Esophageal Cancer Risk Lower Than Expected for Patients With GERD

ScienceDaily (Jan. 1, 2011) The risk of esophageal cancer among patients who suffer from gastroesophageal reflux disease (GERD) is not as high as many may think, according to new research from University of Michigan gastroenterologists. GERD is considered a relative risk for developing esophageal adenocarcinoma, but the absolute risk is not known, says Joel Rubenstein, M.D., M.Sc., an investigator with the Department of Veterans Affairs Center for Clinical Management Research in Ann Arbor and Assistant Professor in the University of Michigan's Department of Internal Medicine. "Since GERD is incredibly common, many people may be worried about their increased risk for developing cancer due to GERD. This study's results help put that risk into perspective and may help physicians decide when screening to prevent cancer is needed," says Rubenstein. Rubenstein and his co-authors set out to estimate the incidence of new cases of esophageal adenocarcinoma in the large population of people with GERD symptoms. The research published in the American Journal of Gastroenterology this week found:
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Women with GERD likely have a low rate of esophageal adenocarcinoma, similar to the rate of breast cancer in men. The rate of esophageal adenocarcinoma in white men who are 60 years old with weekly GERD is just one-third of their rate of colorectal cancer or 34.6 per 100,000 patients per year. The rate of esophageal adenocarcinoma in younger white men with GERD is less than one-third of their incidence of colorectal cancer.

GERD is characterized by symptoms that result from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach and occurs when the lower esophageal sphincter does not seal off the esophagus from the stomach. The two most frequently reported symptoms of GERD are heartburn and regurgitation, which is characterized by the effortless flow of fluid rising up the chest toward the mouth. Some estimates say up to 1 in 4 people in U.S. suffer from GERD. Rubenstein concluded that screening for esophageal adenocarcinoma should not be performed in men younger than age 50 or in women because of the very low incidences of the cancer, regardless of the frequency of GERD symptoms. However, in white men with weekly GERD over the age of 60, the incidence of esophageal adenocarcinoma is substantial and may warrant screening.

"Our study does not say who should be screened or the effectiveness of the screening. But we can say that for a 60-year-old man with GERD, screening for colon cancer is more important than screening for esophageal adenocarcinoma," Rubenstein says. "We hope this study can help physicians recognize the absolute risk of esophageal adenocarcinoma in patients with GERD within the context of the risk of more familiar cancers, and make it easier to communicate these risks to patients, guiding them in rational decisions about screening procedures." He cautioned however, that if patients are experiencing alarm symptoms such as trouble swallowing, unintentional weight loss, or vomiting, they should seek medical care immediately, as these symptoms could be due to a cancer already present in the esophagus. Funding: National Institutes of Health, National Health and Medical Research Council of Australia.
http://www.sciencedaily.com/releases/2010/12/101209121429.htm

REACTION: This article talks about the GERD or gastroesophageal reflux disease that possess less risk of

having esophageal cancer based on the studies that were conducted.

Obesity And Carbs Linked To Esophageal Cancer, Study Suggests

ScienceDaily (Feb. 26, 2008) Cases of esophageal cancer (adenocarcinoma) in the U.S. have risen in recent decades from 300,000 cases in 1973 to 2.1 million in 2001 at age-adjusted rates. A new study shows that these rates in the U.S. closely mirrored trends of increased carbohydrate intake and obesity from 1973-2 A new study illustrates what may be a public heath concern as the composition of U.S. diets changes and total carbohydrate and refined carbohydrate intakes increase. Obesity is a risk factor for many types of cancer, and a diet that includes a high percentage of calories from refined carbohydrates is a common contributor to obesity. Carbohydrates were also unique in that no other studied nutrients were found to correlate with esophageal cancer rates. The causes of esophageal cancer remain largely unknown. Despite recent advances in treatment, esophageal cancer has a poor prognosis. The five-year rate of survival for esophageal cancer remains below 20 percent and is the eighth-leading cause of cancer related death in American men.

