An alarming increase in both esophageal cancer (EC) and the primary precursor lesion for esophageal adenocarcinoma known as Barrett’s esophagus (BE) has been observed among middle-aged adults over the past 5 years, and it’s not due to better or more frequent screening, warn the authors of a new study from Florida.
“We found that the [prevalence of] esophageal cancer and Barrett’s esophagus may have in fact plateaued in the elderly, but there is a concerning increase in their prevalence in middle-aged adults despite the fact that there has been no increase in the use of endoscopy in this population,” Bashar Qumseya, MD, MPH, associate professor of medicine and chief of endoscopy, University of Florida, Gainesville, Florida, told a press briefing.
“This should be of great concern to physicians and to patients, and it is our suggestion that maybe we should consider screening middle-aged patients or even those at younger ages for both conditions,” he added.
The study was highlighted during a press briefing in advance of Digestive Disease Week (DDW) 2022, to be held May 21 to 24 in San Diego, California.
The analysis was carried out using electronic health records from the OneFlorida Clinical Data Research Network, a database that covers over 40% of residents living in Florida. Researchers identified patients who had been diagnosed with EC or BE between 2012 and 2019. “The primary outcome of interest was the adjusted prevalence of EC and BE in the population,” the researchers state.
The cohort was categorized by age: those aged 18–44 years (young); those aged 45–64 years (middle-aged), and those older than 65 (elderly). The number of patients included in the database varied by year and ranged from 4,238,884 to 5,411,838 patients per year, the investigators note. Interestingly, in the most recent year, 2019, more women, at over 57%, were diagnosed with EC than were men.
Over the study interval, the prevalence of EC remained stable among the elderly but nearly doubled among middle-aged patients, from a rate of 49 per 100,000 in 2012 to a rate of 94 per 100,000 in 2019.
Similarly, there was a 50% increase in BE over the same study interval, from 304 per 100,000 in 2012 to 466 per 100,000 in 2019, again in the middle-aged group. The increase in the prevalence of BE was highest in those aged 51–60 years, followed by those aged 61–70 years and then by those aged 41–50, the researchers point out.
Data from the same cohort also indicated that the great majority of patients with multiple risk factors for EC or BE — obesity, diet, and gastroesophageal reflux disease ― had never undergone endoscopy, “so we can definitely do better,” Qumseya said. One simple way to “do better” is to offer patients an endoscopy when they undergo their first colonoscopy at the recommended age of 45 years, he suggested.
“I am not in a position to make the guidelines,” Qumseya commented. “But we do [already] have guidelines that suggest that patients with multiple risk factors [for EC and BE] be screened, and since we know from our data that this is not happening, I believe that if a patient has multiple risk factors, they should have at least one screening endoscopy at the time of colonoscopy. Otherwise, we are missing a good opportunity to do so, and personally, I think this is something that we should be considering,” he said.
Digestive Disease Week (DDW) 2022: Abstract 671. To be presented May 23, 2022.