The rate of esophageal cancer has almost doubled among adults between the ages of 45 and 64, according to a new study that has researchers calling for earlier and more frequent testing for the deadly disease.
The study, set to be presented at Digestive Disease Week, also uncovered a 50 per cent increase in a precancerous condition known as Barrett’s esophagus during an analysis of roughly five million patients between 2012 and 2019. “This strong growth 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, lead author of the study and associate professor of medicine and chief of endoscopy at the University of Florida, Gainesville.
“Whenever we see increasing prevalence of any type of cancer, we should ask whether this is merely due to better screening or it is a true increase in the disease prevalence. In our study, it was due to the latter.”
To be sure, researchers analyzed the rate of esophagogastroduodenoscopy — a diagnostic test that inspects the esophagus, stomach and part of the small intestine — over the same period of time and found no increase in use that might account for their findings.
Esophageal cancer and Barrett’s esophagus are most prevalent in white males over the age of 65, a finding confirmed by the study. Of greater concern, however, was the near doubling of the cancer rate among patients between the ages of 45 and 64, from 49 per 100,000 to 94 per 100,000. In the same age group, the rate of Barrett’s esophagus increased roughly 50 per cent, from 304 per 100,000 patients to 466 per 100,000.
It is estimated that 2,500 Canadians will be diagnosed with esophageal cancer in 2022, according to the Canadian Cancer Society, with around 2,400 patients dying from the disease. This form of cancer is known as a silent killer because it often presents few symptoms until it reaches an advanced stage.
There are roughly 800,000 Canadians living with Barrett’s esophagus, a condition where the cells lining the lower esophagus change, according to the Canadian Digestive Health Foundation. Around 50 per cent of patients with Barrett’s esophagus experience no symptoms and about 0.5 per cent of patients go on to develop esophageal cancer. The condition is largely caused by acid reflux, with advanced age, male sex, obesity, smoking and alcohol consumption also playing a role.
The study analyzed three age groups (18-44, 45-64 and over 65) using health data from the OneFlorida Clinical Data Research Network, which covers more than 40 percent of Florida residents. Analysis is ongoing and is expected to be finalized before the end of the year.
There were a few limitations, including the fact that it was not a randomized controlled trial that followed the same patients over time. It also exclusively used data from Florida residents and, as such, may not necessarily represent other populations.
Still, in light of their findings, the team recommends increasing the timing and frequency of testing. “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,” Qumseya 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. So, from both the patient and provider perspective, we can do better.”
Dave Yasvinski is a writer with Healthing.ca