Skip to main content

Advertisement

SpringerLink
Log in

Barrett’s Esophagus and Esophageal Adenocarcinoma: How Common Are They Really?

  • Review
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Since the early 1970s, the incidence of esophageal adenocarcinoma (EA) has increased dramatically in most Western populations while the incidence of esophageal squamous cell carcinoma has decreased. As a result, EA has become the predominant subtype of esophageal cancer in North America and Europe and is an important contributor to overall cancer mortality. Barrett’s esophagus (BE), a metaplastic columnar epithelium of the distal esophagus, is the known precursor lesion for EA. EA and BE occur more frequently in white men over 50 years old, as well as in people with frequent symptoms of gastroesophageal reflux, in smokers, and in people who are obese. Conversely, EA and BE are less common in persons using nonsteroidal anti-inflammatory drugs and in person with Helicobacter pylori infection. The 5-year survival rate for patients with EA, although generally poor, has improved during the past decade, and long-term survival is increasingly possible for patients with early or locally advanced disease. This review combines a synthesis of published studies with an analysis of data from the United States National Cancer Institute’s Surveillance, Epidemiology, and End Results program to discuss the change in incidence of EA and summarize current knowledge of risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–E386.

    Article  PubMed  CAS  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7–30.

    Article  PubMed  Google Scholar 

  3. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97:142–146.

    Article  PubMed  Google Scholar 

  4. Thrift AP. The epidemic of oesophageal carcinoma: where are we now? Cancer Epidemiol. 2016;41:88–95.

    Article  PubMed  Google Scholar 

  5. Thrift AP, Whiteman DC. The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends. Ann Oncol. 2012;23:3155–3162.

    Article  PubMed  CAS  Google Scholar 

  6. Hur C, Miller M, Kong CY, et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer. 2013;119:1149–1158.

    Article  PubMed  Google Scholar 

  7. Post PN, Siersema PD, Van Dekken H. Rising incidence of clinically evident Barrett’s oesophagus in The Netherlands: a nation-wide registry of pathology reports. Scand J Gastroenterol. 2007;42:17–22.

    Article  PubMed  Google Scholar 

  8. Steyerberg EW, Earle CC, Neville BA, Weeks JC. Racial differences in surgical evaluation, treatment, and outcome of locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol. 2005;23:510–517.

    Article  PubMed  Google Scholar 

  9. Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–1831.

    Article  PubMed  Google Scholar 

  10. Desai TK, Krishnan K, Samala N, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut. 2012;61:970–976.

    Article  PubMed  Google Scholar 

  11. Corley DA, Mehtani K, Quesenberry C, Zhao W, de Boer J, Weiss NS. Impact of endoscopic surveillance on mortality from Barrett’s esophagus-associated esophageal adenocarcinomas. Gastroenterology. 2013;145:312–319.

    Article  PubMed  PubMed Central  Google Scholar 

  12. El-Serag HB, Naik AD, Duan Z, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut. 2016;65:1252–1260.

    Article  PubMed  Google Scholar 

  13. Bhat SK, McManus DT, Coleman HG, et al. Oesophageal adenocarcinoma and prior diagnosis of Barrett’s oesophagus: a population-based study. Gut. 2015;64:20–25.

    Article  PubMed  Google Scholar 

  14. Nordenstedt H, El-Serag H. The influence of age, sex, and race on the incidence of esophageal cancer in the United States (1992–2006). Scand J Gastroenterol. 2011;46:597–602.

    Article  PubMed  Google Scholar 

  15. Cook MB, Chow WH, Devesa SS. Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005. Br J Cancer. 2009;101:855–859.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340:825–831.

    Article  PubMed  CAS  Google Scholar 

  17. Cook MB, Corley DA, Murray LJ, et al. Gastroesophageal reflux in relation to adenocarcinomas of the esophagus: a pooled analysis from the Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON). PLoS ONE. 2014;9:e103508.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Thrift AP, Kramer JR, Qureshi Z, Richardson PA, El-Serag HB. Age at onset of GERD symptoms predicts risk of Barrett’s esophagus. Am J Gastroenterol. 2013;108:915–922.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hoyo C, Cook MB, Kamangar F, et al. Body mass index in relation to oesophageal and oesophagogastric junction adenocarcinomas: a pooled analysis from the International BEACON Consortium. Int J Epidemiol. 2012;41:1706–1718.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Steffen A, Huerta JM, Weiderpass E, et al. General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2015;137:646–657.

