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The incidence of esophageal adenocarcinoma among patients with Barrett’s esophagus was only 1.2 cases per 1,000 person-years in a study of the entire population of Denmark reported in the New England Journal of Medicine.
That rate is four to five times lower than rates reported previously, said Dr. Frederik Hvid-Jensen of the department of surgical gastroenterology at Aarhus (Denmark) University and his associates.
"Our study provides solid evidence that esophageal adenocarcinoma will develop in very few patients with Barrett’s esophagus. Together with another recent study, as well as studies of cost-effectiveness and patients’ quality of life, the results of our study suggest that the risk of esophageal adenocarcinoma among patients with Barrett’s esophagus is so minor that in the absence of dysplasia, routine surveillance of such patients is of doubtful value," the investigators said.
The relevance of such surveillance programs has been questioned before because they have never been shown to improve survival and because an estimated 95% of patients with a new diagnosis of esophageal adenocarcinoma do not have a previous diagnosis of Barrett’s esophagus, they noted.
Dr. Hvid-Jensen and his colleagues used data from Denmark’s nationwide pathology and cancer registries to calculate the incidence of adenocarcinoma among patients with Barrett’s esophagus and compare it with the expected incidence in the general population of 5.4 million people.
A total of 11,028 patients underwent endoscopic biopsy and received a diagnosis of Barrett’s esophagus during 1992-2009. The median age at baseline was 63 years, and patients were followed for a median of 5.2 years.
During that time, 197 of these patients with Barrett’s esophagus developed new esophageal adenocarcinomas, which comprised 7.6% of all the 2,602 incident esophageal adenocarcinomas diagnosed in the general Danish population during 1992-2009.
After excluding cancer cases that developed in the first year after a diagnosis of Barrett’s esophagus, the incidence of esophageal adenocarcinoma among patients with Barrett’s esophagus was found to be 1.2 cases per 1,000 person-years, the investigators said (N. Engl. J. Med. 2011;365:1375-83).
The annual risk of developing the malignancy was only 0.12%, or one case of adenocarcinoma per 860 patient-years.
In contrast, there were four reviews of the literature published in the past decade that pooled the results of numerous small studies conducted throughout the United States and Europe. These studies calculated the esophageal adenocarcinoma incidence as ranging from 5.2 to 7.0 cases per 1,000 person-years. In addition, two previous registry studies calculated similar incidences of 4.0 and 5.0 cases of esophogeal cardinoma per 1,000 person-years.
Current surveillance guidelines are based upon these earlier studies, which appear to have overstated the risks, Dr. Hvid-Jensen and his associates stated.
Their population-based, nationwide study is one of the largest studies of the issue; it included patients of all ages and both sexes and had almost no loss to follow-up. Because of Denmark’s universal health care plan, this study also had no referral bias or diagnostic bias.
"The generalizability of our results is therefore high," they noted.
Moreover, a recent population-based study in Northern Ireland found remarkably similar results: an incidence of 1.3 cases of esophageal adenocarcinoma per 1,000 patient-years among people with Barrett’s esophagus.
And another recent study "in which Markov models were used to evaluate available data on the incidence of adenocarcinoma supports our findings ... [and suggests] that surveillance is not beneficial," the researchers added.
This study was supported by the University of Aarhus Clinical Institute. No financial conflicts of interest were reported.☐
The "elegant" epidemiologic study by Dr. Hvid-Jensen and associates clearly shows that the relative risk of esophageal adenocarcinoma for a person with Barrett’s esophagus, as compared with the general population, is 11.3, "a substantial drop from the increase by a factor of 30 or 40 estimated in early reports," said Dr. Peter J. Kahrilas.
"As our knowledge of the biologic characteristics of Barrett’s esophagus has matured, the significance of the lesion has dwindled. In fact, patients with Barrett’s esophagus have the same life expectancy as does the general population, and esophageal cancer proves to be an uncommon cause of death in patients with Barrett’s esophagus regardless of surveillance," he noted.
Dr. Kahrilas is with the department of medicine at Northwestern University, Chicago. He reported ties to numerous industry sources. These remarks were taken from his editorial accompanying Dr. Hvid-Jensen’s report (N. Engl. J. Med. 2011;365:1437-8).
The "elegant" epidemiologic study by Dr. Hvid-Jensen and associates clearly shows that the relative risk of esophageal adenocarcinoma for a person with Barrett’s esophagus, as compared with the general population, is 11.3, "a substantial drop from the increase by a factor of 30 or 40 estimated in early reports," said Dr. Peter J. Kahrilas.
