Barrett’s patients who smoke are twice as likely to develop esophageal cancer

Barrett’s esophagus (BE) patients who smoke tobacco are at a two-fold increased risk of developing esophageal cancer, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association. BE patients who smoke also double their risk for developing advanced precancerous cells.

“We found that tobacco smoking emerged as the strongest lifestyle risk factor for cancer progression. Contrary to popular belief, alcohol consumption didn’t increase cancer risk in this group of patients with Barrett’s esophagus,” said Helen G. Coleman, PhD, of Queen’s University Belfast in Northern Ireland and the lead author of this study.

While analyzing data (ranging from 1993 to 2005) from one of the largest population-based cohorts of more than 3,000 BE patients worldwide, doctors found that by Dec. 31, 2008, 117 of the patients developed dysplasia or cancers of the esophagus or stomach. For the first time in such a large study, researchers were able to get information about smoking at the time a person was first diagnosed with BE to see how this influenced cancer risk years later. This is important for reducing bias known to be associated with asking patients about their smoking habits in the past.

Current tobacco smoking, regardless of the number of daily cigarettes, was significantly associated with an increased risk of esophageal cancer. This suggests that reducing the number of cigarettes smoked per day may not reduce the risk of cancer in BE patients.

The incidence of esophageal cancer is on the rise in developed countries. It originates from the premalignant condition BE, presumably progressing through low- and high-grade dysplasia (precancerous cells). However, progression along this pathway is uncommon, and the vast majority of BE patients never develop esophageal cancer or high-grade dysplasia. Factors distinguishing the small minority of patients who do progress remain largely elusive. This underscores the importance of identifying modifiable lifestyle factors that may contribute to cancer progression.

Barrett’s Esophagus: Symptoms, Causes, and Treatments
Barrett’s esophagus is a serious complication of GERD, which stands for gastroesophageal reflux disease. In Barrett’s esophagus, normal tissue lining the esophagus - the tube that carries food from the mouth to the stomach - changes to tissue that resembles the lining of the intestine. About 10%-15% of people with chronic symptoms of GERD develop Barrett’s esophagus.

Barrett’s esophagus does not have any specific symptoms. Patients with Barrett’s esophagus may have symptoms related to GERD. It does, though, increase the risk of developing esophageal adenocarcinoma, which is a serious, potentially fatal cancer of the esophagus.

Although the risk of this cancer is higher in people with Barrett’s esophagus, the disease is still rare. Less than 1% of the people with Barrett’s esophagus develop this particular cancer. Nevertheless, if you’ve been diagnosed with Barrett’s esophagus, it’s important to have routine examinations of your esophagus. With routine examination, your doctor can discover precancerous and cancer cells early, before they spread and when the disease is easier to treat.

“Tobacco smoking has been long established as highly carcinogenic,” added Dr. Coleman. “Barrett’s esophagus patients who smoke should start a cessation program immediately.”

Although these findings need to be confirmed in future studies, the study’s researchers suggest that tobacco smoking be discouraged and smoking-cessation strategies considered in BE patients in order to reduce future cancer risk. Further, identifying modifiable lifestyle factors that influence cancer progression may provide an additional cost-effective method of alleviating future cancer burden in this patient group.

About the AGA Institute
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization.

About Gastroenterology
Gastroenterology, the official journal of the AGA Institute, is the most prominent scientific journal in the specialty and is in the top 1 percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, Current Awareness in Biological Sciences, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index.


About Queen’s University Belfast
A member of the Russell Group of the U.K.‘s 20 leading research-intensive universities, Queen’s University has gained global recognition for the impact of its research and education. The institution has won five Queen’s Anniversary Prizes for Further and Higher Education for world-class achievement in cancer research, green chemistry, environmental research, palaeo-ecology and law.

Four prestigious Times Higher Education Awards further recognize the university’s contribution to society. Queen’s received the Award for Excellence and Innovation in the Arts in 2008, was awarded the title of the U.K.‘s Entrepreneurial University of the Year in 2009, the Outstanding Engineering Research Team of the Year in 2010 and Most Innovative Teacher of the Year in 2011.

Founded as Queen’s College in 1845, Queen’s became a university in its own right in 1908, an international center of research and education rooted at the heart of Northern Ireland; it offers a life-changing student experience to students from more than 80 countries. Queen’s is a magnet for inward investment, a patron of the arts and a global player in areas ranging from cancer studies to sustainability, and from pharmaceuticals to creative writing.

About Helen G. Coleman, PhD
Dr. Coleman is a postdoctoral research fellow in the Center for Public Health, within the School of Medicine, Dentistry and Biomedical Sciences at Queen’s University Belfast. Dr. Coleman has been researching diet and lifestyle risk factors for cancer for the past six years, and specializes in pre-cancerous conditions of the esophagus (Barrett’s esophagus) and bowel (colorectal polyps). Dr. Coleman works in the cancer epidemiology and health services research group, which is led by Professor Liam Murray.


Alissa J. Cruz
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American Gastroenterological Association

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