Incidence of Adenocarcinoma with Barrett's Esophagus Estimated
Annual risk of esophageal adenocarcinoma of 0.12 percent much lower than previously reported
WEDNESDAY, Oct. 12 (HealthDay News) -- The relative risk of esophageal adenocarcinoma is significantly higher in patients with Barrett's esophagus compared to the general population, with an annual risk of 0.12 percent, according to a study published in the Oct. 13 issue of the New England Journal of Medicine.
Frederik Hvid-Jensen, M.D., from the Aarhus University Hospital in Denmark, and colleagues investigated the incidence of esophageal adenocarcinoma and high-grade dysplasia in all patients with Barrett's esophagus in Denmark from 1992 to 2009. Data were collected for 11,028 patients from the Danish Pathology Registry and the Danish Cancer Registry and were analyzed for a median of 5.2 years. Standardized incidence ratios were calculated as a measure of relative risk.
The investigators identified 131 new cases of adenocarcinoma diagnosed within the first year after index endoscopy, and 66 new cases during subsequent follow-up. This yielded an incidence rate of 1.2 cases per 1,000 person-years. The relative risk of adenocarcinoma among patients with Barrett's esophagus was 11.3 times the risk in the general population, and the annual risk was 0.12 percent. The adenocarcinoma incidence rate among patients with low-grade dysplasia detected at baseline was markedly higher than that for patients without dysplasia at baseline (5.1 versus 1.0 case per 1,000 person-years). The risk estimates were slightly higher for patients with high-grade dysplasia.
"The absolute annual risk, 0.12 percent, is much lower than the assumed risk of 0.5 percent, which is the basis for current surveillance guidelines. Data from the current study call into question the rationale for ongoing surveillance in patients who have Barrett's esophagus without dysplasia," the authors write.
The author of the editorial disclosed financial relationships with several pharmaceutical companies.