A recent study of five million adults aged 45 to 64 shows esophageal cancer and Barrett's esophagus (a precancerous disease) have increased dramatically between 2012 and 2019—and scientists don't know why. Esophageal cancer rates have almost doubled in that timespan, while Barrett's esophagus is up by 50%. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.
What Role Does Better Screening Play?
Researchers are certain the rise in esophageal cases cannot be attributed simply to better screening. "This strong growth in prevalence should be of concern to physicians, and we should consider screening more middle-aged patients for esophageal cancer if they are at higher risk," says Bashar J. Qumseya, MD, MPH, FASGE, associate professor of medicine and chief of endoscopy at the University of Florida, Gainesville. "Whenever we see increasing prevalence of any type of cancer, we should ask whether this is merely due to better screening or it is a true increase in the disease prevalence. In our study, it was due to the latter."
Esophageal Cancer and Smoking
Research shows smokers are twice as likely to develop cancer of the esophagus as non-smokers. "About half of these cases globally are attributable to smoking while the overwhelming majority of cases nationally are related to smoking," says Moshim Kukar, MD, Associate Professor of Oncology at Roswell Park Comprehensive Cancer Center. "Active smoking is a predictor of poor outcomes. Active smokers are less likely to respond to treatments and can have early recurrence of the cancer. Research indicates the risk for esophageal squamous cell carcinoma decreases within five years of smoking cessation. Individuals who have quit smoking for more than 20 years reduce their risk to about that of lifelong non-smokers."
Esophageal Cancer and Drinking
Drinking alcohol—particularly when combined with smoking—is a high risk factor for esophageal cancer, experts warn. "Drinking alcohol increases the risk of esophageal cancer. The more alcohol someone drinks, the higher their chance of getting esophageal cancer," says the American Cancer Society. "Alcohol increases the risk of squamous cell carcinoma more than the risk of adenocarcinoma. Smoking combined with drinking alcohol raises the risk of the squamous cell type of esophageal cancer much more than using either alone.
What Is Barrett's Esophagus?
Barrett's esophagus is a condition where the esophagus becomes damaged by chronic acid reflux. "The esophagus wants to protect itself, so the cells in the lining begin to change," says Memorial Sloan Kettering thoracic surgeon Daniela Molena. "The normal tissue lining the esophagus begins resembling the lining of the stomach or intestine. Often when I ask patients if they have reflux or heartburn, they'll say, 'I used to have that when I was younger, but I don't anymore.' The pain often goes away when Barrett's develops, which can be counterproductive because people seek less help for their symptoms."
When Should Esophageal Cancer Screening Happen?
"Many patients in the U.S. now have colonoscopies starting at age 45, so conducting an endoscopy at the same time, among those with multiple risk factors, could help capture more patients with Barrett's esophagus and esophageal cancer," says Dr. Qumseya. "From other analyses we have conducted with this dataset, we know that even patients with four or more risk factors for esophageal cancer are not having endoscopies. So, from both the patient and provider perspective, we can do better."