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For Most, Chronic Heartburn Not a Big Risk for Esophageal Cancer
Date:12/20/2010

By Ellin Holohan
HealthDay Reporter

FRIDAY, Dec. 17 (HealthDay News) -- Contrary to popular belief, acid reflux disease, better known as heartburn, is not much of a risk factor for esophageal cancer for most people, according to new research.

"It's a rare cancer," said study author Dr. Joel H. Rubenstein, an assistant professor in the University of Michigan department of internal medicine.

"About 1 in 4 people have symptoms of GERD [acid reflux disease] and that's a lot of people," he said. "But 25 percent of people aren't going to get this cancer. No way."

GERD is characterized by the frequent rise of stomach acid into the esophagus.

Rubenstein said he was concerned that as medical technology advances, enthusiasm for screening for esophageal cancer will increase, though there is no evidence that widespread screening has a benefit. About 8,000 cases of esophageal cancer are diagnosed in the United States each year, he said.

The study was published this month in the American Journal of Gastroenterology.

Using computer models based on data from a national cancer registry and other published research about acid reflux disease, the study found only 5,920 cases of esophageal cancer among whites younger than 80 years old, with or without acid reflux disease, in the U.S. population in 2005.

However, white men over 60 years old with regular acid reflux symptoms accounted for 36 percent of these cases. Women accounted for only 12 percent of the cases, regardless of age and whether or not they had acid reflux disease.

People with no acid reflux symptoms accounted for 34 percent of the cases, the authors said. Men under 60 accounted for 33 percent of the cases.

For women, the risk for the cancer was negligible, about the same as that of men for developing breast cancer, or less than 1 percent, the researchers said.

Yet the vast majority of gastroenterologists surveyed said they would recommend screening for young men with acid reflux symptoms, and many would send women for the testing as well, according to research cited in the study.

Screening for esophageal cancer, called endoscopy, involves placing a tube with a small camera down the throat to look for tumors.

Anyone with acid reflux disease who develops more serious symptoms that don't respond to medication, such as a problem swallowing, unexplained weight loss, or vomiting, should see a doctor, as those symptoms could be signs of esophageal cancer, he noted.

Although it wasn't addressed in this study, obesity and smoking increase the risk for esophageal cancer, said Rubenstein.

The study sought to show a baseline age for esophageal cancer that would compare to the generally established ages for screening for other more common cancers such as colorectal (50 years) and breast cancer (40 years).

In Rubenstein's opinion, screening for esophageal cancer should not be performed routinely in men younger than 50 or in women because of the very low incidences of the cancer, regardless of the frequency of GERD symptoms.

Although Rubenstein said white males have a risk of developing esophageal cancer that's about four to five times higher than the risk for black males, the odds are still comparatively low. Men at any age are three times more likely to get colon cancer than esophageal cancer, according to the research.

Men over 60 who suffer from weekly GERD "might warrant screening," the authors concluded, but only if it were known to be accurate, safe and inexpensive.

Another expert, Dr. Gregory Haber said he had some concerns about the study's design because it is derived from other studies and based on mathematical calculation.

"I'm always a little suspect of studies based on computer models," said Haber, director of gastroenterology at Lenox Hill Hospital, New York City.

Haber also noted that screenings are done for other reasons than discovery of a cancer, citing evaluation of hiatal hernia, esophagealitis, pre-cancerous lesions and other secondary results of frequent GERD symptoms.

But overall, Haber concluded that the study had some important messages.

"There are some good lessons to be learned," he said. "There probably needs to be more emphasis on the disparity between the incidence of esophageal cancer in men and women."

More information

For more on esophageal cancer, visit the U.S. National Cancer Institute.

SOURCES: Joel H. Rubenstein, M.D., investigator, Department of Veterans Affairs Center for Clinical Management Research, assistant professor of internal medicine, University of Michigan, Ann Arbor, Mich.; Gregory Haber, director of gastroenterology, director, Center for Advanced Therapeutic Endoscopy, Lenox Hill Hospital, New York City; American Journal of Gastroenterology, Dec. 7, 2010


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