3%) went on to develop cancer.

* Of 45 patients with BE and low-grade dysplasia, 8 (or 18%) went on to develop cancer.

* Of 115 patients with BE and high grade dysplasia, 32 (28%) went on to develop cancer.

Since the cancer risks vary depending on whether or not there is dysplasia associated with the Barrett esophagus, so do the screening recommendations. Although this varies from center to center, here are some general guidelines for screening of BE. If there is no dysplasia, patients have endoscopy every 3 years. If there is low-grade dysplasia, patients have endoscopy every 6 months for the first year and then annually thereafter. If there is no further dysplasia, they relax back to every 2-3 years. If there is persistent low-grade dysplasia, screening stays annually. With high grade dysplasia, surgery is considered to removed the esophagus or patients have endoscopy every 3-6 months or a new ablation therapy.

As you see, the risk varies a great deal depending on the precise diagnosis and this has generated a lot of confusion. In addition, what one person considers a low level of risk, another might consider a high level of risk.

Two websites are attached with more information about Barrett esophagus.

Related Resources:

Jameline factsheet about Barrett esophagus
National Digestive Diseases Information Clearinghouse

For more information:

Go to the Cancer Genetics health topic, where you can:

Response by:

Heather L Hampel, MS, CGC Heather L Hampel, MS, CGC
Cancer Genetic Counselor
College of Medicine
The Ohio State University

Judith A Westman, MD Judith A Westman, MD
Associate Professor, Clinical Internal Medicine, Pediatrics and Medical Biochemistry
College of Medicine
The Ohio State University