Research links for new members with concerns about Barretts

If you're new and reading this, welcome to Healingwell.

The issue of Barretts oesophagus crops up repeatedly and unfortunately Barretts still has bad "street cred" in terms of cancer risk. Here are a couple of links showing how the medical world is rethinking this now - the risk of transformation of Barretts to adenocarcinoma is now put at less than 1%. You should also remember that Barretts can be found in people without GERD, more so in men over 60 or so, but it is possible to have no signs or symptoms of GERD and still develop Barretts. It is also worth noting that there is no global (or even national in some countries) opinion on screening for Barretts or even when/how often to recall patients who have been found to have Barretts (without dysplasia i.e. early precancerous changes), there is also no consensus on who to screen as there is no defined "risk group" (though obviously if you've got GERD you'll get check over for Barretts anyway).

Have a look at -

http://www.nature.com/nrc/journal/v10/n2/abs/nrc2773.html
(2010)

This recent study points out that 95% of cases of oesophageal adenocarcinoma have no prior diagnosis of Barretts....


http://www.nejm.org/doi/full/10.1056/NEJMoa1103042
(2011)

This one is also very encouraging and questions the need for ongoing surveillance in people who have Barretts without dysplasia....

http://www.cghjournal.org/article/S1542-3565%2809%2901045-3/abstract (2009)
This one is a study (review) looking at the other studies/data around (a meta-analysis), which concludes "Patients with BE are at low risk of malignant progression and predominantly die due to causes other than EAC" (EAC = esophageal adenocarcinoma).

Here in the UK your risk of breast cancer (if you're a woman) is 1 in 8 (lifetime risk i.e. 1 in 8 women will get breast ca)
Here in the UK your risk of bowel cancer for women is 1 in 19, for men 1 in 15
Here in the UK your lifetime risk of developing oesophageal cancer for women is 1 in 118, 1 in 58 for men

The cancer statistics are taken from: http://info.cancerresearchuk.org/cancerstats/types/oesophagus/incidence/

So chances are something else will get you before Barretts does........ so I think we should all focus on whatever healthy eating and healthy lifestyle factors we can manage, and make symptom control and quality of life our priorities!!

Post Edited By Moderator (opnwhl4) : 2/25/2014 11:57:08 PM (GMT-7)

http://www.nature.com/bjc/journal/v105/n2/abs/bjc2011214a.html

OK, here's a new one - came out in 2011. This study followed 133 patients around 25 years. At the final count, 96 died without high grade dysplasia or adenocarcinoma (they died of something else or plain old age) and 24 were still alive at the end of the study with no high grade dysplasia or adenocarcinoma (so I guess that means 11 out of the 133 had developed dysplasia). As my understanding of the article goes, I think it's saying those that had low grade dysplasia at the beginning of the study were likely to progress, but from the abstract doesn't make it clear how likely it is. The study also shows that diagnosis of Barretts at a young age (40s) means you are less likely to have progression, and the article ends by saying that developing high grade dysplasia or adenocarcinoma from Barretts has a long "incubation period" - "suggesting a true incubation period of three decades or more".

It's slightly less cheery than some of the other studies, but bear in mind most of the people either died of something else or had no dysplasia by the end of the follow up period. So perhaps maturer people who are diagnosed with Barretts (and no dysplasia) can be reasssured by the long period of incubation, and those of us who are younger, can be reassured by the fact that we're less likely to have progression.

Came across this today (30.4.12): -

http://www.ncbi.nlm.nih.gov/pubmed/22262413

A study dated this year looking to correlate mineral levels in toenails (as a measure of intake over time) with risk of BO or risk of adenocarcinoma. High zinc or cobalt were associated with risk of Barretts. I haven't been able to access the full article, but for anyone interested please bear in mind: -

~ your levels of zinc may be depleted by long term use of PPIs
~ your zinc levels may be reduced whilst taking iron supplements
~ you may (I believe) have lower zinc levels if you have any form of skin disease (like eczema or psoriasis)
~ copper and zinc are mutually antagonistic (if one goes up the other goes down) - other minerals can be antagonistic to zinc too (including iron, calcium and cadmium*)

*we don't intentionally consume cadmium but it's a contaminant and has recently been linked with breast cancer (http://cancerres.aacrjournals.org/content/72/6/1459.short) - jury still out on that.

I guess it depends what you're most worried about - if you're a bloke you might want to be careful with your zinc to reduce chances of Barretts - if you're a woman you might want to take zinc to reduce chances of breast cancer!!

MMM

Here's the new thread Phil, hopefully we can all keep it tidy and free of general chit chat!

MMM

MMM-

With the amount of recent new members with Barretts and cancer concerns this post is perfectly timed.

Bravo Zulu!

Sunbeam- I agree keeping this going such as the Linx Club or something is a great Idea.

Take care,
Bill

Mud mag, you posted that people with Barrett's have a 90 percent rate at not getting cancer. That means 10 percent will get it. That is not true. There is less than a one percent chance of Barrett's turning into EC. Still not a good number for those outliers. Also, that one percent is in many cases folks who didn't catch their Barrett's in time and by the time they went in for their first endoscopy they already had EC or it was high grade dysplagia . So, it's good to have an endoscopy just to check.

Teacherman,

That quote was from the webmd article that Sunbeam posted the link to. A proportion of people with Barretts (thought to be about 2% of the unscreened population) have no symptoms and I would guess they are unlikely to have endoscopy. As yet a clearly defined "at risk" group has not been established, so there are no plans in any country to role out a screening programme and scope more of the population.

www.bsg.org.uk/images/stories/docs/clinical/guidelines/oesophageal/bsg_barretts_13.pdf

The British Society of Gastroenterology guidelines, which can be accessed from the above link, contains useful flow charts depending on the level of Barretts found (size/dysplasia). Surveillance rates are recommended according to the pathological findings. Page 10 talks about the risk levels, referring to 2 very large population studies (one Danish, one from Northern Ireland), both put the risk at less than 1%, as mentioned at the start of the thread.

MMM

I meant to say that I read the first post and felt so relieved. Thank you!

Bumped up for new readers.....

Thank you for all of the info! It helps all of us stay current with research.

Bumped for new readers!

Thank you for bumping this for the newbies