Regular Screening of Barrett’s Patients Improves Early Cancer Detection
by C.H. Weaver M.D (08/2018)
Patients with Barrett’s esophagus who undergo regular exams have an improved chance that precancerous changes and esophageal cancer will be detected early. These findings were published in the journal Gut.
Barrett’s esophagus is a pre-cancerous condition of the esophagus. It means that there is a type of cell called columnar epithelial cells present in the surface lining of the lower esophagus. Typically, the surface lining of the lower esophagus should only contain squamous cells; however reflux of stomach contents, especially acid, into the esophagus causes these squamous cells to be replaced by columnar epithelial cells more similar to those found in the stomach and intestines.
Barrett’s esophagus can have different levels of what is known as dysplasia, or a number of abnormal cells. In low-grade dysplasia, some of the cells look somewhat abnormal under the microscope; this is a very early form of pre-cancer of the esophagus. In high-grade dysplasia, some of the cells look very abnormal under the microscope; this is a more advanced pre-cancer of the esophagus than low-grade dysplasia. But because relatively few cases of Barrett’s esophagus progress to cancer, many patients are not actively treated and instead undergo surveillance exams using an endoscope (a thin, lighted tube) until signs of progression.
There’s currently some debate over how useful regular surveillance exams with an endoscope are for patients with Barrett’s esophagus. Experts are questioning whether surveillance is needed, given that there tends to be a low risk that Barrett’s esophagus will progress to cancer and a lack of strong evidence that endoscopic surveillance prevents advanced esophageal cancer.
To investigate the impact of endoscopic surveillance on the survival of patients who are diagnosed with early-stage esophageal cancer, researchers in Holland conducted a study including 783 patients. Participants had been diagnosed with Barrett’s esophagus and underwent endoscopic surveillance. The researchers followed these patients and identified those with high-grade dysplasia and tracked their survival. Survival for these patients was compared with survival in the following two groups:
- Patients who were not diagnosed with dysplasia during surveillance
- Patients with esophageal cancer from the general population
Of the 783 patients followed, 53 developed high-grade dysplasia or esophageal cancer at a median follow-up of three years. The majority of these 53 diagnoses were early stage, with 66% (35 patients) at Stage 0, 26% (14) at Stage I, and 8% (4) at Stage II. Surveillance resulted in earlier stage diagnoses compared with the general population. Early detection through surveillance, however, did not appear to impact survival. Patients who were diagnosed with precancerous changes during surveillance did not have a significantly worse rate of death than those without precancerous changes or than those with early-stage esophageal cancer in the general population.
According to these findings, surveillance is useful in detecting esophageal cancer at very early stages. Survival rates are generally good when this disease is detected at early, treatable stages.
Reference: Kastelein F, van Olphen SH, Steyerberg EW, et al. Impact of surveillance for Barrett’s oesophagus on tumour stage and survival of patients with neoplastic progression. Gut. doi:10.1136/gutjnl-2014-308802.