    Article  PubMed  CAS  Google Scholar 

  21. Lindkvist B, Johansen D, Stocks T, et al. Metabolic risk factors for esophageal squamous cell carcinoma and adenocarcinoma: a prospective study of 580,000 subjects within the Me-Can project. BMC Cancer. 2014;14:103.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. El-Serag H. The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci. 2008;53:2307–2312.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Thrift AP, Shaheen NJ, Gammon MD, Bernstein L, Reid BJ, Onstad L, et al. Obesity and risk of esophageal adenocarcinoma and Barrett’s esophagus: a Mendelian randomization study. J Natl Cancer Inst. 2014. https://doi.org/10.1093/jnci/dju252.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cook MB, Freedman ND, Gamborg M, Sorensen TI, Baker JL. Childhood body mass index in relation to future risk of oesophageal adenocarcinoma. Br J Cancer. 2015;112:601–607.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Levi Z, Kark JD, Shamiss A, et al. Body mass index and socioeconomic status measured in adolescence, country of origin, and the incidence of gastroesophageal adenocarcinoma in a cohort of 1 million men. Cancer. 2013;119:4086–4093.

    Article  PubMed  Google Scholar 

  26. Kubo A, Cook MB, Shaheen NJ, et al. Sex-specific associations between body mass index, waist circumference and the risk of Barrett’s oesophagus: a pooled analysis from the international BEACON consortium. Gut. 2013;62:1684–1691.

    Article  PubMed  Google Scholar 

  27. El-Serag HB, Hashmi A, Garcia J, et al. Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett’s oesophagus: a case-control study. Gut. 2014;63:220–229.

    PubMed  Google Scholar 

  28. Kendall BJ, Rubenstein JH, Cook MB, et al. Inverse association between gluteofemoral obesity and risk of Barrett’s esophagus in a pooled analysis. Clin Gastroenterol Hepatol. 2016;14:1412–1419.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kendall BJ, Thrift AP. Unravelling the riddle of gastroesophageal reflux disease, obesity and Barrett’s esophagus. Clin Gastroenterol Hepatol. 2015;13:2273–2275.

    Article  PubMed  Google Scholar 

  30. Chandar AK, Devanna S, Lu C, et al. Association of serum levels of adipokines and insulin with risk of Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2015;13:2241–2255.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Kendall BJ, Macdonald GA, Prins JB, O’Brien S, Whiteman DC. Total body fat and the risk of Barrett’s oesophagus—a bioelectrical impedance study. Cancer Epidemiol. 2014;38:266–272.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Thrift AP, Kramer JR, Alsarraj A, El-Serag HB. Fat mass by bioelectrical impedance analysis is not associated with increased risk of Barrett esophagus. J Clin Gastroenterol. 2014;48:218–223.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cook MB, Kamangar F, Whiteman DC, et al. Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst. 2010;102:1344–1353.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Steevens J, Schouten LJ, Goldbohm RA, van den Brandt PA. Alcohol consumption, cigarette smoking and risk of subtypes of oesophageal and gastric cancer: a prospective cohort study. Gut. 2010;59:39–48.

    Article  PubMed  CAS  Google Scholar 

  35. Cook MB, Shaheen NJ, Anderson LA, et al. Cigarette smoking increases risk of Barrett’s esophagus: an analysis of the Barrett’s and Esophageal Adenocarcinoma Consortium. Gastroenterology. 2012;142:744–753.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Smith KJ, O’Brien SM, Green AC, Webb PM, Whiteman DC. Current and past smoking significantly increase risk for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2009;7:840–848.

    Article  PubMed  Google Scholar 

  37. Edelstein ZR, Farrow DC, Bronner MP, Rosen SN, Vaughan TL. Central adiposity and risk of Barrett’s esophagus. Gastroenterology. 2007;133:403–411.