"As our knowledge of the biologic characteristics of Barrett’s esophagus has matured, the significance of the lesion has dwindled. In fact, patients with Barrett’s esophagus have the same life expectancy as does the general population, and esophageal cancer proves to be an uncommon cause of death in patients with Barrett’s esophagus regardless of surveillance," he noted.
Dr. Kahrilas is with the department of medicine at Northwestern University, Chicago. He reported ties to numerous industry sources. These remarks were taken from his editorial accompanying Dr. Hvid-Jensen’s report (N. Engl. J. Med. 2011;365:1437-8).
The "elegant" epidemiologic study by Dr. Hvid-Jensen and associates clearly shows that the relative risk of esophageal adenocarcinoma for a person with Barrett’s esophagus, as compared with the general population, is 11.3, "a substantial drop from the increase by a factor of 30 or 40 estimated in early reports," said Dr. Peter J. Kahrilas.
"As our knowledge of the biologic characteristics of Barrett’s esophagus has matured, the significance of the lesion has dwindled. In fact, patients with Barrett’s esophagus have the same life expectancy as does the general population, and esophageal cancer proves to be an uncommon cause of death in patients with Barrett’s esophagus regardless of surveillance," he noted.
Dr. Kahrilas is with the department of medicine at Northwestern University, Chicago. He reported ties to numerous industry sources. These remarks were taken from his editorial accompanying Dr. Hvid-Jensen’s report (N. Engl. J. Med. 2011;365:1437-8).
The incidence of esophageal adenocarcinoma among patients with Barrett’s esophagus was only 1.2 cases per 1,000 person-years in a study of the entire population of Denmark reported in the New England Journal of Medicine.
That rate is four to five times lower than rates reported previously, said Dr. Frederik Hvid-Jensen of the department of surgical gastroenterology at Aarhus (Denmark) University and his associates.
"Our study provides solid evidence that esophageal adenocarcinoma will develop in very few patients with Barrett’s esophagus. Together with another recent study, as well as studies of cost-effectiveness and patients’ quality of life, the results of our study suggest that the risk of esophageal adenocarcinoma among patients with Barrett’s esophagus is so minor that in the absence of dysplasia, routine surveillance of such patients is of doubtful value," the investigators said.
The relevance of such surveillance programs has been questioned before because they have never been shown to improve survival and because an estimated 95% of patients with a new diagnosis of esophageal adenocarcinoma do not have a previous diagnosis of Barrett’s esophagus, they noted.
Dr. Hvid-Jensen and his colleagues used data from Denmark’s nationwide pathology and cancer registries to calculate the incidence of adenocarcinoma among patients with Barrett’s esophagus and compare it with the expected incidence in the general population of 5.4 million people.
A total of 11,028 patients underwent endoscopic biopsy and received a diagnosis of Barrett’s esophagus during 1992-2009. The median age at baseline was 63 years, and patients were followed for a median of 5.2 years.
During that time, 197 of these patients with Barrett’s esophagus developed new esophageal adenocarcinomas, which comprised 7.6% of all the 2,602 incident esophageal adenocarcinomas diagnosed in the general Danish population during 1992-2009.
After excluding cancer cases that developed in the first year after a diagnosis of Barrett’s esophagus, the incidence of esophageal adenocarcinoma among patients with Barrett’s esophagus was found to be 1.2 cases per 1,000 person-years, the investigators said (N. Engl. J. Med. 2011;365:1375-83).
The annual risk of developing the malignancy was only 0.12%, or one case of adenocarcinoma per 860 patient-years.
In contrast, there were four reviews of the literature published in the past decade that pooled the results of numerous small studies conducted throughout the United States and Europe. These studies calculated the esophageal adenocarcinoma incidence as ranging from 5.2 to 7.0 cases per 1,000 person-years. In addition, two previous registry studies calculated similar incidences of 4.0 and 5.0 cases of esophogeal cardinoma per 1,000 person-years.
Current surveillance guidelines are based upon these earlier studies, which appear to have overstated the risks, Dr. Hvid-Jensen and his associates stated.
Their population-based, nationwide study is one of the largest studies of the issue; it included patients of all ages and both sexes and had almost no loss to follow-up. Because of Denmark’s universal health care plan, this study also had no referral bias or diagnostic bias.
