Scientists have found alarming growth in a particular variant of cancer

A new study has found that the incidence of esophageal cancer in adults between the ages of 45 and 64 has doubled.

According to the researchers, the data show an urgent need for earlier endoscopic screening

Esophageal cancer is a type of cancer that develops in the esophagus, which is a long, hollow tube that connects the throat to the stomach. Your esophagus helps transport the food you eat to your stomach, where it will be digested. Esophageal cancer usually begins in the cells that cover the inside of the esophagus. However, it can occur at any point in the esophagus.

Esophageal cancer is the sixth leading cause of cancer deaths worldwide. The degree of the disease varies depending on where you live. Tobacco and alcohol use, as well as some dietary practices and obesity, may be associated with an increased risk of esophageal cancer.

According to a study of about five million patients, which will be presented at Digestive Diseases Week 2022, adults aged 45 to 64 had almost double the incidence of esophageal cancer and a 50% increase in esophageal cancer. Barrett between 2012 and 2019

“This strong increase 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,” said Bashar J. Qumseya, MD, MPH. FASGE, lead author of the study and associate professor of medicine and head of endoscopy at the University of Florida, Gainesville. “When we see an increasing prevalence of any type of cancer, we need to ask whether this is due to better screening alone or a real increase in the prevalence of the disease. In our study, this is due to the latter. “

The researchers studied the frequency of esophagogastroduodenoscopy (EGD) during this time period and found no evidence of an increase that could explain the prevalence data. EGD is a diagnostic procedure that examines the esophagus, stomach and the first part of the small intestine (duodenum).

According to the study, esophageal and Barrett’s esophageal cancers are most common in older white men, with those over 65 being the most common. However, the researchers found that the incidence of cancer in the 45-64 age group doubled, from 49 to 94 per 100,000, while the incidence of Barrett’s esophagus increased by approximately 50%, from 304 to 466 per 100 000 individuals.

Esophageal cancer, which is usually detected by endoscopy, is often a silent killer with minimal symptoms until it becomes advanced. Barrett’s esophagus – the primary antecedent lesion of esophageal adenocarcinoma that begins in glandular cells in the esophageal mucosa – is caused mainly by chronic[{” attribute=””>acid reflux. Other risk factors include advanced age, male sex, obesity, smoking, and alcohol consumption.

Dr. Qumseya said that middle-aged patients with multiple risk factors would benefit from earlier and/or more frequent screening, comparing it to the benefit of earlier colorectal cancer screening. “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,” he said.

“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,” he added. “So, from both the 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.

Researchers analyzed records by three age categories, 18 to 44, 45 to 64, and over 65. Further analysis of the database is ongoing, and the 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 is not necessarily representative of the U.S. population. It was not a randomized controlled trial that followed one group of patients over time. In addition, as with any database, there could be problems with the data itself. The EHRs analyzed were of 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 revisit the database to try to differentiate between the two types of esophageal cancer – esophageal adenocarcinoma, which usually affects the lower esophagus, and squamous cell carcinoma, which affects the upper esophagus.

Reference: “Alarming increase in prevalence of esophageal cancer and Barrett’s esophagus in middle-aged patients: findings from a statewide database of over five million patients” by Bashar J. Qumseya et al., 23 May 2022. 

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