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Low Risk of Malignant Progression in Barrett's

Risk of malignant progression for Barrett's esophagus may be lower than previously reported

FRIDAY, June 17 (HealthDay News) -- The risk of malignant progression for patients with Barrett's esophagus (BE) may be lower than previously reported, according to a study published online June 16 in the Journal of the National Cancer Institute.

Shivaram Bhat, M.B., B.Ch., M.R.C.P., from Queen's University Belfast in Northern Ireland, and colleagues investigated the risk of malignant progression in 8,522 patients with BE, with or without specialized intestinal metaplasia (SIM). Participants were diagnosed with BE between 1993 and 2005 in Northern Ireland and followed up for an average of seven years. Incidence of cancer outcomes or high-grade dysplasia was calculated as events per 100 person-years (percent per year) of follow-up, after adjusting for variables.

The investigators identified 79 patients with esophageal cancer, 16 with cancer of the gastric cardia, and 36 with high-grade dysplasia of the esophagus. Of these patients, 46 percent had SIM. The combined incidence of esophageal or gastric cardia cancer or high-grade dysplasia was 0.22 percent per year for the entire cohort and 0.38 percent per year for patients with SIM. At the initial biopsy, the cancer risk was significantly higher in patients with SIM (hazard ratio [HR], 3.54) and in patients with low-grade dysplasia (HR, 5.67) compared to those without, and in men compared to women (HR, 2.11).

"This study has shown a lower incidence of cancer among patients with BE than what was previously reported. Current recommendations for surveillance are based on higher estimates of cancer risk among patients with BE than were seen in this study and, therefore, they may not be justified," the authors write.

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