Concerning Spike in Barrett’s Esophagus, Esophageal Cancer in Middle-Age Adults

Adults in middle age showed an increasing trend of developing more Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) over the years that was not attributed to more endoscopic screening, a researcher reported.

In a cross-sectional analysis in over 5 million adults, those ages 45 to 64 experienced a 50% increase in precancerous BE, and a nearly two-fold increase for EAC, while the prevalence of EAC stabilized for the elderly from 2012 to 2019, respectively:

• BE: adjusted prevalence 304 per 100,000 to 466 per 100,000 patients
• EAC: 49 per 100,000 to 94 per 100,000 patients

The use of esophagogastroduodenoscopy stabilized over the same time period, so that could not be a reason for the finding, according to Bashar Qumseya, MD, MPH, of the University of Florida in Gainesville.

Subgroup analysis showed the increase in BE was greatest for those ages 51-60, followed by ages 61-70, and ages 41-50, he said in a presentation at a press briefing ahead of Digestive Disease Week.

EAC often presents with minimal symptoms that only manifest at advanced stages. BE serves as a primary precursor lesion to EAC, which can develop from chronic acid reflux. BE and EC commonly occur among elderly white men. Both conditions were suggested to have plateaued recently and might be considered age-dependent.

Qumseya and colleagues examined electronic health records data from the OneFlorida Clinical Research Network on patient populations that ranged from 4,238,884 to 5,411,838, depending on the year, from 2012 to 2019. They used ICD-9 and ICD-10 codes to identify patients with EAC and BE diagnoses in the overall population in that same time period. Patients were categorized by ages into three groups: 18-44 (young) 45-64 (middle age), and >65 (elderly). In 2019, over half of all patients were women, 40% were white, and 22% were Black.

The authors reported that the prevalence of EC was shown to significantly vary by age group, with the elderly having a greater prevalence each year, compared to those in middle-age, but this trend stabilized over time.

“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 Qumseya in a press release. “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.”

“Many patients in the U.S. now have colonoscopies [for colorectal cancer screening] 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.

Qumseya advised that people with multiple risk factors for BE or EC should discuss them with their physicians to see if screening would be appropriate. “Risk factors include family history of BE or EC, history of heartburn, obesity, smoking, obesity, white race, and male sex,” he told MedPage Today.

“Some of these risk factors are increasing at a younger age,” Qumseya said. “We looked at patients with four or more risk factors for Barrett’s esophagus or esophageal cancer and only about 29% to 30% of them ever had an endoscopy,” adding that this could be because of a lack of awareness; a lack of consensus of guidelines; or because endoscopy is invasive and can be expensive.

He noted that his group is doing further data analysis, including differentiating esophageal cancer types, such as EAC that affects the lower esophagus, and squamous cell carcinoma that affects the upper esophagus.

Study limitations included a sample size of Florida-based adults so the results may not be generalizable to all U.S. patients, and potential errors in the database, which only included patients who sought medical care at hospitals or clinics. The database did not specify whether patients already had disease at the time of their visit or whether conditions resolved.