Alarming increase found in esophageal cancer and Barrett’s esophagus in middle-aged adults
Adults ages 45 to 64 experienced a nearly doubling rate of esophageal cancer and a 50 percent increase in precancerous Barrett’s esophagus between 2012 and 2019, according to a database analysis of approximately five million patients that will be presented at Digestive Disease Week® 2022.
"This sharp growth in prevalence should concern clinicians, and we should consider screening more middle-aged patients for esophageal cancer if they are at increased risk," said Bashar J. Qumseya, MD, MPH, FASGE, lead author of the study. study and associate professor of medicine and chief of endoscopy at the University of Florida, Gainesville. “Any time we see an increase in the prevalence of any type of cancer, we must ask ourselves if this is simply due to better detection or if it is a true increase in the prevalence of the disease. In our study, it was due to the latter.”
The study team evaluated the rate of esophagogastroduodenoscopy (EGD) during this time period and found no increase that could explain the prevalence data. An EGD is an endoscopic diagnostic test to examine the esophagus, stomach, and the first part of the small intestine (duodenum).
Esophageal cancer and Barrett’s esophagus are most commonly found in older white men, and the study found that the highest incidence remains among those over 65 years of age. But the researchers found that the cancer rate nearly doubled in the 45- to 64-year-old age group, from 49 per 100,000 to 94 per 100,000, while the prevalence of Barrett’s esophagus in this group increased by about 50 percent. percent, from 304 to 466 per 100,000 patients.
Esophageal cancer, usually detected by endoscopy, is often a silent killer with minimal symptoms until it progresses. Barrett’s esophagus, the main precursor lesion of esophageal adenocarcinoma, which begins in the glandular cells of the lining of the esophagus, is mainly caused by chronic acid reflux. Other risk factors include older age, male sex, obesity, smoking and alcohol consumption.
Dr. Qumseya said middle-aged patients with multiple risk factors would benefit from earlier and/or more frequent screening, compared to the benefit of earlier colorectal cancer screening. “Many patients in the US now have colonoscopies starting at age 45, so performing endoscopy at the same time, among those with multiple risk factors, could help capture more patients with Barrett’s esophagus and cancer.” of the esophagus,” he said.
"From other analyzes we have performed with this data set, we know that even patients with four or more risk factors for esophageal cancer do not undergo endoscopies," he added. “So from a patient and provider perspective, we can do better.”
The study was a cross-sectional analysis of electronic health record (EHR) data from the OneFlorida Clinical Data Research Network, which covers more than 40 percent of Florida residents.
The researchers analyzed the records by three age categories, 18 to 44, 45 to 64, and over 65. Further analysis is underway on the database and final results should be ready in the next six months.
Dr. Qumseya noted several limitations of the study: It covered only adults living in Florida, so it is not necessarily representative of the U.S. population. It was not a randomized controlled trial that followed a group of patients throughout weather. Additionally, as with any database, there could be problems with the data itself. The EHRs analyzed were from patients who visited hospitals or doctors’ offices, so the database does not indicate whether they already had a disease at the time of that visit or whether the condition had resolved.
In the final analyses, the research team plans to review the database to try to differentiate between the two types of esophageal cancer: esophageal adenocarcinoma, which usually affects the lower part of the esophagus, and squamous cell carcinoma, which It affects the upper part of the esophagus.
