Increasing incidence of Barrett’s oesophagus: a population-based study
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Oesophageal adenocarcinoma, a highly fatal cancer, has risen in incidence in Western societies, but it is unclear whether this is due to increasing incidence of its pre-cursor condition, Barrett’s oesophagus (BO) or whether the proportion of BO patients undergoing malignant progression has increased in the face of unchanged BO incidence. Data from population-based studies of BO incidence is limited, with equivocal results to date difficult to distinguish from changes in endoscopic practices. The aim of this study was to assess population trends in Barrett’s oesophagus (BO) diagnoses in relation to endoscopy and biopsy rates over a 13 year period. The Northern Ireland Barrett’s oesophagus Register (NIBR) is a population-based register of all 9,329 adults diagnosed with columnar epithelium of the oesophagus in Northern Ireland between 1993 and 2005, of whom 58.3% were male. European age-standardised annual BO incidence rates were calculated per 100,000 of the population, per 100 endoscopies and per 100 endoscopies including an oesophageal biopsy. Average annual BO incidence rates rose by 159% during the study period, increasing from 23.9/100,000 during 1993–1997 to 62.0/100,000 during 2002–2005. This elevation far exceeded corresponding increases in rates of endoscopies and oesophageal biopsies being conducted. BO incidence increased most markedly in individuals aged <60 years, and most notably amongst males aged <40 years. This study points towards a true increase in the incidence of BO which would appear to be most marked in young males. These findings have significant implications for future rates of oesophageal adenocarcinoma and surveillance programmes.
KeywordsBarrett’s oesophagus Epidemiology Population-based Trends
Northern Ireland Barrett’s oesophagus Register
We would like to acknowledge the contribution of the tumour verification officers in the Northern Ireland Cancer Registry and all staff in the Centre for Public Health who contributed to the development of the Northern Ireland Barrett’s register. This work was supported by funding from the Ulster Cancer Foundation and the Health and Social Care Research and Development Office, Northern Ireland. The Northern Ireland Cancer Registry is funded by the Public Health Agency for Northern Ireland. The funding bodies had no role in the study design and all researchers involved in this study are independent of the funding bodies. All authors had full access to all of the data (including statistical reports and tables) in the study and can take full responsibility for the integrity of the data and the accuracy of the data analysis.
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