    Article  PubMed  Google Scholar 

  38. Anderson LA, Watson RG, Murphy SJ, et al. Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma: results from the FINBAR study. World J Gastroenterol. 2007;13:1585–1594.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kubo A, Levin TR, Block G, et al. Cigarette smoking and the risk of Barrett’s esophagus. Cancer Causes Control. 2009;20:303–311.

    Article  PubMed  Google Scholar 

  40. Thrift AP, Kramer JR, Richardson PA, El-Serag HB. No significant effects of smoking or alcohol consumption on risk of Barrett’s esophagus. Dig Dis Sci. 2014;59:108–116.

    Article  PubMed  CAS  Google Scholar 

  41. Hardikar S, Onstad L, Blount PL, Odze RD, Reid BJ, Vaughan TL. The role of tobacco, alcohol, and obesity in neoplastic progression to esophageal adenocarcinoma: a prospective study of Barrett’s esophagus. PLoS ONE. 2013;8:e52192.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Coleman HG, Bhat S, Johnston BT, McManus D, Gavin AT, Murray LJ. Tobacco smoking increases the risk of high-grade dysplasia and cancer among patients with Barrett’s esophagus. Gastroenterology. 2012;142:233–240.

    Article  PubMed  Google Scholar 

  43. Ramus JR, Gatenby PA, Caygill CP, Watson A, Winslet MC. The relationship between smoking and severe dysplastic disease in patients with Barrett’s columnar-lined oesophagus. Eur J Cancer Prev. 2012;21:507–510.

    Article  PubMed  Google Scholar 

  44. Olsen CM, Pandeya N, Green AC, Webb PM, Whiteman DC. Population attributable fractions of adenocarcinoma of the esophagus and gastroesophageal junction. Am J Epidemiol. 2011;174:582–590.

    Article  PubMed  Google Scholar 

  45. Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst. 2003;95:1404–1413.

    Article  PubMed  Google Scholar 

  46. Hazelton WD, Curtius K, Inadomi JM, et al. The role of gastroesophageal reflux and other factors during progression to esophageal adenocarcinoma. Cancer Epidemiol Biomark Prev. 2015;24:1012–1023.

    Article  CAS  Google Scholar 

  47. Freedman ND, Murray LJ, Kamangar F, et al. Alcohol intake and risk of oesophageal adenocarcinoma: a pooled analysis from the BEACON Consortium. Gut. 2011;60:1029–1037.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Thrift AP, Cook MB, Vaughan TL, et al. Alcohol and the risk of Barrett’s esophagus: a pooled analysis from the International BEACON Consortium. Am J Gastroenterol. 2014;109:1586–1594.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Liao LM, Vaughan TL, Corley DA, et al. Nonsteroidal anti-inflammatory drug use reduces risk of adenocarcinomas of the esophagus and esophagogastric junction in a pooled analysis. Gastroenterology. 2012;142:442–452.

    Article  PubMed  CAS  Google Scholar 

  50. Thrift AP, Anderson LA, Murray LJ, et al. Nonsteroidal anti-inflammatory drug use is not associated with reduced risk of Barrett’s esophagus. Am J Gastroenterol. 2016;111:1528–1535.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Vaughan TL, Dong LM, Blount PL, et al. Non-steroidal anti-inflammatory drugs and risk of neoplastic progression in Barrett’s oesophagus: a prospective study. Lancet Oncol. 2005;6:945–952.

    Article  PubMed  CAS  Google Scholar 

  52. Alexandre L, Clark AB, Bhutta HY, Holt S, Lewis MP, Hart AR. Statin use is associated with reduced risk of histologic subtypes of esophageal cancer: a nested case-control analysis. Gastroenterology. 2014;146:661–668.

    Article  PubMed  CAS  Google Scholar 

  53. Beales IL, Vardi I, Dearman L, Broughton T. Statin use is associated with a reduction in the incidence of esophageal adenocarcinoma: a case control study. Dis Esophagus. 2013;26:838–846.