"The generalizability of our results is therefore high," they noted.
Moreover, a recent population-based study in Northern Ireland found remarkably similar results: an incidence of 1.3 cases of esophageal adenocarcinoma per 1,000 patient-years among people with Barrett’s esophagus.
And another recent study "in which Markov models were used to evaluate available data on the incidence of adenocarcinoma supports our findings ... [and suggests] that surveillance is not beneficial," the researchers added.
This study was supported by the University of Aarhus Clinical Institute. No financial conflicts of interest were reported.☐
The incidence of esophageal adenocarcinoma among patients with Barrett’s esophagus was only 1.2 cases per 1,000 person-years in a study of the entire population of Denmark reported in the New England Journal of Medicine.
That rate is four to five times lower than rates reported previously, said Dr. Frederik Hvid-Jensen of the department of surgical gastroenterology at Aarhus (Denmark) University and his associates.
"Our study provides solid evidence that esophageal adenocarcinoma will develop in very few patients with Barrett’s esophagus. Together with another recent study, as well as studies of cost-effectiveness and patients’ quality of life, the results of our study suggest that the risk of esophageal adenocarcinoma among patients with Barrett’s esophagus is so minor that in the absence of dysplasia, routine surveillance of such patients is of doubtful value," the investigators said.
The relevance of such surveillance programs has been questioned before because they have never been shown to improve survival and because an estimated 95% of patients with a new diagnosis of esophageal adenocarcinoma do not have a previous diagnosis of Barrett’s esophagus, they noted.
Dr. Hvid-Jensen and his colleagues used data from Denmark’s nationwide pathology and cancer registries to calculate the incidence of adenocarcinoma among patients with Barrett’s esophagus and compare it with the expected incidence in the general population of 5.4 million people.
A total of 11,028 patients underwent endoscopic biopsy and received a diagnosis of Barrett’s esophagus during 1992-2009. The median age at baseline was 63 years, and patients were followed for a median of 5.2 years.
During that time, 197 of these patients with Barrett’s esophagus developed new esophageal adenocarcinomas, which comprised 7.6% of all the 2,602 incident esophageal adenocarcinomas diagnosed in the general Danish population during 1992-2009.
After excluding cancer cases that developed in the first year after a diagnosis of Barrett’s esophagus, the incidence of esophageal adenocarcinoma among patients with Barrett’s esophagus was found to be 1.2 cases per 1,000 person-years, the investigators said (N. Engl. J. Med. 2011;365:1375-83).
The annual risk of developing the malignancy was only 0.12%, or one case of adenocarcinoma per 860 patient-years.
In contrast, there were four reviews of the literature published in the past decade that pooled the results of numerous small studies conducted throughout the United States and Europe. These studies calculated the esophageal adenocarcinoma incidence as ranging from 5.2 to 7.0 cases per 1,000 person-years. In addition, two previous registry studies calculated similar incidences of 4.0 and 5.0 cases of esophogeal cardinoma per 1,000 person-years.
Current surveillance guidelines are based upon these earlier studies, which appear to have overstated the risks, Dr. Hvid-Jensen and his associates stated.
Their population-based, nationwide study is one of the largest studies of the issue; it included patients of all ages and both sexes and had almost no loss to follow-up. Because of Denmark’s universal health care plan, this study also had no referral bias or diagnostic bias.
"The generalizability of our results is therefore high," they noted.
Moreover, a recent population-based study in Northern Ireland found remarkably similar results: an incidence of 1.3 cases of esophageal adenocarcinoma per 1,000 patient-years among people with Barrett’s esophagus.
And another recent study "in which Markov models were used to evaluate available data on the incidence of adenocarcinoma supports our findings ... [and suggests] that surveillance is not beneficial," the researchers added.
This study was supported by the University of Aarhus Clinical Institute. No financial conflicts of interest were reported.☐
Major Finding: The incidence of esophageal adenocarcinoma among all patients in Denmark with Barrett’s esophagus was 1.2 cases per 1,000 person-years, which is four to five times lower than estimated in previous, smaller studies.
Data Source: An epidemiologic cohort study of esophageal adenocarcinoma among the 5.4 million residents of Denmark, including 11,028 with Barrett’s esophagus followed for a median of 5.2 years.
Disclosures: This study was supported by the University of Aarhus Clinical Institute. No financial conflicts of interest were reported.