If we can reverse the trends in refined carbohydrate intake and obesity in the U.S., we may be able to reduce the incidence of esophageal cancer, says Dr. Li Li, senior author of the study. This study is published in The American Journal of Gastroenterology.

Strawberries May Slow Precancerous Growth in the Esophagus, Study Suggests

ScienceDaily (Apr. 6, 2011) Eating strawberries may be a way to help people at risk of esophageal cancer protect themselves from the disease, according to a new study by researchers at The Ohio State University Comprehensive Cancer Center -- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC -- James) and researchers in China. Dr. Tong Chen is presenting the findings during a press briefing April 6 at the American Association for Cancer Research (AACR) 102nd meeting 2011 in Orlando, Fla. The study is the first-ever collaborative Ohio State cancer clinical trial to be conducted in China. "We concluded from this study that six months of strawberry treatment is safe and easy to consume. In addition, our preliminary data suggests that strawberries decreased histological grade of precancerous lesions and reduced cancer-related molecular events," said Chen, lead author, and assistant professor in the division of medical oncology, department of internal medicine at Ohio State. She is also a member of the Molecular Carcinogenesis and Chemoprevention program in Ohio State's Comprehensive Cancer Center. Previously published research by Chen and colleagues found that freeze-dried strawberries significantly inhibited tumor development in the esophagus of rats. Based on these results, the researchers embarked on a phase Ib clinical trial in China to investigate the effects of freezedried strawberries on patients with esophageal precancerous lesions. "We found that daily consumption of strawberries suppressed various biomarkers involved in esophageal carcinogenesis, including cell proliferation, inflammation and gene transcription," Chen said. Each of the 36 study participants ate 60 grams (about two ounces) of freeze-dried strawberries daily for six months. The researchers obtained biopsy specimens before and after the strawberry consumption. The results showed that 29 out of 36 participants experienced a decrease in histological grade of the precancerous lesions during the study. "We predict that the majority of patients with precancerous lesions in their esophagus will develop esophageal cancer over subsequent decades," said Chen. "Our study is important because it shows that strawberries may slow the progression of precancerous lesion in the esophagus. Strawberries may be an alternative, or may work together with other

chemopreventive drugs, for the prevention of esophageal cancer. But, we will need to test this in randomized placebo-controlled trials in the future." Esophageal cancer is the third most common gastrointestinal cancer and the sixth most frequent cause of cancer death in the world, said Chen, who also holds a doctorate in Public Health. Chen and her team are studying esophageal squamous cell carcinoma which makes up 95 percent of cases of esophageal cancer worldwide. The survival rate of this type of esophageal cancer is very low, with only 10 percent of patients living 5 years after diagnosis. Esophageal squamous cell carcinoma is quite common in China, Japan, the Transkei region of South Africa, Iran, France and Puerto Rico. "Since this clinical trial is being conducted in China, considerably more effort is required to establish and complete the trial than is typically necessary at our own institution. Nevertheless, we have established a team of highly collaborative investigators who are working well together," said Chen. China has the largest population in the world, and the number of potential participants for clinical trials is higher than in any other country in the world. "We believe that establishing collaborative research teams will enhance clinical research, and that our project will 'open doors' for multiple other trials in China," Chen said. In the United States, Canada and Europe, the risk factors for developing esophageal cancer include tobacco and alcohol use, along with poor diet lacking fruits and vegetables. In Asia, additional risk factors include dietary intake of salty food and of food contaminated with various mycotoxins, deficiencies in dietary vitamins and minerals and thermal injuries due to the consumption of hot beverages. More than 16,000 new cases of esophageal cancer will be diagnosed in the United States this year, according to the American Cancer Society. Funding from the California Strawberry Commission supported this research. Other researchers involved in the study are Fei Yan and Huaji Guan of Ohio State; Gary D. Stoner of Medical College of Wisconsin; and from China: Jiaming Qian, Guiqi Wang, Ning Lu, Hongbing Zhang, Mingzhou Guo, Lian Li, Yanli Zeng, Xiaomin Wang.
http://www.sciencedaily.com/releases/2011/04/110406085056.htm