    Article  PubMed  CAS  Google Scholar 

  54. Nguyen T, Khalaf N, Ramsey D, El-Serag HB. Statin use is associated with a decreased risk of Barrett’s esophagus. Gastroenterology. 2014;147:314–323.

    Article  PubMed  CAS  Google Scholar 

  55. Nguyen T, Duan Z, Naik AD, Kramer JR, El-Serag HB. Statin use reduces risk of esophageal adenocarcinoma in US veterans with Barrett’s esophagus: a nested case-control study. Gastroenterology. 2015;149:1392–1398.

    Article  PubMed  CAS  Google Scholar 

  56. Singh S, Garg SK, Singh PP, Iyer PG, El-Serag HB. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus: a systematic review and meta-analysis. Gut. 2014;63:1229–1237.

    Article  PubMed  Google Scholar 

  57. Nie S, Chen T, Yang X, Huai P, Lu M. Association of Helicobacter pylori infection with esophageal adenocarcinoma and squamous cell carcinoma: a meta-analysis. Dis Esophagus. 2014;27:645–653.

    Article  PubMed  CAS  Google Scholar 

  58. Fischbach LA, Nordenstedt H, Kramer JR, et al. The association between Barrett’s esophagus and Helicobacter pylori infection: a meta-analysis. Helicobacter. 2012;17:163–175.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Becker J, May A, Gerges C, et al. Supportive evidence for FOXP1, BARX1, and FOXF1 as genetic risk loci for the development of esophageal adenocarcinoma. Cancer Med. 2015;4:1700–1704.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  60. Palles C, Chegwidden L, Li X, et al. Polymorphisms near TBX5 and GDF7 are associated with increased risk for Barrett’s esophagus. Gastroenterology. 2015;148:367–378.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  61. Levine DM, Ek WE, Zhang R, et al. A genome-wide association study identifies new susceptibility loci for esophageal adenocarcinoma and Barrett’s esophagus. Nat Genet. 2013;45:1487–1493.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  62. Lee E, Stram DO, Ek WE, et al. Pleiotropic analysis of cancer risk loci on esophageal adenocarcinoma risk. Cancer Epidemiol Biomark Prev. 2015;24:1801–1803.

    Article  CAS  Google Scholar 

  63. Dong J, Buas MF, Gharahkhani P, Kendall BJ, Onstad L, Zhao S, et al. Determining risk of Barrett’s esophagus and esophageal adenocarcinoma based on epidemiologic factors and genetic variants. Gastroenterology. 2018;154:1273–1281.

    Article  PubMed  CAS  Google Scholar 

  64. Thrift AP, Garcia JM, El-Serag HB. A multibiomarker risk score helps predict risk for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2014;12:1267–1271.

    Article  PubMed  Google Scholar 

  65. Thrift AP, Kendall BJ, Pandeya N, Vaughan TL, Whiteman DC. A clinical risk prediction model for Barrett esophagus. Cancer Prev Res (Phila). 2012;5:1115–1123.

    Article  Google Scholar 

  66. Thrift AP, Kendall BJ, Pandeya N, Whiteman DC. A model to determine absolute risk for esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2013;11:138–144.

    Article  PubMed  Google Scholar 

  67. Thrift AP, Vaughan TL, Anderson LA, Whiteman DC, El-Serag HB. External validation of the Michigan Barrett’s esophagus prediction tool. Clin Gastroenterol Hepatol. 2017;15:1124–1126.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Thrift AP, Kanwal F, El-Serag HB. Prediction models for gastrointestinal and liver diseases: too many developed, too few validated. Clin Gastroenterol Hepatol. 2016;14:1678–1680.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Epidemiology and Population Sciences, Department of Medicine, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, MS: BCM305, Houston, TX, 77030-3498, USA

    Aaron P. Thrift

Authors
  1. Aaron P. Thrift
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aaron P. Thrift.

Ethics declarations

Conflict of interest

The author declares that he has no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thrift, A.P. Barrett’s Esophagus and Esophageal Adenocarcinoma: How Common Are They Really?. Dig Dis Sci 63, 1988–1996 (2018). https://doi.org/10.1007/s10620-018-5068-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-5068-6

Keywords

Search

Navigation